Dear Colleagues
I am not asking you to look into a crystal ball and come up with a
definitive answer.  What I do want is some thoughts and opinions that
might ease a mother's concern.  I was working with a mother, primarily
over the telephone, who felt that her infant might be aspirating
breastmilk.  She had been in to the pediatrician who observed a feeding
and thought it was an overactive let down reflex, therefore we treated
it as such.  The usual recommendations helped some as did positioning.
I finally saw the mom when the infant was 6 weeks old.  The infant was
barely 6 ounces above birth weight.  He went to breast eagerly, but as
soon as the let down started, he had milk coming out of his nose, the
way water comes out of a bubbler/water fountain.  Mom had a diaper in
place to collect all of the milk.  The infant would take himself off
breast, catch his breath and resume feeding until he appeared to be
content.  He was never in distress.  His intake was 30 cc, the diaper
had 15 cc breastmilk.  His lungs sounded awful.  Mom was referred to the
pediatrician on call (that was the god send) who admitted the baby to
the hospital.  The diagnosis was an enlarged upper esophageal spincter.
Although the baby never looked cyanotic, I was concerned about the
oxygen saturation and mother, who is an ICU RN was also concerned.  On
admission to the hospital, his O2 sats were in the upper 80's.   The
neurologist told it it was doubtful, but the word CP was used and mom is
worried.  The baby is doing great.  Since starting with G-tube feedings,
his weight has shot up, he's on track for growth and development, but
mom is still worrying.  Our (mom's and my) question to all of you is,
have you encountered encountered anything like this in your practice?
What was the outcome in your situation?  How long does it take to
diagnose CP.
On a positive note for breastfeeding, his white count was elevated on
admission to the hospital, but he never developed an infection from
aspirating breastmilk for so long.

The mother and I thank you for any information.

Christine A. Raasch, RN, IBCLC
Menomonee Falls WI

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