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From:
Jennifer tieman <[log in to unmask]>
Reply To:
Lactation Information and Discussion <[log in to unmask]>
Date:
Mon, 16 Sep 2002 08:40:50 -0400
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My name is Jennifer Tieman and I am a family physician practicing in rural
Illinois.  I have been lurking for a while and was delighted to see a few
familar names!
I wanted to comment on the jaundice and formula issue.  I am new to the area
here and find that most of the jaundiced babies I take care of have moms who
have heard from someone else that breastfeeding causes jaundice, or that
formula decreases bilirubin faster than breastmilk.  Most moms are asking me
for formula if baby looks a little yellow.  I have had success in reassuring
moms and preserving the breastfeeding relationship by letting mom know that
preserving breastfeeding is a "medical" goal.  I tell them that in the long
run, baby receives so many benefits from breastfeeding that decreasing
bilirubin a little faster is just not worth interfering with breastfeeding.
 If phototherapy is necessary, I try to use a bili blanket at home.  If that
is not available and baby must be under lights for a short time, I allow
baby to be out as long as needed for breastfeeding.  Most of the time we are
treating a non-dangerous bili level because we are worried about it getting
higher and causing trouble.  If baby is receiving some phototherapy and
feeding well, bili should stay stable or decrease.  Of course there are
exceptions, if baby has a cause for pathologic jaundice, or is not feeding
well they may need help with feeding issues or more aggressive phototherapy.
 Our hospital is a community hospital, so I am dealing with primarily
healthy term infants, and the occasional near-term premie.  Obviously sick
or premature infants would have to be treated differently.
I think breastfed baby jaundice here is contibuted to by lack of frequent
feeds.  Our hospital has rooming-in, but the majority of moms choose to send
their babies to the nursery at night.  Although our nurses bring babies out
to be fed, they tend to make sure baby is "truly hungry" before taking baby
to mom.  Baby may be rocked, patted, or even given a pacifier during all the
early cues for feeding, so baby and mom miss out on the opportunity for
frequent feeds based on baby's cues.  True unrestricted exlusive
breastfeeding is pretty uncommon in the town I practice in, and few moms
follow my advice for full rooming-in and unrestricted feeding.  I haven't
figured out yet a way to convince moms to keep their babies close, and that
"being used for a pacifier" isn't a bad thing!
Jennifer Tieman, MD

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