Several thoughts come to mind regarding the baby with the heart condition whose needs to gain weight:
1. It is normal for a baby with congenital heart disease to fatigue quickly. Frequent (far more frequent than the usual 10-12 times a day definition of "frequent" in Western cultures), short feedings are an appropriate intervention. This appears to be the biologically normal pattern for our species in the first place. A baby with congenital heart disease has less ability than the average healthy full-term baby to accommodate culturally based expectations and restrictions on the frequency of nursing. The mother may need to be taught to look for more subtle cues than she is accustomed to looking for. Other helpful techniques may include using a semi-upright position and taking short breaks during breastfeeding. Weight gain should be monitored.
2. Carrying any baby in a sling is appropriate. Carrying a baby with congenital heart disease in a sling may be essential. The less energy the baby spends keeping warm, giving cues, etc., the more energy will be available for feeding.
3. "Kangaroo Mother Care" (which is really "biologically normal care of human babies") is appropriate for healthy full term babies and premature babies, and may be essential for a baby with congenital heart disease. Keeping this baby directly on the mother's chest mayhelp the baby conserve energy for feeding. See http://www.kangaroomothercare.com/ for more information.
4. Additional calories can be obtained by utilizing the knowledge that the emptier the breast, the higher the fat content. The mother can express after feedings and provide the higher-calorie milk via a tube feeding device at the breast. Any non-human-milk supplement increases the baby's risk of a multitude of additional health problems.
5. This mother is likely to need a great deal of support, practically and emotionally, if she is going to accomplish the special care her baby needs. If a friend of hers can arrange to have meals brought every day for a month, and have the person bringing the meal stay a couple of hours to wash dishes, do laundry, help with other children, etc., the mother will have more time and energy to focus on accomplishing the above suggestions. This coordinator can contact friends, members of the mother's house of worship if she has one, neighbors, local La Leche League Group members, and family members. *The mother should not have to make these arrangements herself.* If needed, the above suggestions (and any others deemed helpful) can be endorsed by a health care provider and written on a prescription sheet so that she and others can see them as necessary medical treatment for her baby's condition.
6. For other suggestions regarding helping mothers of babies with congenital disorders, see my article, "Congenital Disorders: Implications for Breastfeeding" (accessible from the publications page of my website: http://home.attbi.com/~ammawell) and my Unit, "Congenital Disorders in the Nursling," in LLLI's Lactation Consultant Series II.
P.S. My five-year-old daughter is sitting on my lap reading this email. She was working on the second suggestion above and got stuck on "congenital heart disease." So she just concluded with "Carrying a baby is a very good thing." : )
Best wishes to this mother, baby and their family,
Cynthia
Cynthia Good Mojab
Ammawell
Email: [log in to unmask]
Web site: http://home.attbi.com/~ammawell
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