I am an RD in a small hospital, with no LC and little lactation support.  We
had a 3-week old baby admitted last week, diagnosed as Failure to Thrive, with
"poor parental skills."  The MD asked for a nutrition consult, so I was
involved in the baby's care.

Baby was born at 36 wks gestation, 4# 10oz., small but healthy.  Although Mom
stated her desire to breastfeed before her c/section (documented in her
medical record,) the baby was given sugar water the first day and Enfamil 24
for the rest of his newborn stay.  Mom states, "They didn't let me breastfeed
him -- they just gave him formula."  She assumed that since he was little, he
must have needed it.  The discharge instructions say to give ABM.

After discharge, Mom started breastfeeding with her Grandmother's help.  Per
instructions, she also gave ABM, although she had to switch to standard-
kcalorie stuff per WIC.  She states Baby started throwing up the new ABM.  At
15 days, she took Baby to Emergency Room with throwing up and "diarrhea."  I
suspect the "throwing up" was overflow from stuffing too much in his tiny
little tummy, and Baby's stools were described as soft, mushy, yellow, and
seedy.  (She has 3 older children, all bottle-fed, and was never told what
breastmilk poops look like.)  She was told to give Pedialyte x 2 days, half
P'lyte & half formula x 1 day, then full-strength formula.  No mention of
breastfeeding.

Well, guess what??  Mom, with her "poor parental skills," *follows
instructions* (given to her by her wise HCP's,) but Baby can't gain weight on
electrolyte-water!  So when Pediatrician sees Baby at 19 days and he's only at
his birthweight, (but according to her admission assessment, is not clinically
dehydrated,) she admits Baby for FTT, sticks him with an IV, tells Mom her
milk doesn't have enough kcalories for Baby, and puts him on Isomil *Diarrhea
Formula* every 2 hours around the clock, "and breastfeeding."

While hospitalized, Mom is observed appropriately holding & caring for Baby
... dutifully follows instructions of wise HCP's and feeds ABM AND tries to
breastfeed, with on-again, off-again success ... when Baby will latch, feeds
well, but finally gets nipple-confused ... Mom gets manual pump from WIC ...
is able to pump several ounces of thick-looking yellowish milk ... Baby
latches, doesn't latch ... gains 5 oz first day ... IV taken out, loses 3 oz
next day ... Mom gets discouraged ... Mom assumes she can't meet Baby's needs
... no weight gain next day (net 2 oz x 2 days) ... Mom even more discouraged
... Mom tells nurses she probably won't breastfeed when she gets home (due to
discouragement rather than actual desire) ... Pediatrician assumes she's
giving up on breastfeeding & goes to 24 kcal ABM to speed up wt gain ...

I talked to Mom on Day 4 in hospital ... told her she is ultimate decision-
maker for Baby, and it's up to *her* to decide what to feed him.  Asked her
plainly, "What do YOU want to do??"  Without hesitation she says, "I want to
breastfeed him."  Assured her that milk is by far the best nourishment for
him, higher in kcals than ABM, etc.  Talked to MD, changed order to
breastfeeding, or at least breastmilk if he wouldn't latch, with ABM as last
resort.  Baby gained 2 oz & was discharged on Day 5, to be followed by WIC
breastfeeding peer counselor and Home Health nurse.

NOW ... my question.  Considering:  1) Mom's documented desire to breastfeed
baby; 2) MD's & Nursing's disregard of feeding choice (no medical reason for
this variance was noted in the medical record); 3) Staff's neglecting to
educate about breastfeeding, normal stools, etc.; 4) Mom's applaudable
intentions and great compliance, but lack of confidence and assertiveness; 5)
Inappropriate treatment plan from ER visit that compounded the problem and
likely was the cause of Baby's slow weight gain; and 6) 5-day hospitalization
that could most likely have been avoided with proper care, treatment, and
education -- what should I do??  Variance report?  Complaint -- to whom?
Anything else?  I'm so furious about this whole situation I can hardly think
straight.

Sorry for the length of this post, but I have greatly appreciated the wealth
of knowledge and experience I've observed here, and feel sure that there is
someone out there with a few words of wisdom or support that are greatly
needed right now.

-Sandra McMillan, RD
Dillon SC