[NP-Clinical] Breastfeeding advice

[Cherie Wright]

As some on the list may know, I am also a La Leche League leader, and we've
recently had a challenging situation.  The family is apparently awaiting
genetic testing, which they should hear about this week.  If no established
diagnosis is made, they will be going to Johns Hopkins next week.  I've
pasted the original email and my response below.  And by the way, this list
serves as the "colleagues I know!"  Any insight would be greatly
appreciated!

 

 

TIA, Cherie Wright, FNP

_______________________________________

 

 

I talked to Brandy earlier today, but I wanted to pass along some
comments/questions I had for her.  I also thought of a couple other things
too.

 

First and foremost, the weights need to be done on the same exact scale in
roughly the same amount of clothing.  For instance, the scale in my office
and the one in the office across the street from me are a half a pound
different.  That's really a lot when you're talking about an 8 month old.  

 

The second thing is that if he has a respiratory infection, it may be very
stressful for him to breathe and eat at the same time.  Feedings actually
require a significant amount of energy, especially in someone who is
compromised respiratory or cardiac-wise.  And there is a lot of coordination
between sucking and swallowing and breathing that may be too much for him
right now.  That is the primary reason why premies are tube fed until they
start gaining weight.  Of course, the suck and swallow reflex may not be
developed, too, but I have actually seen premies lose weight simply because
they were sucking rather than having a tube feeding.  As Brandy pointed out,
too, it may be painful to eat if he has ear infections on both sides.

 

He may also be constipated due to an increased loss of water through
breathing and sweating. If he is breathing faster or harder, he will lose
excess moisture, and if he is running a fever, he will also lose more
moisture by sweating.  The medical term for this is insensible loss since it
can't be easily measured.

 

Like Brandy and Hilary, I find it hard to believe that mom would all of a
sudden stop making milk, unless there was a specific trigger.  But if she
feels engorged at times, she must be making some milk!  As Hilary pointed
out, decongestants are notorious for reducing supply.  I have seen that a
lot in my practice--much more than our reference books point out.  Brandy
also mentioned in our phone call that mom is thin, and that the pediatrician
felt that her weight caused a drop in supply.  Now if it were a sudden loss
(10 pounds in a week), that might make sense.  But this isn't the case-mom
has always been small and is not "underweight."  I was down to 110 lbs when
Sarah was just about the same age, and as Brandy said, I "could have fed the
neighborhood!"  I really did have an excessive supply, and it did not change
as my weight went down. 

 

I did pull up some information on Alexander's disease (it's been awhile
since I studied that stuff), and feeding usually does become a problem
because of the muscular problems that develop.  But at this point, there is
no established diagnosis, so I wouldn't get so hung up on that until we know
more. 

 

I am going to ask a few colleagues I know about their take, and I'll pass
along any information that comes across.

 

Cherie 

 

-----Original Message-----
From: Brandy Walters

Sent: Monday, January 15, 2007 1:09 PM
To: Debbie K; hilary; Kelly H; Sarah G; Cherie Wright
Subject: LLL question

 

I have a friend w/ an 8 1/2 month old son. He is mentally retarded,

but still doesn't have a diagnoses. We are waiting to hear if it is

Alexander's disease. He is a fantastic nurser. She mentions

engorgement when he goes too long but he has always slept thru the

night, literally. At his 8 month check up, he was 17.9 lbs. She took

him now, 2 weeks later and he has a double ear infection (history: he

is on breathing treatments every 4 hours for respiratory stuff since

before Thanksgiving. You can hear how congested he is when he nurses).

Here is the concern right now: He now weighs 16. something and lost

almost 2 lbs in 2 weeks. She has noticed he is constipated, when he

does poop, it is hard and dark. Of course, she realizes she is feeding

him food that would cause this, ie bananas, cereal and applesauce. And

his nursing has changed, but I mentioned the double ear infection

probably hurts a lot.

 

The Dr. said she is no longer making enough milk and should

supplement. A LOT of other BAD info came out of the meeting too.

Anyway, I suggested pumping after a feeding and giving that as a

supplement if she wants, charting all eating times, including length

of time, charting any amount she pumps, etc. She goes back for a

weight check in a week.

 

Oh, and her daughter who is almost 3 had a weight STOP at 8 months

also. In fact, they were doing signficant medical testing because of

it. Note, she began walking at 9 months and has a small stature

similar to my Nathan. But is healthy and eats fine now. So, the Dr.

thinks my friend just stops producing milk at this point postpartum.

 

But because of his retardation, I don't know if I am missing something

significant. Anyone? Oh, and my friend is totally dedicated to nursing

extensively, she knows is absolutely best for him, especially now. And

he is digestive stuff too, so formula may not go over very well

anyway.

 

Thoughts, pointers, anything? Thanks guys! B

 

-------------- next part --------------
An HTML attachment was scrubbed...
URL: http://lists.nurse.net/pipermail/np-clinical/attachments/20070115/697a1a1a/attachment.html