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Breastfeeding the Hospitalized Baby
by Cyndi EgbertWhile it is a blessed fact that babies come in two genders, for the sake of clarity, mother is referred to as "she" and baby is referred to as "he" for the purposes of this information sheet.
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None of the information contained herein is meant to provide medical or legal advice. These are merely suggestions. All decisions should be discussed with your health care provider.
Because preemies have very specific issues, I have not addressed their special needs in this context. There is information available from La Leche League International on the special situation of breastfeeding a preemie.
Index: Breastfeeding the Hospitalized BabyMain Text
Appendix A - Glossary of Useful Terms
Appendix B - Chain of Command
Appendix C - Where to Find Help
Quick Checklist - At-A-Glance Reference
This information is a guideline, a starting point for discussion with your child's caregivers. Because each child's condition and situation is unique, anything affecting the child’s overall well-being should be agreed upon by all involved. It must be stressed that, ultimately, the parents have the final say on all aspects of their child’s care.
Pregnancy is generally a time of anticipating wonderful things to come. Even when the pregnancy was unexpected, most mothers are eager to greet and come to know their new child by the time of the birth. The thought that there might be a problem occurs to all of us at one time or another; but it is usually dismissed quickly as unfounded.
Sometimes it is apparent during the pregnancy that something is amiss, but more often it is at delivery or within a few days after that problems suddenly show up. An older baby may suddenly become very ill and require hospitalization.
As unfortunate as these things are, it is more unfortunate still that many mothers, overwhelmed by their child’s condition, the medical staff and the hospital setting itself, conclude that breastfeeding is no longer an option. Breastfeeding may be abandoned or never initiated.
Following are a few guidelines that may help breastfeeding remain a viable option.
Once your baby is physically able to nurse, different issues come into the picture.
Your baby may have some difficulties
with the act of nursing. This may be due to being intubated,
an aversion to being touched around the face or mouth, congestion, weakness
or congenital abnormalities of the mouth. Some problems, such as
weakness or congestion, may just take some time to resolve. A very
weak baby will likely be tube-fed to conserve energy, and in that case
nutrition will not be the main concern. Other problems may warrant
a consultation with the lactation consultant on staff or a local La Leche
League Leader. She will be able to offer concrete suggestions, perform
an evaluation, or refer you to an appropriate therapist and/or other resources.
I know how difficult it is to breastfeed in adverse circumstances. My own daughter would not have been breastfed were it not for my background as a former La Leche League Leader. Even with my determination, there were many obstacles to overcome. I am thankful for the friends who were able to support me through the six weeks we spent at the hospital. My daughter did not successfully nurse until after she was discharged at six weeks of age. At two months of age she still had not regained her birthweight! Two months after that, however, she was actually plump.
She is frequently ill and has had pneumonia a number of times. Many of the pediatric nurses at her hospital know us on sight. Yet, when I talk with other parents of children with her problems, I realize how very lucky we’ve been. I am sure that breastfeeding has prevented far worse complications than the ones we deal with. So while no one can promise that your child will never get sick again if you breastfeed, you can be sure that the benefits will still be tremendous.
GLOSSARY OF USEFUL TERMS
ambu bag (am-boo’)- a mask attached to a bag which is filled with oxygen. There is a rubber middle that can be squeezed. It is used to give the baby extra oxygen if the oxygen levels have gone down for some reason. It is especially used when a baby is on the ventilator.
art line- an abbreviation for “arterial line”. It is similar to an IV but it is inserted into an artery as opposed to a vein. It is often considered necessary for the purpose of keeping a close check on oxygen and carbon dioxide levels in a baby that is on a ventilator.
attending - the physician on duty who is ultimately responsible for all care in his/her own specialty.
bolus - a term that is used to describe any type of fluid that is put in through a tube in a fairly quick way. This can describe IV fluids or milk that is put down a feeding tube.
catheter - describes any long, thin tubing. Different types are used as feeding tubes, for IV lines and for suctioning.
cc - an abbreviation for “cubic centimeters”. It is a fluid measure. Approximately 33 cc is equal to 1 ounce. This term is interchangeable with ml.
charge nurse - the charge nurse is the nurse on duty who is the supervisor of all other nurses in the same unit. Also “head nurse”
chart - the chart is where ALL information regarding your child is written during the hospital stay. Physician’s orders, nurse’s notes, medications, special instructions and results of all tests and consultations are kept in this binder. You have every right to review the chart at any time. They may want you to have a doctor present to answer any question, but they can not deny you access to the chart.
child life specialist - the people whose job it is to see that anything that might make the hospital stay easier for your child is provided, i.e. a tape recorder to play tapes from home, a mobile to hang up for visual stimulation, a baby swing for the room, etc.
code - the common term that is used to describe cardiac arrest.
cpt - an abbreviation for “chest physio-therapy”. A baby that has a lot of congestion in the lungs or is on a ventilator may have difficulty coughing the mucous up on his own. A special technique is used (sometimes with a special piece of equipment, sometimes with just their hands) to tap on the chest and back in order to dislodge the mucous from the lungs to enable to baby to get rid of it.
cut down - a technique sometimes resorted to when an arterial line must be placed. A small incision is made and the line is inserted visually into the artery. This is common with small babies because their arteries are so small they are often hard to find.
dietitian - a medical professional whose job is to monitor any actual food (formula or breastmilk) that is being given to the baby. She/he calculates calories and may make suggestions on ways to increase intake.
diuretics - drugs that encourage fluid loss. They are commonly used after surgery to counteract the retention of fluid which is the body’s natural response to trauma.
DNR - an abbreviation for the term “Do Not Resuscitate”. This is used to indicate that no extreme measures are to be taken in the event of cardiac arrest.
drip - refers to any medication or fluid which is allowed to “drip” into an IV line.
et tube - stands for “endo-tracheal” tube. This refers to the tube that is put down the throat to enable use of a ventilator.
extubate - removal of the et tube
fellow - a doctor who is receiving extra years of training in their chosen specialty.
foley - a type of catheter that is inserted into the urethra to allow drainage of the bladder and collection of urine samples.
HMF or Human Milk Fortifier - often used to increase the number of calories in breastmilk that is being tube or bottle-fed to a sick baby. It was developed for premature infants and may cause electrolyte imbalances or allergic reactions.
hyperal - a type of IV nutrition that is given when food is not possible or advisable.
ins - the common term for the number of ccs of food, medication and IV fluids taken in during a given time.
intubate - the procedure of putting an et tube into the throat to enable use of the ventilator
IV - refers to an “intravenous line”. This is a catheter inserted into a vein for the purpose of administering medication.
kilogram - a metric unit of weight. One kilogram is equal to 2.2 pounds. (abbr. is k)
lactation consultant - she is a medical professional (usually board certified - IBCLC) whose job is to help mothers overcome problems to successfully breastfeed their babies.
lactation specialist - often a nurse with some extra knowledge of breastfeeding. She may take the place of a certified LC in some hospitals, but she may not be as knowledgeable as an LC would be.
La Leche League Leader - a mother who has breastfed her own children and who volunteers her time to support breastfeeding mothers and help them through any difficulties that may arise with breastfeeding. She has a tremendous wealth of resources available and is accredited by LLLInternational to counsel breastfeeding mothers.
neonatologist - a doctor who specializes in the care of newborn babies.
ng tube - describes a “naso-gastric tube” which is put into the stomach through the nose. This is used for feeding babies that are not capable of eating normally and for giving “oral” medications that do not have an IV equivalent.
npo - “non per os” nothing by mouth
O2 - the abbreviation for oxygen.
OT - the abbreviation
for “occupational therapist”. An OT works with babies that have feeding
outs - describes the amount of fluid (vomit, urine, blood) and bodily waste that is lost in a given time period. This is compared to the “ins”.
pediatric intensivist - a doctor that specializes in critical care of children
po - “per os” by mouth
port - term refers to the place in an IV or tube that is used to put in medications or food
pulse-ox - a special
monitor that uses a glowing band aid (that’s what it looks like) to
q - stands for “every” and is used as in “q-4” to mean that something is supposed to happen every 4 hours. This refers to medications, taking vital signs, and similar purposes.
resident - a doctor who is in training before going on to their own practice.
RT - stands for “respiratory therapist”. These are the people who adjust oxygen levels, monitor ventilators, administer breathing treatments, and do “cpt”.
sat - this refers to the oxygen saturation level given by the pulse-ox and it is expressed in a percentage.
SNS - stands for “Supplemental Nutrition System” and is sometimes used to allow weak babies to be fed at the breast. It is also used to enable adoptive mothers to nurse their babies.
social worker - the person who helps ensure that you have adequate financial help and can help arrange for social support if you have none.
the process by which excess mucous is removed from the nose, mouth
tech- term that refers
to any person whose only job is to operate some type of
vent- an abbreviation for the term “ventilator”.
ventilator- a machine
that delivers oxygen and can actually breathe for a baby that is
yankeuer (yon’ker)- a rigid plastic rod that is used with a vacuum source for suctioning.
THE CHAIN OF COMMAND
It is helpful to understand exactly who is in charge and what the role is of each person involved in your child’s care during a hospitalization. Each person has their own duties and responsibilities and different people will sometimes give conflicting answers to the same question.
You are always the ultimate decision-maker. Sometimes it doesn’t seem that what the parents think really matter at all in a hospital setting, but that is far from the truth. You have the final say in all treatments and you have a right to have each and every one of your questions answered to your satisfaction before making any decisions. It is you, the parent, who will have to live for the rest of your life with the consequences of choices that are made. The doctor and the nurses get to go home at the end of the day and put “work” behind them. So always proceed with the utmost respect for the power that you hold in your hands as the protector of your child.
WHERE TO FIND HELP
Sometimes, it may be necessary to find someone who can help you through any difficulties you may experience. The following are some things to consider in choosing a lactation professional and some resources for finding someone who is qualified. If you are not happy with the person with whom you are working, please seek another source for information. Many mothers give up on nursing because the person who was “helping” them with breastfeeding was not much help!
Things to consider:
Resources for finding appropriate help:
La Leche League International - LLL has trained Leaders in every state in the
United States as well as a number of other countries. LLL Leaders are volunteers who have
nursed their own babies and have met training and continuing education guidelines. They
offer monthly support meetings as well as phone counseling to pregnant and nursing mothers.
Home or hospital visits would be done at the discretion of the Leader. There is no cost for
their services, although membership in LLLI is available if desired.
International Lactation Consultant Association - ILCA has listings of certified
lactation consultants in your area. Not all certified LCs are listed with ILCA, but all
listed LCs are board certified. When looking for a certified LC, look for the initials
IBCLC which stand for International Board Certified Lactation Consultant. This guarantees
that she has a minimum background of counseling hours and has passed a comprehensive test
on a wide variety of breastfeeding situations and topics.
Women’s, Infant’s and Children’s Program - WIC is a program that is administered by the state Department of Health. They provide food supplements, nutritional counseling, and breastfeeding support for pregnant or lactating women and children up to the age of 5. While not all WIC programs are as supportive of breastfeeding as they should be, many have IBCLCs on staff and/or breastfeeding Peer Counselors who are trained to assist mothers wishing to breastfeed. They may also have breastpumps and other special supplies available as well as literature supportive of breastfeeding. You can contact your local health department to find out what services they have available. Many programs do not require that you be eligible for or on WIC to utilize their services. This can be very helpful if you can not find a local LLL Leader and/or do not have the resources to pay for a private LC.
Remember: if you are not comfortable with a course of action, the person you are working with, or the services provided, speak up. She is there to HELP YOU, not to lecture you, give you ultimatums or get in your way. Please do not let a bad experience with one person get in the way of seeking help elsewhere. You and your baby deserve the best start possible, and that includes a successful breastfeeding relationship.
copyright 1998 by Cyndi Egbert
Copyright 1997-2012 by Gentle Christian Mothers™
Scripture quotations taken from the NASB.
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