Published Jul 25, 2002
Can any of you please share with me your experiences in caring for hospitalized infants who have been dx with FTT and had been breastfed? Is this relatively common? Any information would be great! :)
They can add supplements to breastmilk for added calories. Also, we use to weigh the babies before and after nippling to make sure they were getting enough via grams and then supplement with formula if not. The breast milk is a lot gentler on the stomach and easier to tolerate and some of our sickest babies who couldn't digest the regular formula were able to tolerate the breast milk. We always preferred breast milk to formula with very sick kids, but if the kid isn't gaining and growing we start becoming concerned he may not be getting enough calories or taking enough bm from mom. that is why we weighed before and after.
We add a supplement after the breast for 24 hours. If the baby has gained we d/c the supplement for every other feeding for 24 hours. If the baby is still gaining we d/c the supplements but still weigh the baby qod for at least 7 days to make sure the increase in breast mild is sustained.
in my experience these type of cases don't come around to often in our unit, i hate to generalize but most of the time is due to the mother neglecting the child, there are some special cases where the baby does have some metabolic disorder.
hope it helps,
Unfortunately, our facility is in a very impoverished area. Most of our FTT breastfed babies are either victims of neglect or the mother's general health is poor due to lack of proper nutrition. In such case, we normally place the child on a 24 cal supplement and do strict I&O's and dly wt's naked. After discharge, the baby is placed on the WIC program so the mother can obtain government funded high nutrition formula for her child. In some cases of FTT, we may have to get a social services consult to have the home atmosphere investigated in order to insure the child is receiving proper home care. If the child has to be removed from it's mothers care due to neglect, it generally turns out that the mother is a young teenager and has no maternal skills. She will be given the opportunity to attend parenting classes to learn to care for the child and herself. After she has shown proof of competence, the mother can regain guardianship of her child and receive follow up visits from the Dept of Health and Human Services for a short period of time to insure the child is getting proper care.
Our cases don't seem to be majority neglect as above posters believe. There is the rare case of neglect, but most of our babies have some type metabolic and/or GI problem or they are just poor feeders. Many of ours end up with fundo/gt's. As for prevelance among breast fed babies, most of our FTT's are not breast fed. However, on the rare case they were, we would have mom pump for a few days and alternate expressed milk with breast every other feed. This way, we can be assured the infant is receiving minimal nutrition. Also, weighing the diapers and monitoring UOP is helpful to assess the amount of intake. If, after a few days of monitoring, we feel the infant is receiving adequate intake from the breast yet wt gain still inadequate, then we may move to supplementing bm with something high calorie.
How old is this infant you're referring to??
Many times FTT in breast fed infants is due to strictly scheduling feeds--there is a book called Babywise that has generated a huge amt. of controversy, unfortunately many moms follow it. Strictly scheduled feeds equals low milk supply equals FTT--not to mention that baby also sometimes just gives up. A good LC should be able to convince mom to turn this around, and once she starts nursing on cue her supply should pick up.
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