Nurses that give bottles to breastfeeding babies.

allnurses Guide · Jul 20, 2004

We have the opposite problem . . moms who get frustrated with b/f and want a bottle.

We would not give a bottle if the mom says no.

Having said that, my son had a bottle for a few days after delivery for jaundice (yes, I know it is not necessary) and is still breastfeeding and will turn 3 years old on the 22nd of July.

The nurses on night shift need to stop. We sent all our nurses and CNA's to a breastfeeding class so we are all on the same page. Amazing how many old wives tales that were being spread.

Good luck -

steph

fergus51 · Jul 20, 2004

For consistency's sake I would never give a bottle to a breastfeeding baby. That said, I don't believe for a second that nipple confusion or giving a baby a bottle is what's causing them to have trouble latching. It's a theory, and I don't buy it. I have seen literally hundreds of Chinese women who bottlefeed until their milk comes in and then breastfeed without problems (traditional women from certain parts of the country won't breastfeed right away because they don't want the baby to get colostrum). Parents who don't want their kids to have bottles need to take the initiative. (A bottle can't be given without their consent unless they are putting the baby out of the room for some reason).

If you want to know how this has been done where I have worked before... We had a strict policy put in place. Upon admission parents were asked about bottling and told about the nipple confusion theory. If they didn't want bottles, a "no supps/no soothers" sticker was placed on the isolette. They were told that if the baby was hungry mom would have to breastfeed (no "I want to nap for 8 hours, but don't give my kid any bottles" allowed). They were also told about other ways of feeding if interested or if it became necessary (finger feeding/cup feeding). If they said they were ok with bottles, nurses had to get over it and let them have bottles. Once it became a policy, written in stone, most nurses were good about it.

allnurses Guide · Jul 20, 2004

For consistency's sake I would never give a bottle to a breastfeeding baby. That said, I don't believe for a second that nipple confusion or giving a baby a bottle is what's causing them to have trouble latching. It's a theory, and I don't buy it. I have seen literally hundreds of Chinese women who bottlefeed until their milk comes in and then breastfeed without problems (traditional women from certain parts of the country won't breastfeed right away because they don't want the baby to get colostrum). Parents who don't want their kids to have bottles need to take the initiative. (A bottle can't be given without their consent unless they are putting the baby out of the room for some reason).
If you want to know how this has been done where I have worked before... We had a strict policy put in place. Upon admission parents were asked about bottling and told about the nipple confusion theory. If they didn't want bottles, a "no supps/no soothers" sticker was placed on the isolette. They were told that if the baby was hungry mom would have to breastfeed (no "I want to nap for 8 hours, but don't give my kid any bottles" allowed). They were also told about other ways of feeding if interested or if it became necessary (finger feeding/cup feeding). If they said they were ok with bottles, nurses had to get over it and let them have bottles. Once it became a policy, written in stone, most nurses were good about it.

I don't believe in "nipple confusion" either. There is something else causing trouble with latching. Still, if the mom does not want a bottle, then those nurses need to stop giving a bottle.

steph

reyna · Jul 20, 2004

if the mother said breastfeeding...breastfeeding it shall be. it's not for the nurse to decide how to feed the babies unless it's her own child. i wonder why the mom's doesn't question why she doesn't do feedings at night? my son had to stay in the hospital for about 2 weeks (he was premature) and we've decided to bottlefeed our son with my breastmilk. that's our choice. my son is 2 years olds now and thankfully, he's healthy, strong ang without complication from being born 6 weeks early and just a little over 3 pounds.

L&D_RN_OH · Jul 20, 2004

Have pts complained? Do you have a breastfeeding policy?

I have had a problem with one nurse who has fed my breast babies bottles, without a medical indication. Pts have complained, and since it goes against our breastfeeding policy, incident reports have been completed for these instances. Our policy states breastfed babies are to have no supplements unless medically indicated.

I think the only way to change the situation, is to have a set policy in place, and advocate for these pts. Because, unfortunately, some pts don't know they can complain.

mitchsmom · Jul 21, 2004

Even if you don't believe in nipple confusion, there are other issues with giving formula to a baby who has been exclusively breastfed:

“Just One Bottle Won’t Hurt”---or Will It?

by Marsha Walker, RN, IBCLC

Background

The gastrointestinal (GI) tract of a normal fetus is sterile.

The type of delivery has an effect on the development of the intestinal microbiota.

* lady partslly born infants are colonized with their mother’s bacteria.

* Cesarean born infants’ initial exposure is more likely to environmental microbes from the air, other infants, and the nursing staff which serves as vectors for transfer.

Babies at highest risk of colonization by undesirable microbes or when transfer from maternal sources cannot occur are cesarean-delivered babies, preterm infants, full term infants requiring intensive care, or infants separated from their mother.

Breastfed and formula-fed infants have different gut flora.

* Breastfed babies have a lower gut pH (acidic environment) of approximately 5.1-5.4 throughout the first six weeks that is dominated by bifidobacteria with reduced pathogenic (disease-causing) microbes such as E coli, bacteroides, clostridia, and streptococci o babies fed formula have a high gut pH of approximately 5.9-7.3 with a

variety of putrefactive bacterial species.

* In infants fed breast milk and formula supplements the mean pH is approximately 5.7-6.0 during the first four weeks, falling to 5.45 by the sixth week.

* When formula supplements are given to breastfed babies during the first seven days of life, the production of a strongly acidic environment is delayed and its full potential may never be reached.

* Breastfed infants who receive supplements develop gut flora and behavior like formula-fed infants.

The neonatal GI tract undergoes rapid growth and maturational change following birth.

* Infants have a functionally immature and immuno-naive gut at birth.

* Tight junctions of the GI mucosa take many weeks to mature and close the gut to whole proteins and pathogens.

* Open junctions and immaturity play a role in the acquisition of NEC, diarrheal disease, and allergy.

* sIgA from colostrum and breast milk coats the gut, passively providing immunity during the time of reduced neonatal gut immune function.

* Mothers’ sIgA is antigen specific. The antibodies are targeted against pathogens in the baby’s immediate surroundings.

* The mother synthesizes antibodies when she ingests, inhales, or otherwise comes in contact with a disease-causing microbe.

* These antibodies ignore useful bacteria normally found in the gut and ward off disease without causing inflammation.

Infant formula should not be given to a breastfed baby before gut closure occurs.

* Once dietary supplementation begins, the bacterial profile of breastfed infants resembles that of formula-fed infants in which bifidobacteria are no longer dominant and the development of obligate anaerobic bacterial populations occurs. (Mackie, Sghir, Gaskins, 1999)

* Relatively small amounts of formula supplementation of breastfed infants (one supplement per 24 hours) will result in shifts from a breastfed to a formula-fed gut flora pattern. (Bullen, Tearle, Stewart, 1977)

* The introduction of solid food to the breastfed infant causes a major perturbation in the gut ecosystem, with a rapid rise in the number of enterobacteria and enterococci, followed by a progressive colonization by bacteroides, clostridia, and anaerobic streptococci. (Stark & Lee, 1982)

* With the introduction of supplementary formula, the gut flora in a breastfed baby becomes almost indistinguishable from normal adult flora within 24 hours. (Gerstley, Howell, Nagel, 1932)

* If breast milk were again given exclusively, it would take 2-4 weeks for the intestinal environment to return again to a state favoring the grampositive flora. (Brown & Bosworth, 1922; Gerstley, Howell, Nagel, 1932)

In susceptible families, breastfed babies can be sensitized to cow’s milk protein by the giving of just one bottle, (inadvertent supplementation, unnecessary supplementation, or planned supplements), in the newborn nursery during the first

three days of life. (Host, Husby, Osterballe, 1988; Host, 1991)

* Infants at high risk of developing atopic disease has been calculated at 37% if one parent has atopic disease, 62-85% if both parents are affected and dependant on whether the parents have similar or dissimilar clinical disease, and those infants showing elevated levels of IgE in cord blood irrespective of family history. (Chandra, 2000)

* In breastfed infants at risk, hypoallergenic formulas can be used to supplement breastfeeding; solid foods should not be introduced until 6 months of age, dairy products delayed until 1 year of age, and the mother should consider eliminating peanuts, tree nuts, cow’s milk, eggs, and fish from her diet. (AAP, 2000)

In susceptible families, early exposure to cow’s milk proteins can increase the risk of the infant or child developing insulin dependent diabetes mellitus. (IDDM) (Mayer et al, 1988; Karjalainen, et al, 1992)

* The avoidance of cow’s milk protein for the first several months of life may reduce the later development of IDDM or delay its onset in susceptible individuals. (AAP, 1994)

* Sensitization and development of immune memory to cow’s milk protein is the initial step in the etiology of IDDM. (Kostraba, et al, 1993)

Sensitization can occur with very early exposure to cow’s milk before gut cellular tight junction closure.

Sensitization can occur with exposure to cow’s milk during an infection-caused gastrointestinal alteration when the mucosal barrier is compromised allowing antigens to cross and initiate immune reactions.

Sensitization can occur if the presence of cow’s milk protein in the gut damages the mucosal barrier, inflames the gut, destroys binding components of cellular junctions, or other early insult with cow’s milk protein leads to sensitization. (Savilahti, et al, 1993)

References

American Academy of Pediatrics, Work Group on Cow’s Milk Protein and Diabetes Mellitus. Infant feeding practices and their possible relationship to the etiology of diabetes mellitus. Pediatrics 1994; 94:752-754

American Academy of Pediatrics, Committee on Nutrition. Hypoallergenic infant formulas. Pediatrics 2000; 106:346-349

Brown EW, Bosworth AW. Studies of infant feeding VI. A bacteriological study of the feces and the food of normal babies receiving breast milk. Am J Dis Child 1922; 23:243

Bullen CL, Tearle PV, Stewart MG. The effect of humanized milks and supplemented breast feeding on the faecal flora of infants. J Med Microbiol 1977; 10:403-413

Chandra RK. Food allergy and nutrition in early life: implications for later health. Proc Nutr Soc 2000; 59:273-277

Gerstley JR, Howell KM, Nagel BR. Some factors influencing the fecal flora of infants. Am J Dis Child 1932; 43:555

Host A, Husby S, Osterballe O. A prospective study of cow’s milk allergy in exclusively breastfed infants. Acta Paediatr Scand 1988; 77:663-670

Host A. Importance of the first meal on the development of cow’s milk allergy and intolerance. Allergy Proc 1991; 10:227-232

Karjalainen J, Martin JM, Knip M, et al. A bovine albumin peptide as a possible trigger of

insulin-dependent diabetes mellitus. N Engl J Med 1992; 327:302-307

Kostraba JN, Cruickshanks KJ, Lawler-Heavner J, et al. Early exposure to cow’s milk and solid foods in infancy, genetic predisposition, and risk of IDDM. Diabetes 1993; 42:288-295

Mackie RI, Sghir A, Gaskins HR. Developmental microbial ecology of the neonatal

gastrointestinal tract. Am J Clin Nutr 1999; 69(Suppl):1035S-1045S

Mayer EJ, Hamman RF, Gay EC, et al. Reduced risk of IDDM among breastfed children. The Colorado IDDM Registry. Diabetes 1988; 37:1625-1632

Savilahti E, Tuomilehto J, Saukkonen TT, et al. Increased levels of cow’s milk and blactoglobulin antibodies in young children with newly diagnosed IDDM. Diabetes Care 1993; 16:984-989

Stark PL, Lee A. The microbial ecology of the large bowel of breastfed and formula-fed infants during the first year of life. J Med Microbiol 1982; 15:189-203

12/18/2003

SmilingBluEyes · Jul 21, 2004

We have the opposite problem . . moms who get frustrated with b/f and want a bottle.
We would not give a bottle if the mom says no.
Having said that, my son had a bottle for a few days after delivery for jaundice (yes, I know it is not necessary) and is still breastfeeding and will turn 3 years old on the 22nd of July.
The nurses on night shift need to stop. We sent all our nurses and CNA's to a breastfeeding class so we are all on the same page. Amazing how many old wives tales that were being spread.
Good luck -
steph

Sounds like where i work. WE NEVER EVER give breast babies bottles UNLESS special medical needs exist that necessitate this. AND even THEN, we cupfeed after breast feeding FIRST. I can't understand how nurses can think they should do this. It's unethical and wrong to go against breastfeeding moms' wishes by sticking a bottle in a baby's mouth. Unless a ped orders it specifically for medical needs, we do NOT do this.

fergus51 · Jul 21, 2004

Even if you don't believe in nipple confusion, there are other issues with giving formula to a baby who has been exclusively breastfed:

Don't mean to imply breast milk isn't best, only that I personally don't think the latching problems are all about a baby having one bottle feed.

SmilingBluEyes · Jul 21, 2004

I don't either ferg. they either get it or they don't. and the ones who don't have to be worked with whether it be bottle or breastfeeding. some infants are just plain lousy at sucking in the first days of life. it's beyond frustrating to try and overcome them, but we do our best. i have experienced extreme frustration with strictly bottlefed babies who refuse to suck, too. it can be so hard to get them going.

webbiedebbie · Jul 21, 2004

Where I work, I am considered a "nipple nazi". I am one who believes that if the pt wants to breastfeed, then NO bottles are to be given to the baby unless medically necessary. We have nurses on our unit who feel that it is okay to give the baby a bottle at night so "mom can get some rest". We actually get in report that the mom is both breast and bottle!

"Mom" would get plenty of rest if visiting hours weren't during all hours of the day and night! I've had parents say that they are uncomfortable asking visitors to leave when it is time to breastfeed. But that's a whole other thread!

fergus51 · Jul 21, 2004

AMEN Debbie! I wish all the moms who wanted to breastfeed were completely committed to it and willing to sacrifice visitors and a full night's sleep.