Watch Your Language - Breast Isn't Best!

LilPeanut, MSN, RN, NP · Jul 28, 2005

The mode used in sucking on a finger is closer to the technique used when nursing, which is why finger feeding is often successful in helping train nipple confused babies to go back to the breast.

And of course everything is a tradeoff, but even without NEC, introducing milk proteins into an immature gut can permanently alter the gut and flora residing there. Sometimes it is necessary, but for some, it may be worth it to use an IV. My dh had multiple severe food allergies as a child and introduction of non-breastmilk has been indicted in increasing the likelihood of food allergies, iron absorption issues and other problems. If it is merely a transient thing, some parents may very well choose to preserve their child's gut to get them through the next hour or two.

allnurses Guide · Jul 28, 2005

I'm with you Deb. Every place I've ever worked has included breastfeeding education as a requirement and every place has LCs if the nurses are having trouble. Our NICU has two LCs who are specialized for our population (both are former OB and NICU nurses). Most hospitals are extremely supportive of breastfeeding in my experience. We don't all meet Jack Newman's standards, but we are all trying to do what's best for our patients.

We have a great LC but we noticed that the nurses and CNA's were not giving the same uniform and correct information. So we sent everyone to become certified in breastfeeding information.

You of course have heard that you must stop breastfeeding your baby if your baby has a cold - right? :rolleyes: One of our seasoned nurses (in her 50's) told this to a mom who called us for help. Old wive's tales live on unfortunately . . . but education is the key.

Regarding your pacifier vs. gloved finger question . . . I don't understand that either.

I use a pacifier when I assist with circs all the time . .. I actually haven't had a mom ask us not to. Rural area may be different than the city.

My 4 year old was sent home slightly jaundiced and I gave him formula and breastfed . . . even four years ago the old info about normal physiological jaundice was to give formula . . it didn't hurt him and he didn't get nipple confusion and he nursed until he was over 3 years old.

One of my kids had a pacifier at times and nursed until he 18 months. My daughter sucked her thumb and nursed until she was three.

I don't buy "nipple confusion" . .. . at least for my kids.

steph

allnurses Guide · Jul 28, 2005

The mode used in sucking on a finger is closer to the technique used when nursing, which is why finger feeding is often successful in helping train nipple confused babies to go back to the breast.
And of course everything is a tradeoff, but even without NEC, introducing milk proteins into an immature gut can permanently alter the gut and flora residing there. Sometimes it is necessary, but for some, it may be worth it to use an IV. My dh had multiple severe food allergies as a child and introduction of non-breastmilk has been indicted in increasing the likelihood of food allergies, iron absorption issues and other problems. If it is merely a transient thing, some parents may very well choose to preserve their child's gut to get them through the next hour or two.

With my first son (he is 22) I breastfed him until he was 6 months old and started on formula - he got severe "allergies" - crying bouts and weight loss. We ended up with that predigested protein formula - put him on soy for a year.

He can drink milk without problems and the only allergies are hay fever and to walnuts.

I wish I had known more and NOT switched to formula but he is a smart kid in college and healthy.

steph

LilPeanut, MSN, RN, NP · Jul 28, 2005

My son was nipple confused. He was a 34 weeker who didn't begin PO feeding until he was 36w+ GA. He had two good nursing sessions, then a bottle feed and then after that, he started showing issues. The signs of nipple confusion I think are often misunderstood. It's the baby who latches on and then immediately latches off, the one who will sit there for a few min and then scream or fall asleep.

It's because when they feed from the bottle, the milk dribbles (or pours) straight out and down their throat. They have to use their tongue to press on the nipple to stop the flow so they don't drown. With nursing, they have to actively stimulate the milk ejection reflex (except during the shower at letdown ) and so if they want a break or whatever, they just stop sucking and the milk stops.

So when a baby who is used to the bottle goes to the breast, they try to suck the "wrong" way and they are frustrated because there isn't the same constant flow of milk.

The manner of drinking from a bottle is also why most BF babies will seem to always gulp down a bottle after nursing - they're not used to how to stop the flow of milk from the nipple and so they have to drink.

allnurses Guide · Jul 28, 2005

My son was nipple confused. He was a 34 weeker who didn't begin PO feeding until he was 36w+ GA. He had two good nursing sessions, then a bottle feed and then after that, he started showing issues. The signs of nipple confusion I think are often misunderstood. It's the baby who latches on and then immediately latches off, the one who will sit there for a few min and then scream or fall asleep.
It's because when they feed from the bottle, the milk dribbles (or pours) straight out and down their throat. They have to use their tongue to press on the nipple to stop the flow so they don't drown. With nursing, they have to actively stimulate the milk ejection reflex (except during the shower at letdown ) and so if they want a break or whatever, they just stop sucking and the milk stops.
So when a baby who is used to the bottle goes to the breast, they try to suck the "wrong" way and they are frustrated because there isn't the same constant flow of milk.
The manner of drinking from a bottle is also why most BF babies will seem to always gulp down a bottle after nursing - they're not used to how to stop the flow of milk from the nipple and so they have to drink.

I understand and that makes complete sense . . I guess I don't understand the issue with using a pacifier one time during a circ or giving one bottle . . . . but then all babies are different so you are probably right.

steph

BoonersmomRN · Jul 28, 2005

When my 2nd son was born he wouldn't latch at all...the hospital sent in several LC's to see me..none of which helped. I was manually pumping with an Avent Isis and getting quite a bit ( up to 3 oz within the 1rst 2 days) and tube feeding him. FINALLY the 4th ( yes I do mean the 4th) LC realized that his problem was that his hard palate was really high..and no matter what he just couldn't make the connection.so I had to feed him expressed milk with a haberman feeder until he was about 3 months and could take it through the Avent bottles. Anyway...the hospital kept trying to get me to use their electric pump but my breasts are huge and no matter how hard I tried even with the bigger adaption- I couldn't get squat out of the machine...they even tried telling me that they "weren't comfortable" sending me home as a manual-pumper b/c I wasn't using formula as a back up. I didn't NEED formula...I was pumping plenty of milk ( loads of extra). They MADE me agree to take the stupid electrical pump with me ( I swear it looked like R2D2...it was huge)- for a $30 rental fee- of which I NEVER used.

I pumped for an entire year with that manual Isis and never had to resort to formula..although I won't lie and say there weren't times I was FED UP with pumping ( when I finally stopped at 12 months...I jumped up and down on top of that pump until it was a zillion pieces...lol).I had SO many people give me a hard time about what I was doing. I got so much flack about " why dont you just give him formula". Trust me, there were days I wished when my wrist hurt soooo bad.

Thing is I was able to do it- I was a SAHM and I had the time to do it..I doubt highly I could have done that had I been working. I was pumping 10-15X a day to keep my supply up b/c I knew it would drop about 6-8 months. I did have some people praise me like I did some amazing thing...but I never felt that way...to me it was just A) I knew it was better for him and B) it's free ( well minus the bottles to feed it in).

It really saddens me when I see moms struggle w/ breastfeeding and they feel like they are failing their child. I never felt that way...to me a healthy fed child and a happy mom are more important.

fergus51 · Jul 28, 2005

I don't buy "nipple confusion" . .. . at least for my kids.
steph

I'm skeptical about the theory of nipple confusion (it's just a theory). I have posted this before, but a lot of our patients from China would pump and throw away colostrum and wouldn't breastfeed until their milk came it. Their babies all started with bottles and formula for a few days and I never saw them have problems. I have seen women who exclusively breastfeed experience the types of things Lilpeanut described as symptoms of nipple confusion (I call them "immediate gratification babies":)). What worked best for me and my patients was simply expressing a little bit of milk onto the nipple before latching the baby. Sometimes we used a lactation aid with expressed milk at the breast for the first minute or two just so the baby got that immediate satisfaction he seemed to be craving, but we didn't have to do it all that often.

Like I said, I'll do the gloved finger thing (even though I don't see why my pinky finger is different than a pacifier) to please the parents and err on the side of caution. BUT, if I can't I will use a paci dipped in sweetease for a procedure like IV insertion. The baby isn't getting any food from it, so the "ease of flow" idea that is the basis of the nipple confusion theory isn't an issue. You could argue the suck they do it different, but for a matter of 2 or 3 minutes, I'll risk it. Better to have a calm baby when starting an IV than have to stick them numerous times because they are so wild. I would think anyone who has tried to start an IV on a dehydrated and angry term baby who hasn't been eating well would say the same thing. Only once have I had a parent refuse to allow me to use a paci or a gloved finger and I refused to start the IV myself because I knew how bad it was going to be. I got another nurse to do it (thank God every unit has an IV supernurse).

I do sometimes wonder if all the talk about nipple confusion and the like is just a symptom of the larger problem: our lack of confidence in breastfeeding. The women who seem to have the most problems are sometimes the most educated about all that can go wrong and it becomes this horrible self fulfilling prophecy.

fergus51 · Jul 28, 2005

I understand and that makes complete sense . . I guess I don't understand the issue with using a pacifier one time during a circ or giving one bottle . . . . but then all babies are different so you are probably right.
steph

We use slow flow nipples for babies who are going to be breastfeeding. They don't pour formula out at all (yes, we all had fun holding them upside down to see if it would spill and pretending we were going to dump milk on our coworkers :chuckle ). The shape is also different than traditional nipples. They are great because the babies who breastfeed in our unit can't breastfeed for every feed since parents don't spend the night. We could OG all those feeds, but then the baby thinks it can sleep through the night, so it doesn't encourage breastfeeding at home.

SmilingBluEyes · Jul 28, 2005

We use slow flow nipples for babies who are going to be breastfeeding. They don't pour formula out at all (yes, we all had fun holding them upside down to see if it would spill and pretending we were going to dump milk on our coworkers :chuckle ). The shape is also different than traditional nipples. They are great because the babies who breastfeed in our unit can't breastfeed for every feed since parents don't spend the night. We could OG all those feeds, but then the baby thinks it can sleep through the night, so it doesn't encourage breastfeeding at home.

we do the same thing. And I am grateful to have a terrific LC on staff where I work. A good IBCLC nurse/professional is worth her weight in gold.

And I am very conflicted on the nipple confusion issue---I don't go for it---but I am willing to study and learn more before I say it's total bunk.

geekgolightly, BSN, RN · Jul 30, 2005

i had a preemie who was hospitalized for two weeks. we fed my pumped milk to seth int he hospital and when he was finally released we tried and tried and tried to get him to latch. it was difficult bc of his nipple confusion; we were successful at getting him to latch for a minute or two at a time. after six weeks of pain, misery, stultifying depression and agony, i was about to give up entirely. i hated pumping to the core, and felt that if he had six weeks of my milk that might be ok, but i wanted to give it one more go. i stopped bottles entirely and decided that for 24 hours i would only nurse him. i cried baout it, felt i was starving my new baby, but within 10 hours he latched beautifully. i can only thank my midwife for the suggestion, because even LLL gave up on my efforts after six weeks.

he is now 20 months and we are still going strong. my breast milk was so wello established that after i began working again, when he was ten months old, there was no need to pump.

i think the language does need to be changed, because if you do not educate yourself, the nurses (at least in my hospital) won't. everyone tiptoes around this subject, and if i hadn't educated myself about breastfeeding, i would have had no clue as to the importance of it.

every single hour of those six weeks, trying to get him to latch and all of that pumping, which i detested, was totally worth it.

geekgolightly, BSN, RN · Jul 30, 2005

What worked best for me and my patients was simply expressing a little bit of milk onto the nipple before latching the baby. Sometimes we used a lactation aid with expressed milk at the breast for the first minute or two just so the baby got that immediate satisfaction he seemed to be craving, but we didn't have to do it all that often.

didnt work for me.

fergus51 · Jul 30, 2005

didnt work for me.

Sorry to hear that.

I do feel the hospital failed you though. We won't discharge a baby home until they have been able to latch and feed well at the breast if the mother wants to breastfeed. At my old hospital we even had a care by parent room so the mother could spend 24 hours there before going home and during that time the baby would ONLY breastfeed. It was a great confidence booster for the moms who were worried about it.