What is your hospital's policy on supplemental feeding?

fergus51 · Nov 8, 2004

If mom is breastfeeding well there is no need for supplemental formula. If she isn't and baby is looking nasty dehydrated or jaundiced or has low blood sugar, he will be supplemented. The method depends on the baby. If the problem is just that moms milk hasn't come in we'll use a lactation aid at the breast. If he can't latch we'll use cup or bottle. The LCs all prefer anything other than the bottle. If it is an ongoing issue we will sometimes even insert an NG and gavage.

SmilingBluEyes · Nov 8, 2004

Same thing as what Fergus said. We use cups, SNS, gavage mostly, depending on need and how well babies thrive in the nursery (if they are special care infants).

palesarah · Nov 8, 2004

For healthy, term breastfeeding kids, we need an MD order to supplement formula(technicality since the nurses are usually the ones to assess the need for supplementation). But we do not do it frequently and it is certainly not openly encouraged. If a baby is not breastfeeding well (maintaining latch & suck) at 24 hours we initiate pumping with a hospital grade double pump setup and give the expressed colostrum (we can mix with 1-5ml sterile h20 if it's really thick and sticky) most often by syringe. Our IBCLCs don't believe the body of evidence strongly supports the idea of "nipple confusion" so they recently redid our breastfeeding matrix and if mom is pumping more than 10mL and not adverse to introducing artifical nipples we can have them give it by bottle. That's been working out surprisingly well for the few women who pump that much that soon We very rarely use the SNS.

If after 24-48 hours of pumping mom is not producing an adequate amount, or at any point if baby becomes dehydrated or hypoglycemic (we only check sugars if symptomatic on these healthy term kids with no other risk factors) then we will get an order to supplment with formula according to the kid's needs based on weight. Formula is given by cup or bottle (whichever parents prefer), only as much as needed and only until the kid is stable. Bili babies we do case-by-case, usually they are not taking enough at the breast to poop all that bili out so mom is usually pumping and either bottle feeding EBM or supplementing EBM with formula by bottle.

I've never seen us drop an NG tube on a healthy kid, but that is how we supplement our special care babies until they are taking po well. Most of our growing preemies will go to breast with a nipple shield during NG feeds at first, some go home without ever having taken a bottle but most go through a transitory period with EBM by bottle as well as breast.

Hope that helps-

palesarah · Nov 8, 2004

Just thought of something- the hospital I did my OB clinicals at in school treated things much differently. If baby wasn't doing well at breast, they'd have mom pump with a manual pump and then automatically supplement with formula. They'd add colostrum to formula and cup feed, avoiding the bottle at all costs.

We focus more on establishing a good milk supply and avoiding introducing formula unless absolutely necessary so as not to disrupt the intestinal flora (one little sip of formula changes it all).

(edited to correct a typo)

LINUS · Nov 9, 2004

We aren't allowed to push supplementing with formula, but if a mother requests it, whether she's BF well or not, we will give her one. It's the mother's decision, not ours. If the baby is not BF well, and is jaundiced and under bili lights, the doctors will usually write an order to BF, pump, and supplement up to 30 cc's if needed-- they can use give the supplement via a bottle with a cross cut nipple, SNS (which is pretty useless unless you have a personal lactation consultant for each patient for every single feed) or syringe. I think it's the mother's choice and if she wants it, then give it to her. I have never seen a baby get nipple confused in my whole career.

bam_bam · Nov 9, 2004

No supplements here except by mom's request or dr's order. This is very rare though. If babe isn't nursing well, mom pumps and give that to babe. We cupfeed. If babe is jaundiced, under lights, usually pc per md order

BETSRN · Nov 10, 2004

With problems, we have started initiating pumping much sooner and encourage Mom to pump every 3 hours (if baby will do little or nothing). We have had great results with increasig milk supplies sooner with this new pumping thing. If baby is a good nurses, then we leave well enough along. SNS only works if baby is an efficient nurses at breast.

BETSRN · Nov 10, 2004

Are you kidding? All a baby needs is to have a nipple and then they don;t want to open their mouths again for the breast, not to mention,giving larger amounts of supplement sets the baby up for being really dissatisfied with the breast until Mom's supply catches up.

fergus51 · Nov 10, 2004

I don't believe in nipple confusion either. Worked on the west coast and none of our Chinese mothers would breast feed until their milk came in because they didn't want to feed the baby colostrum. They would all toss their colostrum and bottle feed until their milk came in and we never had more trouble getting their babies to take to the breast.

klone, MSN, RN · Nov 10, 2004

I don't believe in nipple confusion either. Worked on the west coast and none of our Chinese mothers would breast feed until their milk came in because they didn't want to feed the baby colostrum. They would all toss their colostrum and bottle feed until their milk came in and we never had more trouble getting their babies to take to the breast.

They were lucky. Sadly, nipple confusion (I prefer nipple "preference") DOES exist. Not in all babies and not all the time, but in enough situations that makes it hellish for both mom and baby. It is especially likely if mom's supply is not where it should be, and baby gets used to the fast and easy flow of the bottle.

I get phone calls from moms at least once a month, distraught because her 6-week-old baby will not take the bottle and she is preparing to go back to work. That right there is proof that nipple confusion DOES exist. If it didn't, you wouldn't have babies who refuse bottles - they would be able to easily go back and forth from breast to bottle with no problems.

fergus51 · Nov 10, 2004

That's not proof, that nipple confusion exists anymore than my seeing hundreds of babies go back and forth without difficulty is proof that it doesn't exist. Nipple confusion (or nipple preference) is a theory. Some nurses believe it 100%, I'm just not one of them. I should say that I don't think it exists nearly as much as people would have us believe. It seems like every person who has trouble breastfeeding will blame it on nipple confusion if the baby sucked on a pacifier for 3 seconds. I don't give breastfeeding babies bottles, but it isn't because I believe that one bottle will lead them to give up the breast. Some babies will prefer one breast over the other. Some babies won't take to cup feeding. That's just individuality.

Personally, I think a lot of the reason we have so much trouble with breastfeeding in our society is that we have turned it into such a high stress event. The fact that many babies have trouble accepting bottles can just as easily proove that breastfeeding is easier for them, not that they get so confused that they can't do both. Like I said, the asian moms I had never had this kind of difficulty and I think a lot of it had to do with their confidence that breastfeeding is a completely natural event. They weren't so worried that their baby wouldn't learn to breastfeed if they didn't do everything perfectly from the moment the baby was born. I can't tell you how many times we tried to get these women to breastfeed from birth.