Ina May's Guide to Breastfeeding
When Babies Get Sick or Need Hospitalization
If your breastfed baby becomes sick and it’s possible for him to swallow, you should continue nursing. He will continue to need the hydration, nourishment, and comfort that he gets from nursing while the illness runs its course or while he undergoes treatment for whatever condition he has.
Babies with nasal congestion often have a hard time nursing because of difficulty with breathing. There are several steps that you can take to relieve this congestion. These will not only make nursing easier, they will lessen the chance that your baby’s mucus congestion will give rise to a bacterial infection because the mucus isn’t moving out of the nose at the rate that it should.
Make sure that the air in the room where your baby spends the most time is not too dry, as dry air will aggravate his nasal congestion. You can do this by following these tips:
· Run a cool-mist vaporizer near where your baby sleeps.
· Be sure to clean your vaporizer one or two times per week. You can use a bleach solution (half a cup of bleach to a gallon of water) or whatever the manufacturer suggests.
· Take him into your bathroom after you have created a steam environment by running a hot shower with the door closed. The steam will help to drain his nasal congestion.
· Add a pinch of salt to a cup of warm tap water and, with a plastic eyedropper, squirt a few drops into each of your baby’s nostrils while he is held in a sitting position (by you or someone else). Wash the eyedropper after each use. If you don’t already have an eyedropper, there are saline nose sprays available at pharmacies prescription-free.
· Use a nasal aspirator or ear syringe to suction mucus from your baby’s nostrils. Squeezing the rubber bulb first, insert the tip into his nostril far enough to establish a good seal, and then slowly release the bulb so that the suction will pull out loose mucus.
If you notice that your baby is just too congested to swallow enough milk to stay hydrated, you can express some milk and give it to him with a tiny cup.
Avoid medicated nasal drops and sprays, decongestants, and antihistamines. All have been shown to be potentially dangerous to babies, and none works as well as the salt solutions recommended above.
A healthy breastfed baby’s poop is loose, yellow, and has the consistency of pea soup. It has a slightly yeasty odor, but it doesn’t stink. Diarrhea, on the other hand, is quite watery and foul-smelling. A babywith a gastrointestinal infection may have diarrhea twelve or more times within a day. Sometimes you might find a tinge of blood in the baby’s diaper as well.
Whatever the degree of severity of your baby’s diarrhea, continue breastfeeding, keeping close track of his weight. Weigh him undressed each morning before a feeding. If he isn’t losing weight, feeds well, and is playful, he is likely to be doing fine. If he’s listless and has lost five percent of his weight, call your pediatrician, as your baby is probably dehydrated and needs help.
Babies may sometimes get diarrhea as an allergic reaction to a new food that they cannot tolerate. If you suspect this, try eliminating the food to see if that solves the problem.
Another possible cause for watery poops, particularly if your baby is also acting fussy and seems to have belly cramps, is that he is getting too high a proportion of foremilk and not enough of the higher-fat-content hindmilk. This can happen if you are switching your baby to your second breast before the first is well emptied. If this is the problem, it’s good to keep the baby much longer on the first breast before moving to the next.
Gastroesophageal Reflux Disease
Most babies spit up occasionally during their first weeks of life. This happens because the sphincters at the entrance to the stomach of a young baby are still young and weak, allowing just-swallowed milk (and sometimes stomach acid as well) to flow up into the esophagus. Stomach acid is very irritating to the delicate lining of the esophagus and causes the discomfort that we know as “heartburn.” When this happens occasionally, it’s nothing to worry about; it’s part of being a baby. However, when this kind of reflux happens at virtually every feeding, the tissue of the esophagus can become so inflamed that it becomes painful for the baby to swallow. This is called gastroesophageal reflux disease (GERD), and it occurs in about three percent of babies.
GERD is very distinct from normal spitting up. Some infants with GERD vomit more than four or five times every day and spend most of their waking hours during their first weeks of life screaming in pain. Others don’t vomit this much, because their stomach acid moves up into the esophagus but is never thrown up. This is known as “silent reflux.” Nevertheless, the irritation is still taking place; the baby with silent reflux may have as many problems feeding as the one who vomits several times a day.
Babies with reflux disease are not able to settle at the breast, suckle until they are satisfied, or enjoy the feeling of a full tummy. They may cry as they approach the breast, take a few swallows, and start coughing and choking. They often turn their heads to the side or arch their backs while feeding, stretching their bodies out as flat as possible instead of cuddling up and melting into your body. When they throw up, they usually lose most of what they have just swallowed. Babies with GERD cry and scream during and after feedings, and they may have frequent episodes of hiccups. Some of them will also breathe with a rattling sound from the chest. Babies with a severe form of the condition may come to associate pain with feeding and thus resist it.
The scariest symptom suffered by babies with severe GERD is sleep apnea. These babies may have episodes in which they stop breathing for short periods of time while they are asleep.
Because of the symptoms that I have named, babies with GERD are sometimes mistakenly thought to have “colic.” The problem with this misdiagnosis is that it may not lead to a solution of the problem.
Many babies with GERD can be helped with some fairly simple strategies:
· Avoid dressing your baby in a garment with an elastic waistband.
· Feed him in a position that puts his head well above his bottom. Experiment with pillows, if necessary, to find one that helps prop him into position.
· Try giving your baby a breastfeeding tea made up of caraway seed, fennel seed, stinging nettle, and anise seed. Give it warm (body temperature), testing the temperature on the inside of your own wrist. This can be given at any age, but I would sterilize the tea water by boiling it first for five minutes for a baby younger than six months.
· When changing a diaper, do it on a surface that is slightly raised on the “head” end, and avoid lifting the baby’s legs during the process. You can roll him onto his side instead.
· Put a small wedge under the head end of the place where your baby sleeps.
· Swaddling may help calm your baby and soothe his crying.
· Give him shorter, more frequent feedings, as this may reduce the incidence of vomiting and the esophageal irritation.
· If you have plenty of milk, consider feeding him at only one breast at each feeding, paying attention to how this affects his condition.
· If your diet includes dairy products, try a dairy-free diet for two weeks. (This strategy has helped many women, but please be aware that you might not see the benefits from it until several days have passed.)
· Eliminate caffeine from your diet for two weeks.
· Eliminate wheat products from your diet for two weeks.
· Some GERD babies are helped if you give them a pacifier to suck on between feedings. Don’t overdo it, but the pacifier may give you enough minutes of calm and quiet to brush your hair and to attend to your own needs or those of an older child.
If your baby’s weight gain is quite slow and his condition doesn’t improve with the above measures, it would be wise to see a pediatrician for an accurate diagnosis (I would recommend that you do this even before buying an over-the-counter antacid product). There are several prescription medications that may help your baby, including cimetidine (brand name: Tagamet), aluminum with magnesium hydroxide (Gaviscon), ranitidine (Zantac), aluminum hydroxide (Mylanta), omeprazole (Prilosec), and lansoprazole (Prevacid). Be aware that some of these products may have the side effect of constipation. Babies with severe GERD sometimes need to be on medication for several years.
If at all possible, continue breastfeeding; your baby with GERD will usually continue to suffer the same problems when given a cow’s milk formula, without receiving the benefits of your breast milk. If your baby does wean himself, do not blame yourself for this. If you feel criticized by family members and friends who give you advice or comments, realize that they have not been in your particular situation and that they probably don’t understand why what they say is hurting you.
The good news about GERD is that your baby’s problem can be managed and treated. Unfortunately, there is often no quick fix. You will need as much help as you can find, because the sleep deprivation and stress associated with caring for a baby with GERD can be serious enough to put women into postpartum depression. Some mothers of GERD babies talk about how this condition delayed their developing feelings of love for the babies until the symptoms began to subside. If you have such feelings, you are not alone. I suggest that you seek out other women who have had babies with GERD; for instance, you can visit the following websites: www.reflux.org and www.cryingoverspiltmilk.co.nz.
There is life after GERD, but it may take time to get there.
Besides normal spitting up, you may now and then see what is called projectile vomiting—the kind when your baby vomits with such force that it sprays two or three feet away. Sometimes a baby who is overfed or squeezed around the midsection shortly after being fed will have an episode or two of projectile vomiting without there being something really wrong. Don’t worry about this.
However, if projectile vomiting continues to happen and your baby begins to lose weight and his skin looks wrinkled and dry, these may be indications that he has a condition called pyloric stenosis (baby boys have it more often than girls). With this condition, there is a narrowing of the tube between the stomach and the intestines, which makes it hard for milk to move out of the stomach, so out it comes—suddenly. Pyloric stenosis most often becomes noticeable between two and eight weeks of age. A simple nonemergency surgery can correct the condition, and usually the baby can go back to breastfeeding within a few hours afterward.
If Your Baby Is Hospitalized
If your baby should ever be hospitalized, your breastfeeding relationship is going to be one of the most important elements in his healing. Think of it this way: Your baby suddenly finds his life turned upside down. It will probably seem to him that grown-ups are no longer trustworthy! They keep coming at him with needles and sharp things, and soon enough he may start thinking that nearly every person who enters the room wants to hurt or irritate him. Breastfeeding will be the only pleasurable activity for a baby who has just had surgery or undergone some other painful medical procedure. Fortunate, then, is the baby who is breastfed, because your breast will continue to be a source of comfort and solace for him when he feels unsafe. Hopefully, the hospital staff will understand the importance of your baby’s continued breastfeeding during hospitalization and will help meet your needs.
If your baby is so sick that he is unable to swallow for a time, express and store your milk. You should do this at least five times per day. This is particularly important if you are not always able to be by your baby’s side at the hospital; it will help keep your milk supply up and will allow your baby to have milk ready for him when he can take it.
My own godson, Mason, was diagnosed with a cancerous tumor of the kidney. His story is particularly close to my heart because I had attended his birth and the births of both of his parents. His experiences show how important breast milk can be to hospitalized babies and also how important it is to have the help of supportive health-care professionals. His mother, Laura, tells their story:
Laura: For me, breastfeeding wasn’t a political statement or part of an alternative lifestyle, it was just the normal thing to do. I knew that breastfeeding for at least one year was the current recommendation, and I hadn’t really thought much about the need to nurse beyond that—until Mason’s illness was diagnosed.
Two weeks before his first birthday, he started pushing away his food (something he had never done before). Over the next few days he pretty much stopped eating altogether, but he was still nursing. The less he ate, the more he would nurse. During this time, we asked the advice of our neighbor, a physician’s assistant. She agreed with us that likely it was constipation. Over that weekend I tried all the home remedies you could name to move his bowels. Things were moving out, but still nothing was going in. He was still nursing, though, so he was hydrated and relatively well nourished.
I made an appointment Monday morning to see our pediatrician. Upon first examination and my description of Mason’s symptoms, he agreed it was some sort of bowel obstruction. A second examination, which included X rays and an ultrasound, revealed that he had a large growth in his abdomen. We went straight to a large children’s hospital, where specialists diagnosed a cancerous Wilms’ tumor of the kidney. It was so large (more than two pounds, and about the size of a child’s football) that it was pinching the large intestine.
Mason underwent a six-hour surgery the next day. That’s when I learned that, in general, breastfed infants can be nursed up to three hours prior to surgery. Formula is stopped at six hours, solid foods at eight. I was glad to be breastfeeding; it’s very hard to explain to a sick one-year-old why he can’t eat. After his major abdominal surgery, Mason wasn’t allowed even a sip of water for forty-eight hours. When it was time to reintroduce liquids, he was insatiable; he drank every last drop we offered. After a couple of hours, once the Pedialyte stayed down, the staff said I could nurse him. They would have made him wait another twenty-four hours for formula. Once again I was glad I was nursing.
When Mason first came out of surgery, he spent the day almost comatose; he was worn out from anesthesia and the traumatic process of being in this strange place, where strange people were allowed to poke and prod him—where even his own parents helped hold him down for an IV to be set up. (There are less traumatic ways for doing this, but they take time. This was an emergency; the tumor could have leaked cancerous cells.) My son could understand little or nothing of his situation. He couldn’t talk yet, couldn’t tell us how he felt. When he finally started to come around, he seemed to glare at the world around him. “What is this new place, when can we leave?” he seemed to ask. Finally he was allowed to nurse. Ahh, his mother did love him. He became as needy as a newborn and wouldn’t let me out of his sight.
We were told Mason might be in the hospital for two weeks, but we were discharged in six days. We were told it could take until the end of the week for him to keep down solid food, but he was eating ravenously by day three. I credit much of this rapid healing to breastfeeding. Formula and cow’s milk are very heavy and hard to digest. Breast milk offered the perfect primer to get Mason’s stomach going again. Once he was eating well and food was passing through without any trouble, we were free to go home.
The following week, we started both radiation and chemotherapy. The radiation therapy lasted one week, and chemo lasted six months. There were many times when Mason would eat nothing but toast and breast milk, and he managed to maintain his weight.
There were many doctors who didn’t think I should be breastfeeding him anymore. They didn’t give much credit to the benefits of his nursing after the first year. This was very disheartening. I had trusted my son’s life to these doctors, and they made my efforts seem insignificant or even damaging. One doctor actually thought breastfeeding was having a negative-calorie effect (that Mason was using more calories to get the milk than the milk provided him). These doctors wanted me to wean Mason and give him cow’s milk or PediaSure (which is cow’s milk with lots of sugar!). This proves to me that if you are having any problems or doubts about nursing, you should seek professional breastfeeding help, either through a nutritionist or lactation consultant. We were very lucky to have a professional nutritionist assigned to us. She stuck up for us with the doctors and even had my milk analyzed. (She was able to determine that it was more nutritious than cow’s milk.) Mason was the only child under four I saw in the oncology clinic who didn’t have a nasogastric tube (a feeding tube that goes through the nose to the stomach, used for bypassing the mouth in people who can’t or won’t eat). Mason was able to gain just enough weight not to need one. I can’t help but wonder how big a part breastfeeding played.
If your baby needs to be hospitalized, it’s important that those who will be caring for him are familiar with the importance of breastfeeding for your baby (and you) and will see to your needs. Best are the hospitals that provide sleeping facilities so you don’t have to sit in a hard chair all night to be near your baby. Keep up your commitment to breastfeeding, and arrange for all the support you can get. Returning to breastfeeding will help your baby recover his health more quickly. If your pediatrician tries to convince you to stop nursing your sick baby, you might want to seek a nutritionist’s support like Laura did.