Beyond the Typical: One Mother's Unique Challenge to Continue Providing Breastmilk for Her Special Needs Baby

Sunday, June 16, 2013

Title: Beyond the Typical: One Mother's Unique Challenge to Continue Providing Breastmilk for Her Special Needs Baby

Ryman Hall B4 (Gaylord Opryland)
Debra A. Otto, BSN, RN, CCE, IBCLC , Parent Education and Lactation Services, Christiana Care Health Services, Newark, DE
Kathryn E. Low, BSN, RN, CCE, IBCLC , Parent Education and Lactation Services, Christiana Care Health Services, Newark, DE

Discipline: Advanced Practice (AP), Childbearing (CB), Newborn Care (N), Women’s Health (WH)

Learning Objectives:
  1. Describe information on medication half-life and Tmax.
  2. Apply information on medication half-life and Tmax to guide a mother in determining an appropriate feeding schedule to minimize infant side effects.
  3. Identify the importance of breastmilk on an infant’s gastrointestinal system.
Submission Description:
Background: Breastfeeding is the undisputed optimal feeding for babies.  Healthy People 2020 has recognized this and called for an increase in the number of infants who are breastfed at one year to 34.1%. The Center for Disease Control listed this breastfeeding rate for 2012 as only 25.5%. To accomplish this breastfeeding goal mothers need excellent breastfeeding support throughout the entire first year especially when difficulties arise. The American Academy of Pediatrics 2005 policy statement recommends infants breastfeed exclusively for 6 months and should continue breastfeeding for at least one year as complimentary foods are added.

  Case: Studies have shown an overwhelming number of infant health benefits associated with breastfeeding including protection of the infant from: bacteremia, diarrhea, respiratory tract infection, necrotizing enterocolitis, otitis media, urinary tract infection, late-onset sepsis in preterm infants, type 1 and type 2 diabetes, lymphoma, leukemia, Hodgkins disease and childhood obesity. The more breastfeeding support a mother receives, the more likely she will be able to offer these benefits to her child. This support is even more important when a mother faces challenges that put her at risk for breastfeeding cessation.

   In this case, the mother (M.B.) of a nine month old infant called the lactation resource line at our institution seeking breastfeeding advice. She shared her infant's history which was significant for severe gastrointestinal (GI) symptoms since birth (including blood in stool, vomitting and fussiness). When M.B. was exclusively breastfeeding, she was able to control his symptoms with maternal diet elimination. With the introduction of solid foods however, the symptoms returned. With the help of her pediatrician MB was able to decifer and subsequently eliminate the offending foods.  At the time of the call MB was suffering from mastitis and was placed on an antibiotic which seemed to be triggering the same GI symptoms for her infant. Faced with the prospect of pumping and discarding her milk until the completion of the antibiotic treatment, she was calling for advice.  The lactation consultant was able to research the half-life and Tmax of this otherwise safe medication and devise a feeding plan with MB. It was paramount to feed the infant when the medication concentration in MB's milk was at its lowest in order to minimize the infant's symptoms.

Conclusion: The implementation of this creative feeding plan allowed MB and her infant to continue breastfeeding with minimal GI disturbances. MB was extremely happy to be able to continue providing the optimal nutrition for her baby.

Keywords: breastfeeding, breastmilk, medications

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