Identifying Infant Dehydration in Breastfed Babies
Edited by Alicia Clemens Booksh
Kenner, Louisiana, USA
From: NEW BEGINNINGS, Vol. 11 No. 6, November-December 1994, pp. 184-5
We provide articles from our publications from previous years
for reference for our Leaders and members. Readers are cautioned to
remember that research and medical information change over time.
In the middle of World Breastfeeding
Week [1994], and just one week after a long-awaited announcement by
the US to reverse its position and support the WHO code (which protects
against abuses by infant formula manufacturers), a television news program
aired a story focusing on the "dangers of breastfeeding" or "why some
women should choose not to breastfeed." The promotional spot for the
program showed part of an interview with a mother who said, "If I knew
before what I know now, I would never have chosen to breastfeed." What
timing! Lactation consultants, pediatricians, La Leche League Leaders,
La Leche League mothers, and others concerned about support for breastfeeding
tuned in.
The story focused on mothers
whose infants suffered from dehydration--cases so severe that a child
suffered brain damage and another suffered limb amputation. The mothers
blamed their choice to breastfeed for the birth tragedies, although
each mentioned things about their babies' behavior (sucking improperly,
sleeping constantly, etc.) that immediately caught La Leche League Leaders'
attention.
It seems clear that the
title of the program should have been "The Dangers of Dehydration" or
"The Need for Better Lactation Support and Education."
Dehydration most often occurs
in infants born to first-time mothers new at breastfeeding and child
rearing. The warning signs of dehydration are often present at discharge
from the hospital. There may have been a difficult delivery or maternal
medication for pain before or after the baby was born. This can lead
to a less vigorous or sleepy baby and thus, inadequate feeding at the
breast. Often, supplementary bottles of water or artificial baby milk
products are given in the hospital instead of working on improving the
baby's breastfeeding skills. None of these important details were offered
in the television story.
One of the most common questions
raised by new mothers who breastfeed is "How can I tell if my baby is
getting enough?" This question is one that is addressed at LLL meetings,
and one that should be addressed by an informed and knowledgeable hospital
staff, qualified to provide current and accurate information. In addition,
this staff must be willing to pass out creditable breastfeeding support
and information with the same regularity that the free pamphlets supplied
by artificial feeding product manufacturers are distributed at discharge
time.
Mothers should be aware
of their babies' wet and dirty diapers: after the first day or two,
six to eight wet diapers (five to six disposables, although determining
wetness in disposables can be difficult) and two to five bowel movements
every twenty-four hours means a baby is being nourished adequately.
When a three- or four-day-old baby is not producing wet and soiled diapers,
the mother should seek help immediately from someone knowledgeable about
breastfeeding.
Mothers should be attentive
to a baby's activity level and possible symptoms: Does he suck actively?
Is he enthusiastic at nursing? Is he nursing 8-10 times every twenty-four
hours? Is he swallowing? Is he sleeping through too many nursings? Has
his activity level decreased over time? Hydration can be assessed by
observing an infant's general responsiveness and skin tone. A baby who
is dehydrated will be listless and act sick.
A baby's weight gain is
also an indication of sufficient nourishment at the breast, although
each baby gains at his own rate, and it can take up to three weeks to
regain birth weight. Many health professionals who advocate breastfeeding
suggest that breastfed babies be seen by the doctor at one week of age
to be certain that everything is going well. At a pediatrician's examination,
the lethargy, dryness of mucous membranes, and possible malnutrition
associated with a dehydrated infant would be immediately recognized.
The degree of hydration is best determined by the extent of rapid weight
loss.
In rare situations, an infant's
failure to thrive or dehydration can be due to a mother's inability
to produce enough milk. A retained placental fragment can delay adequate
milk production. Previous breast surgery, particularly breast reduction,
may have severed necessary nerves or removed too much glandular tissue.
Perhaps a birth defect or injury to the developing breast doesn't permit
full lactation.
In a few case reports, diminished
lactation has led to elevated sodium levels in mother's milk which could
cause dehydration in newborn infants. Excessive sodium levels can also
occur when there is an unusual delay in the maturation of colostrum
to breast milk. Sodium levels can be normalized with appropriate lactation
counseling, including pumping between feedings to increase a mother's
milk supply more rapidly.
Mothers can also watch for
signs that their breasts are functioning normally. Did her breasts increase
significantly in size during pregnancy? Did the mother feel her milk
"coming in" a few days after birth? Does she feel thirsty? Does she
feel a let-down? Does she see any milk dribble or squirt from her breast?
Pumping or hand expressing a bit of milk may relieve a new mother's
concern about whether or not she is actually producing milk.
A more likely possibility
to explore is that the baby is unable to suckle properly. Someone with
an understanding of proper breastfeeding (an LLL Leader or a knowledgeable
health professional) should observe the baby's position at the breast
and determine whether or not the baby is latched on properly. The mother
can be helped to determine what baby is doing as he sucks and can be
taught how to work with her baby to improve his breastfeeding skills.
Successful breastfeeding is a partnership; the experience of both partners
should be assessed in the case of insufficient milk supply.
As mothers, our hearts go
out to those who shared their stories of dehydration to warn parents
about its realities. Unfortunately, their tragedies have been linked
to breastfeeding in the minds of some. "The people I've talked to aren't
remembering the breastfeeding benefits discussed in this news story,"
said one lactation professional. "They are remembering the suffering
infants and connecting that suffering to breastfeeding."
We in La Leche League can
help prevent tragedies that occur because of failure to identify infant
dehydration. We can further educate our health care providers and the
general public as to what makes breastfeeding successful. We can promote
the benefits of providing a child with his mother's milk and teach mothers
ways to determine whether or not their infants are thriving. We can
help an uncertain, uninformed, or isolated mother learn more about the
factors that affect her ability to breastfeed her infant. Finally, we
can continue to offer Group meetings where everything a woman needs
to enjoy a successful breastfeeding relationship is provided in an extended,
mother-to-mother context that can make all the difference in the world.
Problems with breastfeeding can be solved before they become serious;
no one should have to feel regret over her decision to breastfeed. Breastfeeding
is too important, too precious. Every mother should have the help she
needs to breastfeed successfully.
References
Branski, D., E. Kerem, E.
Gross-Kieselstein et al. Bloody diarrhea--a possible complication of
sulfasalazine transferred through human breast milk. J Pediatr Gastroenterol
Nutr 5:316, 1986.
Huggins, Kathleen, RN, M.S., The Nursing Mother's Companion, rev. ed. Harvard Common Press. Boston, MA 1994.
La Leche League International, THE WOMANLY ART OF BREASTFEEDING, 35th Anniversary Edition. LLLI, Franklin Park, IL, USA, 1991.
Lawrence, Ruth A. Breastfeeding
A Guide for the Medical Profession, 4th ed. St. Louis: Mosby, 1994.
Mohrbacher, Nancy and Julie Stock. THE BREASTFEEDING ANSWER BOOK. LLLI, Franklin Park, IL, USA, 1991.
Neifert, M. R. et al. Failure of lactogenesis associated with placental retention. Am. Obstet Gynecol 1981;140(4):477-78.
Neifert, M. R. et al. The
influence of breast surgery, breast appearance, and pregnancy-induced
breast changes on lactation sufficiency as measured by infant weight
gain. Birth 1990; 17(1):31-38.
Riordan, Jan and Kathleen G. Auerbach. Breastfeeding and Human Lactation. Jones and Bartlett Publishers, Boston, MA, 1993.
Sofer, S. et al. Early severe dehydration in young breast-fed newborn infants. Isr J Mod Sci 1993; 29(2-3):85-89.
Thullen, J. D. Management of hypernatrenic dehydration due to insufficient lactation. Clin Pediatr 1988; 27(8):370-72.
Last updated Wednesday, October 11, 2006 by njb.
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