From The Sunday Times
March 1, 2009
Breast-feeding mothers ‘must get more support’
More needs to be done to prevent babies being dehydrated, doctors say
Doctors who have treated several babies suffering severe dehydration say that breast-feeding mothers need more support to ensure their children are getting sufficient milk.
Information is now being gathered across Ireland and the UK about the number of newborns readmitted to hospital with severe hypernatraemic dehydration, a rare but potentially fatal condition. It occurs when babies fail to take in sufficient quantities of milk in the first days of life. The levels of sodium in their blood rise dramatically and, if untreated, the condition can lead to kidney failure, blood clotting, seizures, brain damage and, in the worst cases, death.
If spotted early enough, the effects are easy to reverse with a steady process of rehydration. It is not always easy to detect, however, as babies can look pink and alert while being on the verge of becoming critically ill.
Serious cases tend to involve first-time mothers who are highly motivated to breast-feed. The number of cases may be rising as more women heed the “breast is best” message.
Sam Richmond, a consultant neonatologist at Sunderland Royal hospital, said: “There are clearly endless upsides to breast-feeding — this is a rare downside. It’s because people persevere [with breast-feeding] beyond the time when it’s healthy for the baby to continue. The mothers should be supported better in doing it properly.”
Richmond said that most grandmothers bottle-fed their babies and don’t know how to breast-feed.
Pamela O’Connor, a consultant neonatologist at Crumlin and the Coombe hospitals, said: “The real reason a lot of these things happen is because of poor community follow-up. [Mothers] feel they have to [breast-feed] and this is in a society where traditionally we were all not breast-fed. We don’t get the family support because of [that].”
It is not only new mothers who can have difficulties breast-feeding. O’Connor treated the fifth child in one family for severe dehydration. “Sometimes the baby is convincing the mother it is actually sucking and swallowing [when it isn't],” she said. “It does happen but it is actually rare to get to the state of profound dehydration due to failed breast-feeding.”
Richmond was prompted to investigate the problem after a colleague lost a baby to the condition. He has treated around 10 newborns.
“The babies you see with this condition appear to fix on the breast and convince the mother they’re breast-feeding but in effect they are taking very little or no milk at all yet surviving. The \ is to spot the baby who is having difficulty breastfeeding before it gets to the stage where it collapses.”
A standard system of weighing babies in the first week or two of life would help spot those becoming dehydrated. Babies usually lose between 10%-12% of their weight in the first few days after birth. But those who get into serious trouble with hypernatraemic dehydration have lost more than 15% and sometimes as much as 30% of their birth weight.
There is a comments box on the page as well, I like Pamela O’Connor’s comment that we are not culturally supported to breastfeed any more but I am wonder what Sam Richmond thinks is ‘beyond the time when it’s healthy for the baby to continue (to breastfeed)’. I thought the risk of dehhydration was with new babies, and very unusual at that. Lisa