For Those Who Can’t Breastfeed: Part 2

Last week I discussed the many emotional and physical reasons why mothers cannot/should not breastfeed.  This week I’m going to talk about the physical reasons why babies cannot/should not breastfeed and alternative feeding methods.

Reasons Why Babies Cannot Breastfeed

1) Tongue Tied- also known as ankyloglossia is a congenital condition where the membrane tissue connection on the underside of the tongue is thick and short.  Some parents opt to have the tissue clipped to help their infants breastfeed easier.  Other parents opt to wait it out so that the child’s tongue will be longer with age.  I recommend discussing any breastfeeding problems with your pediatrician and a lactation consultant.

2) Classic Galactosemia- is a genetic medical condition in which people cannot process galactose (sugar) properly.  With this particular type, even infants are intolerant to the galactose in breast milk.

3) Maple Syrup Urine Disease- also called branched-chain ketoaciduria is genetic metabolic disorder where people cannot break down branched-chain amino acids (protein).  The disorder is called maple syrup urine because infants’ urine is sweet smelling.  If left untreated, infants can suffer brain damage and eventually death.  These infants, therefore, cannot eat breast milk.

4) Phenylketonuria (PKU)- is an inherited metabolic disease where people cannot metabolize the amino acid PHe into the amino acid tyrosine.  Unlike the other two conditions, some infants can be breastfed with careful supervision.  Many mothers of breastfed PKU babies are on strict diets.

5) Premature Newborns- Because of prematurity some newborns may need to supplement in the beginning.  Some newborns require extra nutrition then their mothers can provide because of their early birth.  This is not true in every case.  I would consult your pediatrician and a lactation consultant before supplementing.

6) Severe Food Allergies- Some infants are born with severe food allergies (like milk or soy).  Traces of these allergy causing foods are found in the breast milk of mothers who consume these foods.  Therefore a breastfeeding baby with a food allergy will cause the mother to have to drastically change her diet.  Usually, a woman can still breastfeed her child, but if the changes to her diet harm the mother, she may have to stop breastfeeding.  I recommend that mother/baby pairings in this situation work with both physicians and lactation consultants to find a solution best suited for mother and baby.

For more information about acceptable reasons to not breastfeed, please read the World Health Organization‘s site.

Breastfeeding Alternatives

1) Pumping and using bottles-  A friend of mine gave birth to two adorable twin boys.  Because of the added stress of trying to either feed one at a time or attempting to tandem nurse, she opted to pump and feed them simultaneously with bottles.  While it’s more ideal to bring baby to breast because breast milk changes to fit the nutritional needs of the infant, pumping and feeding by bottle is a good option.

2) Supplementing- In the beginning of my son’s life, I had supply problems.  While I was working on boosting my breast milk supply, giving him a small amount of formula helped.  Some families are able to obtain another woman’s breast milk and supplement with that too.  Supplementing may last the entire breastfeeding relationship or it may be only for a short period of time.  How much additional breast milk/ formula to supplement with depends on the nutritional needs of the infant.

3) Milk Supply Banks- Milk supply banks will take pumped breast milk and pasteurize it so that infants can drink breast milk.  Typically these milk supply banks give milk out on basis of need.  Therefore premature infants usually are at the top of the list.  It’s also expensive to obtain breast milk from a supply bank so this may not be a viable option for low income families.

4) Milk Supplied Directly from a Donor- It’s becoming more common for women to pump out extra breast milk and give it for free to another infant.  During the testimony given by the post-partum depressed mother, she explained that her sister-in-law dutifully would pump extra and share.  A word of warning:  Before accepting breast milk, make sure you know the donor’s medical history.  Do they drink alcohol, and how close was their last drink to when they pumped?  Do they have any medical conditions?  Are they on any medications?  Most medical communities do not recommend accepting breast milk directly from a donor because of the potential medical risks to the infant.

5) Formula- Because of metabolic reasons, some infants have to be placed on special diets/formulas.  This may also be the only affordable option for some families who have other reasons not to breastfeed.  While breast is best, formula comes in a close second when feeding infants.

I do not recommend using water, sugar water, baby cereal, or baby food as substitutes/supplements for breast milk or formula until a child is at least four months old.  Please talk to your pediatrician, physician, or a lactation consultant to come up with the best solution for you and your family.