Nutrition Interventions for Children with Special Health Care Needs

Chapter 4
Section 2 - Problem-Based Nutrition Interventions
Breastfeeding for the Child with Special
health Care Needs
Robin P. Glass, MS, OTR, IBCLC and Lynn S. Wolf, MOT, OTR, IBCLC
The nutritional benefits of breastfeeding and breast milk for the typically developing
infant are undisputed (1). These benefits are also important for the infant with
special health care needs (2). However these babies may reap additional benefits
from breast milk due to their initial medical problems. The anti-infective properties
found in breast milk often play a crucial role in the baby’s recovery from medical
complications and support their health in the early months of infancy.
For the typically developing infant, exclusive breastfeeding is considered to be getting
all nutrition at the breast. For the infant with special health care needs, a broader
definition should be considered. Breastfeeding can be seen on a continuum from
full nutrition directly from the breast through receiving breast milk either fully or
partially from a bottle or tube feeding. For this reason, attention to the adequacy of
the mother’s milk supply is crucial. In particular, the first few weeks of life will be
vital to the mother’s ability to provide her baby with enough breast milk for growth
over the next six to twelve months. For all infants who are receiving mother’s milk
recommended supplements include a single shot of Vitamin K at birth, use of a
Vitamin D supplement started within a few days of birth, and a supplement of iron
introduced in the first few months of life.
If the infant is not able to feed at the breast within two hours after birth, the mother
should be assisted to begin pumping using a hospital grade pump. The first two
weeks after birth are a crucial time for the establishment of a full milk supply (3).
Encourage the mother to ideally pump a minimum of eight times per day, spaced at
2-3 hour intervals during the day with a break of no longer than 4-5 hours at night.
The aim is to produce at least 16 oz or more of breast milk per day at two weeks
after birth.
Pumped expressed breast milk can be stored for five days in the back of the
refrigerator or frozen and kept for 3-6 months in the freezer of a refrigerator with a
separate door for the freezer. If the mother is struggling with her milk supply even
though she is pumping regularly, a referral to a lactation consultant (LC) is indicated.
The LC, in conjunction with the mother’s primary medical doctor, (PMD) might
Nutrition Interventions for Children With Special Health Care Needs 51