Nutrition Interventions for Children with Special Health Care Needs

Chapter 4 - Breastfeeding
recommend galactogogues to help boost milk supply. These are medications and
herbs that can increase the mother’s rate of milk production and help her pumping
efforts (1).
Many mothers worry that their baby is not getting enough milk at the breast. This
may reflect a new mother’s lack of confidence, but can be an indication that the
mother’s milk supply is low, or that the baby is having trouble transferring milk from
the breast (4). If the baby has inadequate growth or appears to be hungry even
after feeding, a detailed assessment is indicated to identify the problem. Issues with
breastfeeding can reside with the mother, infant or both. Careful evaluation by a
registered dietitian, a lactation consultant, and an occupational, physical or speech
therapist with a specialty in breastfeeding can determine the problem and develop
treatment strategies.
The most common reasons mothers have low milk supply are related to delay in the
start of pumping after birth if the baby is unable to feed at the breast, incomplete
milk removal by the baby, and/or low frequency of pumping (3). Mothers may also
have hormonal issues such as hypothyroidism, retained placental parts or hypoplastic
breast development during pregnancy that can be linked with poor milk supply (3).
Once the contributions from mother-sided issues are determined, more detailed
evaluation of the infant’s role can occur. Assessment of the infant’s oral motor
control as it relates to the ability to latch to and remove milk from the breast is an
important first step (5). When observing a mother/baby breastfeeding, a pre-post
breastfeeding weight is the only reliable method to determine intake from the breast.
The amount of time spent at the breast is an extremely inaccurate measure of milk
transfer. In addition to pre/post weights, observing the infant's sucking pattern
and rate of swallowing can give some indication of the baby’s ability to breastfeed
also known as efficiency of milk transfer. Frequent weight checks to monitor overall
weight gain and growth velocity will also provide valuable data on which to base a
treatment plan.
How satisfied the baby appears after nursing and the length of time between
feedings can also provide clues to the adequacy of milk transfer from the mother
to the infant. Health professionals should be aware, however, that there are babies
who are “happy to starve,” so that behavioral cues alone may not accurately reflect
the amount of nutrition the baby is receiving at the breast. Infants with special
health care needs may be particularly vulnerable to under-eating, as they may have
diminished endurance from their primary medical conditions.
Many infants will require additional calories, beyond what they are capable of taking
each day, in order to grow adequately. The RD’s individualization of the care plan
52 Nutrition Interventions for Children With Special Health Care Needs