Can a baby with a cardiac defect breastfeed? Not if you deny him the chance to do so. Here are just a few tips for the beginning of the journey.
Not all cardiac defects are alike
Some cardiac defects are very severe and involve multiple surgeries and a long road to achieving feeding success and general well-being. Others are very mild. In fact, some go completely undiagnosed during childhood.
Watch the baby
What happens when most babies breastfeed? They may or may not latch. They may or may not fuss. And they may or may not transfer milk easily. But they do look okay.
If you see feeding behavior that doesn’t look okay, trust your gut. Something is wrong.
As a nurse, I was taught to observe adult patients for “SOB on exertion.” For an adult, that might mean becoming short of breath when walking to the bathroom. But for an infant, “exertion” is what occurs during a feeding.
A baby who is gasping for breath when they’re feeding may have a cardiac defect. A baby who finishes a feeding and looks exhausted, rather than satiated, might have a cardiac defect.
I remember the first time I saw this situation. I saw a slight bluish discoloration around the baby’s mouth. (Circumoral cyanosis.) I was frightened out of my wits. Luckily, I saw the need to stop the feeding. I grabbed the oxygen.
I’m not a physician, but I recognized classic signs of cardiac insufficiency. If the baby is struggling that much to consume a feeding, don’t encourage “trying” a little more. Get medical help.
Dispel the idea that it “can’t” be done
With bottle-feeding and formula as the default in our society, we presume that breastfeeding is impossible for compromised infants, including those with cardiac defects.
There’s just no truth to that. At all.
Remember that breastfeeding is easier
That’s right. I said easier.
Oddly, people presume that bottle-feeding is easier on the heart and lungs. To my knowledge, there are no studies to substantiate that.
To the contrary, there are several older studies which show that babies have better oxygenation when they are breastfeeding. These studies aren’t appreciated because nowadays, everyone ignores studies that are more than 5 years old. While our medical colleagues look at quality of evidence, we get stuck on “age.” (Don’t get me going!)
It also appears that infants who bottle-feed are at higher risk for difficulty swallowing (called dysphagia) that is sometimes associated with cardiac difficulties.
So, this isn’t medical advice, but it’s for sure something you should consider: If the baby can take oral feedings, they are better off breastfeeding. Take a look at Dr. Lawrence’s book for more details.
Beware of sequelae
If the baby cannot completely drain the mother’s breast, there are a whole lot of consequences that will follow.
The two big ones are poor infant weight gain and maternal engorgement (and risk for mastitis.) Getting that milk out of the breast (and hopefully, into the baby) is key to avoiding these and related issues.
Test-weighing, (that is, weighing the baby before and after feedings) is a major strategy to monitor growth. This is a best practice for infants with cardiac defects and issues.
Consider opportunities and threats
To minimize weight gain problems, be aware of opportunities to conserve calories. For example, keep the baby at an optimal temperature. Conversely, reduce threats to calorie-burning (such as crying).
There’s substantial evidence that infants have better body temperatures, more stable heart rates, and better breathing during skin-to-skin contact. Skin-to-skin contact promotes comfort and improves newborn physiologic stability both before and after cardiac surgery. Not to mention decreasing the stress response as measured by salivary cortisol levels.
If the baby with a cardiac defect can be with his mother, encourage baby-to-chest as a first step. Baby-to-breast can come later.
Always be on the alert for situations that maximize the opportunities and reduce the threats to good milk transfer, high caloric consumption (and conversely, conservation of calories), and ways to decrease exertion.
Be prepared for multiple separations
Some babies with a cardiac defect endure many surgeries. Many.
Human milk is the ideal source of nutrition for infants with congenital heart disease. The family needs to be prepared for pumping and collecting milk. Also, they should be prepared to consider using donor milk if the mother cannot maintain a supply.
Have you had any experience breastfeeding or watching a baby with a cardiac defect to breastfeed? What kinds of signs did you look for? Share your experiences below!