• Every day an exclusively breastfed newborn is admitted to the hospital for jaundice and dehydration due inadvertent insufficient feeding. This can be prevented. 
• This is a petition to increase monitoring of exclusively breastfed newborns in the hospital.  The specific patient safety initiatives being petitioned include the following:

1) Instructional videos on manual expression to check for the presence of colostrum. Mom should also be instructed on listening for swallows to detect transfer of milk.

 2) Pre- and post-breastfeeding weights to ensure transfer of milk and identify newborns at risk for underfeeding.

 3) Calculation of the 7% weight loss threshold at delivery so that a mother knows when supplementation may be needed, which can be posted in her room. The most critical clinical data an exclusively breastfeeding mom needs to know is the percent weight loss of her child.

 4) Universal informed consent and thorough counseling on the possibility of underfeeding and jaundice due to delayed or failed lactogenesis and giving mothers permission to supplement their child if they go under the weight limit at home using a baby scale. Mothers must know the signs of a newborn in distress including hours of feeding continuously, crying after unlatching, and not sleeping. Most of all, a mother should be advised to check her supply by hand-expression or pumping to ensure that her child is in fact getting fed. If little milk is present, she should be given permission ahead of time to supplement by syringe with next-day follow-up with a pediatrician and lactation consultant to assess the effectiveness of technique and transfer of milk if such an event arises.

5) Uniform daily bilirubin (abnormal > 15) and glucose checks (abnormal glucose < 46) for exclusively breastfed infants who are losing weight or who have any degree of jaundice. Both these values are critical to detect physiology that can cause brain injury.

6) Twice daily weight checks in the hospital and at home until lactogenesis and consistent milk transfer has been established with a mother-baby dyad. These can be plotted before discharge to predict the expected weight loss the day after discharge if mother’s milk does not come in. A mother can check the weight at home and supplement if the child reaches the weight loss threshold.

7) Detailed instructions on supplementation only after nursing to continue the stimulation needed for milk production. Supplementation should be a choice and be accepted and supported by the medical community as a patient right. A mother has the right to feed her child above all goals the medical community has for her.

8) A breastfeeding safety checklist to reduce medical error in the care of a mother and exclusively breastfed newborn.

If you need to hear the voices of mothers whose children have been harmed from starvation jaundice, go to the following website. Their voices are imbedded within the many threads of the site but are highlighted on the main page:

https://www.facebook.com/insufficientbreastfeedingdangers