Infant Hospitalization

SUMMARY: Assess according to pathology. In general, few infant diseases contraindicate or hinder breastfeeding. Children admitted to hospitals have the right to remain with their mothers and, if they can be fed by mouth, breastmilk, directly or expressed, is the best option.
--------------------------------------------------
Infant hospitalization is a risk factor for partial or total cessation of exclusive breastfeeding (Bochner 2020, Heilbronner 2017, Lapillonne 2013, Courtois 2010, Souza 2008, Quattrone 1995).
The causes of this risk are the emotional impact and fatigue it causes on the mother and baby, the seriousness of the infant’s clinical situation, maternal and family misinformation and, above all, hospital practices that are not very favourable to breastfeeding (routine administration of bottles, difficulty for the adequate and comfortable stay of the mother, absence of a specific protocol) and the lack of knowledge about breastfeeding of the health personnel (Heilbronner 2017, Courtois 2010, Souza 2008, Quattrone 1995).

The company of the mother and breastfeeding reduce the anxiety that the hospital environment causes in the baby. Breastfeeding produces analgesia in invasive practices such as venous access, tests, catheters, etc. (AEP 2018, CW 2019, ABA 2017, Costa 2016). In many cases, sick children can only tolerate the mother's breast, rejecting all other food. Breastmilk provides them with defensive immune factors that help them fight infection and protective factors of the intestine, shortening the duration of hospitalization (CW 2019, ABA 2017, Costa 2016, Courtois 2010). In these cases especially, breastmilk serves as both food and medicine (CW 2019).

"Hospitalized children have the right to be accompanied by their parents or the person who substitutes for them as long as possible during their stay in the hospital, not as passive spectators but as active elements of hospital life" (European Charter for Hospitalized Children , European Parliament 1986).

There is a great deal of inconsistency between hospitals in practices regarding admissions of breastfed infants and some are not the most appropriate (Bochner 2020, Heilbronner 2017, Courtois 2010).
It should be facilitated for the mother to stay in the same room or, if the clinical situation does not allow it, provide her with a nearby room and facilities so that she is in a position to breastfeed or be able to express milk for her baby (Lawrence 2016 p517).
Breastfeeding training should be on the curriculum of all health personnel working in pediatric units (Meek 2017).
It is desirable that the hospital has personnel trained in breastfeeding and in manual or mechanical expression of breastmilk and offers the mother the appropriate resources.
Otherwise, the mother must have her own knowledge and means for expressing breastmilk (ABA 2017). Expressed breastmilk must be labelled with the date before freezing and storing (CW 2019).
All staff (doctors, nurses) should know that the mother is breastfeeding the admitted child and the type of breastfeeding, exclusive or partial-mixed (ABA 2017).

As long as the illness of the admitted infant allows for oral feeding, direct breastfeeding or using expressed and administered breastmilk is the best option (Lawrence 2016, Costa 2016).

If the mother cannot breastfeed, either because the hospital does not permit joint admission, or because of the baby's clinical situation, it is advisable to express milk frequently to avoid breast problems (retention, mastitis), maintain production and have milk available for the baby, freezing it if necessary (CHP 2018).

In general, few diseases suffered by a hospitalized infant prevent breastfeeding or only temporarily until the clinical situation improves. An individual assessment is necessary according to the disease and, day by day, according to its evolution.
Respiratory diseases (bronchiolitis, pneumonia), except for extreme respiratory distress, will allow breastfeeding with short feeds and frequent pauses or the administration of breastmilk through a nasogastric tube (Costa 2016).

If the infant is to undergo surgical intervention, the child can breastfeed up to 3 to 4 hours before anesthesia. Longer fasting times are not necessary since breastmilk is digested in that time, not interfering with anesthesia and calming the infant (ABA 2017, Costa 2016).
Most surgical procedures allow breastfeeding as soon as the baby is awake; an individual assessment according to the type of operation and disease is required (CW 2019, ABA 2017).

During hospitalization, the mother may notice a decrease in milk production. Normally, once they have returned home and the baby has recovered, they can return to breastfeeding as before hospitalization (ABA 2017).

It is instructive to read brochures and guides from various hospitals and pediatric associations (CW 2019, AEP 2018, CHP 2018, ABA 2017, Costa 2016).

See below the information of these related products:

• Preoperative Fasting (Fairly safe. Mild or unlikely adverse effects. Compatible under certain circumstances. Follow-up recommended. Read Commentary.)
• Surgical intervention of the infant (Fairly safe. Mild or unlikely adverse effects. Compatible under certain circumstances. Follow-up recommended. Read Commentary.)