by Anne Eglash MD, IBCLC, FABM
The question this week is about Downs Syndrome and Breastfeeding. In August 2016, The Academy of Breastfeeding Medicine published an update of its Clinical Protocol entitled ‘Breastfeeding the Hypotonic Infant’. The article highlights suggested breastfeeding management of the infant with Trisomy 21, also known as Downs syndrome.
Which of the following statements is NOT TRUE regarding breastfeeding management for a baby with Downs syndrome immediately after birth:
- Strong support for the baby’s head and body during breastfeeding is advised.
- Avoid skin-to-skin, since a baby with Downs syndrome has a higher risk of airway collapse.
- The ‘Dancer hand’ position could be considered to support the infant’s chin and jaw while nursing.
- The baby’s nursing skills ought to be checked at least every 8 hours in the hospital after birth.
- For a Down Syndrome infant who needs supplementation due to low tone, a supplementer at the breast has the risk of not being effective.
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Milk Mob Comment by Anne Eglash MD, IBCLC, FABM
This clinical protocol on infant hypotonia, and specifically Trisomy 21, is a marvelous document for nurses and other professionals, both inpatient and outpatient, who are caring for families with a hypotonic infant. It is easy to make an assumption that a Trisomy 21 baby will need supplementation because these infants may appear weak. As the protocol points out, low tone does not necessarily imply weakness. In addition, the authors point out that there is no evidence that hypotonic infants feed better with a bottle than at the breast! Special oromotor support at the breast, along with using breast compressions, can help drive breastfeeding success. Some research indicates that Trisomy 21 infants may improve their sucking skills over time, as they age and become stronger.
Families who experience the birth of a Trisomy 21 baby do not experience a ‘typical’ postpartum course. Encouraging the family to nurse the infant without automatic supplementation, and to perform frequent skin-to-skin, may help the family gain a sense of normalcy, and may encourage the family to identify the newborn infant’s strengths.