When Breast-Feeding

By Christine Gorman

At 6 lbs. 5 oz., Bradley Erwin looked like a healthy baby when he was born last March. He just didn't seem to get the hang of breast-feeding. His mother Kimberly, 38, a medical technician, tried to nurse him. "He would bob his head, root and try to latch on, but he wasn't getting anywhere," she recalls. "Everybody kept saying, 'Don't worry. Don't worry."' It was bad advice. When the infant was 12 days old, his parents rushed him to Children's Hospital in Cincinnati, Ohio. His breathing was shallow; his eyes had rolled back. "I was frantic because I could see he was withering," she recalls. Doctors found the child's weight had slipped below 5 lbs. Their diagnosis: severe dehydration. Bradley was starving. A few days later, he suffered a stroke. Just how much damage it caused remains to be seen.

Everyone knows that breast-feeding is natural and that doctors agree it is the best way to feed an infant. It is a less advertised fact that not every woman -- or baby -- can do it. "In our attempt to promote breast-feeding, we have overstated how easy it is," says Dr. Marianne Neifert, medical director of the lactation program at Presbyterian-St. Luke's Medical Center in Denver. Neifert is an expert on a rare condition called low-milk syndrome, which occurs when a baby fails, as Bradley did, to get enough nutrition. Her studies suggest that perhaps 5% of new mothers fail to produce milk in sufficient quantity. In other instances, the babies, for a variety of reasons, are unable to nurse successfully. In either case, the risks are extreme: seizures, strokes and blood clots that could lead to brain damage or loss of a limb.

Thereason for low milk production, Neifert found, is usually anatomical. Some women simply lack sufficient glandular tissue (as opposed to fatty tissue) in their breasts. A history of breast surgery -- biopsies, breast reduction -- increases the risk. (A warning sign of the problem: the breasts do not swell significantly during early pregnancy.) How does one tell if a breast-fed baby is getting enough to eat? The proof, say experts, is in the diaper. In the first few weeks of life, a nursing baby normally wets at least six diapers a day and has very frequent bowel movements. For mothers who cannot produce enough milk, the solution is easy: supplement the baby's diet with infant formula.

While low-milk syndrome is not necessarily on the rise, some doctors believe that they are seeing more severe cases than in the past because shorter hospital stays for new mothers make it harder to train them in the techniques of breast-feeding and harder to identify problems. "We aren't able to intervene in day two or three of life," says Dr. Michael Farrell, chief of staff at Cincinnati's Children's Hospital. Most American women now leave the hospital within 36 hours of giving birth and don't see a pediatrician until a week later -- often too late to forestall severe dehydration and other problems.

Prompted in part by reports about low-milk syndrome, the American Academy of Pediatrics is considering a recommendation that mothers bring their newborns for a checkup when the babies are just three or four days old. That might have made all the difference for Bradley Erwin.

With reporting by Alice Park/New York City