Indian Pediatrics 2000;37: 1114-1116
Breastfeeding in Adopted Babies
It is well recognized that breastfeeding is the ideal nutrition in early infancy. However, adopted babies in developing countries are usually breastfed. Several studies have documented the success of breastfeeding in adoptive babies (1,2). The present study was conducted to evaluate the factors affecting the induction of lactation in adoptive mothers.
Twenty-three mother and adopted baby pairs were evaluated. The parents were counseled in 3 to 4 sittings to breastfeed the adopted infants. The first advice was to discontinue bottle feeds abruptly and they were told about the possibility of breastfeeding. Surprise was the general reaction. All were advised to suckle the baby two hourly. Top milk was to be given by spoon and cup. If babies refused to suckle at the breast, the drip drop technique(3) was adopted. All the adoptive mothers who agreed to suckle were given Metaclopramide(4) 10 mg twice a day for 15 to 20 days. Eight children were hospitalized for this purpose.
Appearance of breast milk on manual expression was designated as successful initiation, replacement of one or two feeds was designated as partial success and replacement of 4 to 5 feeds was designated as successful breastfeeding.
The ages of mothers ranged between 35 to 45 years. Fifteen belonged to low socio-economic status. Six were from middle and two from high socio-economic status. Four mothers were graduates, 1 was midwife, 5 were matriculates, 10 went to primary school only and 3 were illiterate. Professionally, one each was bank officer, school teacher and midwife; the rest were housewives.
Age of baby at the time of adoption ranged from 3 to 45 days. Fifteen were male babies. All of them had no obvious illness at birth. In 6 babies the birth weight was not known. In others, birth weight ranged between 2.5 kg to 3 kg, except in 1 child who weighed 1.8 kg. Duration between adoption and contact with us varied from two days to one month. Ten pairs had been already seen by other doctors. Twenty two babies were bottle fed, only one was on spoon feeds. Bottle feeds were advised by doctors in ten children. None of them was advised breastfeeding. Seventeen subjects presented with illnesses like diarrhea (n = 11) respiratory infections (n = 4), neonatal sepsis (n = 1), and hypocalcemic convulsions (n = 1). The remaining came for immunization services. Eighteen children gained weight poorly and two had no weight gain. Twelve babies were adopted from recognized institutions and 4 from known parents. One baby was adopted by grandmother who wanted to give this baby to her daughter.
Twenty two mothers were advised breastfeeding (one was a grandmother). Ten (45%) refused to breastfeed. The stated reasons for this were age of mother, shy to breastfeed adopted baby, working status, could not believe the possibility of breastfeeding, to breastfeed was not an ambition and unwillingness of husband.
Out of 12 mothers who agreed to try, 7 were from low socio economic class. Only 4 educated mothers agreed to try. It was easy to convince poorly educated women who felt breastfeeding was natural. Education about advantages of breastfeeding proved more effective, especially when probable effect on intelligence was told. In poor mothers reduction in cost of feeding was also found to be useful.
Initiation of breastfeeding was documented in 8 subjects; it was partially successful in 4 and successful in 4 including exclusive breastfeeding in 1. Success of initiation depended on motivation of mothers. The mean initiation occurred at 8 days (range 4 to 17 days). The most motivated mother started lactating on the fourth day and could exclusively breastfeed.
Younger the adopted baby and earlier the initiation, better was success. Similar observations have been reported earlier(5). Drip drop technique(3) was used in 4 mothers; other authors have used lact-aid also(5). The 4 mothers who failed to lactate were suckling very infrequently and lack of motivation and family support were the main reasons for failure. Replacement of even two feeds was given value because this also needs patience and perseverance. Moreover, it is not only nutrition and infection which are important but also the emotional bond between an adopted baby and mother(4). Oher workers have used many drugs like oxytocin, phenothiazine, estrogens and progesterone (4,5). However, I used only Metaclopramide.
This study shows that it is quite possible to lactate an adoptive mother and in developing countries like India it may be a life line for adopted babies. Motivation of mothers and family support are important factors for ensuring success.