Sunday, February 10, 2013

Benefits of Breastmilk for the Baby/Child with Traumatic Brain Injury

The Benefit of Omega 3's - Fats for brain development.

*Breastmilk also contains some very beneficial fats. Mainly, Omega 3 fats such as DHA and AA. These fats are there to help the baby's brain work, ensure that his immune system is functioning, and helps him take in fat-soluble vitamins. The fats that are found in formula are not digested completely by the infant, and formulas also don't contain DHA.  The fat level in mature breastmilk is approximately 4% and is independent of what mom eats.

*Brain injured patients need Omega 3s, not high doses of Omega 6s which is what the Hormel pudding is loaded with! The ratio of 6:3 is what's key and most American diets are overboard on 6's and have zero to limited 3s.

"Omega 3 fatty acids are important for the baby's developing eyes and brain," says Dr. Sheila Innis, the study's principal investigator, head of the nutrition and metabolism program at the Child & Family Research Institute at BC Children's Hospital, and professor, department of pediatrics, University of British Columbia. 

*Composition of Breastmilk (to combat the argument that Charlotte needed hydration)
Water 88.1%, Fat 3.8% Protein 0.9%
Lactose 7.0% Other 0.2%
Source: Lawrence R. Breastfeeding: A guide for the medical profession. 4th ed. St.Louis: Mosby-YearBook, Inc.1994

*Breastfeeding is best for brain growth and neuromotor development of the babies. Nearly two-third of the brain weight is due to phospholipids and long chain fatty acids. Docosahexaenoic acid (DHA) and arachi-donic acid (AA) are key fatty acids for growth of the brain. Human milk contains 30 times more DHA than cow’s milk. According to WHO, infants should get 20 mg DHA/kg every day. Human milk is rich in choline, taurine and zinc which are required for brain growth. Human milk contains almost double the quantity of lactose compared with milk of other mammals. Lactose is credited to facilitate the synthesis of cerebrosides and myelination of central nervous system (CNS). Breast fed babies have at least 8 points higher intelligence quotient in later life as compared to formula fed babies (6, 7).
There is enough evidence to suggest that the food we eat influence our memory, concentration, comprehension, judgment, intellect, mood and emotions. There are at least 50 brain chemicals or neurotransmitters that are affected by the intake of food and micronutrients (8).

Physiological effects of nutrients on brain growth
A number of amino acids are recognized as precursors of neurotransmitters. Tryptophan is required for production of serotonin which improves the mood and sense of wellbeing. Choline is required for production of acetylcholine which is critical for our memory. Tyrosine helps in motor coordination by elaboration of dopamine. Taurine is required for maturation of retina.

Micronutrients are required for production of several enzymes and co-factors for a number of metabolic pathways. It is known since ages that pellagra (niacin deficiency) leads to reduced cognition and dementia. A number of other B-complex vitamins especially B1, B2, B6, B12, niacin and folic acid are needed for synthesis of several neuro-transmitters. Thiamin deficiency hampers the ability of the brain to utilize glucose. Deficiency of folate, B6, B12 and choline are associated with elevation of plasma homocysteine level which may lead to thromboembolic complications and stroke (9). Iodine is required for synthesis of tri-iodothyronine and thyroxine. Iron deficiency is associated with reduced physical activity, neuromotor incoordination and reduced cognition (10). Cytochrome oxidase in the mitochondria is an iron-dependent enzyme. Oligodendrocytes require iron to synthesize fatty acids and cholesterol for myelin production and its integrity. Iron is also required for functioning of neurotransmission system such as dopamine, serotonin and GABA. Iron deficiency has been shown to adversely affect brain stem auditory activity and visual evoked potentials which may persist even after correction of iron deficiency anemia. There is some evidence to suggest that excessive tissue concentration of iron may lead to Parkinson’s disease in adults. Zinc is an important component of over 200 metalloenzymes and there is high concentration of zinc in the brain (11). Copper is an important component of cytochrome oxidase and superoxide dismutase in the brain. Copper deficiency is associated with Menke’s disease while copper excess is a recognized marker of Wilson’s disease, familial amyotrophic lateral sclerosis and Alzheimer’s disease.

Sea food is eminently brain-friendly food. Fish and fish oils are important sources of omega-3 fatty acids and DHA. Omega-3 fatty acids are credited to reduce cellular and vascular inflammation in the brain, promote vasodilatation and ensure integrity of brain cell membranes to keep them soft and pliable(12,13). DHA constitutes almost one-half of the total fat in the brain cell membranes. DHA is the building material for fabrication of synaptic communication centers in the brain. It increases the level of "feel good" neurotransmitter serotonin and the "memory boosting" chemical acetylcholine.
Unlike adults, infants cannot convert a short chain fatty acid alpha- linoleic acid into DHA and they must be provided with this essential nutrient de novo in the diet. Table I lists the essential nutrients required for the development of CNS (1). Fish is a good source of omega-3 fatty acids, taurine, iodine and zinc. Incidentally, junk food is rich in omega-6 Trans fatty acids which compromise the integrity of the CNS by making cell membranes less pliable and more rigid.

Smart Nutrients for the Brain
• Omega-3 fatty acids, dcosahexaenoic acid (DHA) and arachidonic acid
• Vitamin B complex, folic acid, vitamin C, vitamin E
• Iodine, iron, zinc, selenium
• Essential amino acids including taurine
• Choline
• Antioxidants

Apart from direct adverse effects of nutritional deficiencies on the brain, there are indirect consequences of under nutrition on brain development. Children with under-nutrition are apathetic and listless with poor interest to explore their environment. Because they are small in size, they are treated as "too young" and given inappropriate stimulation by their parents. The altered behavior and mood of the undernourished children often leads to the altered attitude of the caretakers towards them with poor level of interaction and play activity.



Our Stance Regarding the Value of Breastmilk for Charlotte as Nutrition & Medicine

We are committed that Charlotte gets all of what breastmilk has to offer which includes a heavy infusion of Omega 3s for her brain.   Neurosurgeons are using Omega 3 supplementation as an essential component of their TBI patients with dramatic results. Good nutrition is the basis for Charlotte’s performance meaning when she consumes the ultimate nutrition; it has and will continue to positively impact her therapies.

It's not JUST that breastmilk is high in the "good stuff", it's that formula/sugar laden drinks and foods are high in the bad stuff such as corn syrup and vegetable oils. In other words, it's a win-win for Charlotte to receive BM as her primary fluid along with healthy complementary foods.

We have attempted to understand your explanation of the food "challenge". Reason being if Charlotte could take in the "calories" by solid foods and liquid then she would not need a PEG put in to go home. We understand that many children "drink their calories" and have no room left for food.  This would understandably be a concern if we were talking about anything other than breastmilk which is easily digested and 99% bio-available. It doesn't sit in the stomach for 4-6 hrs. like commercial formulas do. Also water is "filling" as well and can discourage eating plus it contains no nutritional or medicinal value. Shouldn't we be concerned where the calories are coming from- not just counting calories?   I implore you to produce the studies that show water and high calorie supplements are healthy.

It is clear to us that Charlotte may not be able to take in orally the required fluid amount thus requiring a PEG to go home - so be it. We are very pleased with her eating and drinking of nectars including the amount she can eat now. Progress is expected. But we feel strongly that breastmilk remain a main staple of her diet - any way she can get it. And discontinuing it would only compromise her health & well-being. We have come too far to allow that to happen.

Yes, Charlotte has a traumatic brain injury - we are not denying that. But you act like the TBI child is so different that "normal" anything doesn't apply. She is still a human baby so human milk is what she needs.

Side note: An influential mainstream nonprofit focused on protecting healthy infants is in the process of writing a story about Charlotte's journey through JDCH.  A similar story was done from her stay at St. Mary's. Much of it will be about the courage and camaraderie it took on your part to open up to new ideas, let down your guards, and get Charlotte where she was to where she is now. The goal here is not for her merely to survive, but to THRIVE. She needs live nutrient dense specialized food to do that. Human Milk is a Super Food! And you are Super Heroes for breaking with the past and making it happen.

We appreciate your cooperation.

Maria Parlapiano RN IBCLC

* here is another heartwarming story of a child who was adopted by a couple when she was near death and is alive today because of donated breastmilk

Saving Our Miracle

This blog was supposed to be called “Sharing A Miracle- Part 2”,  a follow up essay about my recent weekend visit with Charlotte.  I had hoped to bask in the glow of her amazing recovery as well as the success of her miracle milk. The night before, I barely slept.  Reading prayers and asking for God’s blessing consumed most the night.  I eagerly anticipated holding her in my arms for the first time.  And the nurse- in- me could hardly wait to evaluate for myself how well she was doing.

My prayer focus was to ask God for the ability to connect with Charlotte on an intimate level.  You see, we were told based on the results of her CAT scan that she probably won’t be able to show emotion.  I refuse to believe that.  After all, she is part Italian!  But seriously, it was my fervent prayer that this not be so.  Also, I wanted to be able to follow and read her wants and needs so she would feel listened to and understood.  Very important as well, my visit was intended give my sister a worry free, much needed rest. These were my prayers and intentions.

Unfortunately, the situation was not exactly what I expected.  I arrived at the hospital at 1:30 am after a long flight delay.  Charlotte was a cranky, fussy, crying mess, teething horribly and clearly overstimulated -pretty much inconsolable. .  Then I see a bag of water hanging attached to her NG tube (stomach tube) and many empty Emfamil sterile water bottles as well as Nestle Pure Life water bottles- UGH!   What’s going on?!  Where’s the breastmilk?! When I learned that her banked breastmilk was completely stopped 36 hours earlier, I immediately went into save and protect mode.  Which means “Jerzee” was in the house and ready for action!   

I was told that the nutritionist weaned Charlotte off the breastmilk as a “challenge” to see if she would eat more solids. Apparently, it was her belief that the breastmilk might be filling her up too much.  Better that she eats more calories in food so her tube can come out, even though Charlotte has yet to master drinking fluids.  So the nutritionists and PEDS doctor agreed to give Charlotte only water down her NG tube -water continuously all night (1/2 liter) and 3 ounce boluses of just water 4x/day.  Cram in as many high-calorie pureed “fake-foods” and sugar nectars throughout the day instead.  This is what they called a good nutrition plan. And they drove my sister crazy measuring, force-feeding and counting the calories – where these calories came from did not matter, just calories. 

Sadly, this plan did nothing but set everyone up for failure especially our little Charlotte.  This “challenge” was compromising her health, basically pulling the rug right out from under her, nutritionally and medically.  My sister was simply scared by the looming threat of Charlotte needing a stomach tube surgically implanted. So she tried to follow the plan feeding Charlotte as much food as humanly possible.  But as you can imagine, the stress and anxiety to perform on her part as well as Charlotte’s was overwhelming. They were crashing and burning.

Needless to say, GrAuntie Maria was fit to be tied and brought on the “Post-Storm Jerzee Fresh” once again.  After getting a brief orientation to Charlotte’s schedule and care, I sent my sister home.  Then I began the hard task of correcting this nutritional travesty.  `As with the first hospital she was in, I had nothing but praise for the medical care.  Same here and in addition, I was quite impressed with her various therapists.   But again, the nutritional aspect of her care was severely lacking.  And again, there was little to no knowledge about breastmilk  and its appreciation, as an integral part of Charlotte’s care.   So the first thing to go is the breastmilk?!  Oh, I don’t think so ;)

This was a very long night as well since I needed to wait until the day shift to address the issue and fix it.   I pulled together my citations and strategized my approach as I felt a pressing urgency to get that breastmilk back up.  I held Charlotte a lot that night, neither of us slept much.  I was sick with worry and prayed hard for God to help me once again advocate on her behalf.

First thing in the morning, Danielle Rigg, cofounder of, reached out to see how things were going as she was writing a blog about Charlotte and her miracle milk.  It was truly a “God thing”.  As I was brought to tears, Danielle listened as I told her how disgusted I was, that once again I had to rescue and justify our use of banked breastmilk for Charlotte.  Exhausted and depressed, I dreaded confronting the nutritionist and doctor as I know the way these conversations go but it must be done.  My commitment is to none other than Charlotte Rose and her well-being.

Danielle reassured me and supported me with the words I needed.  She helped me re-group and focus. Our angle would be Charlotte’s urgent need for the potent Omega 3 fatty acids in breastmilk to help heal and nourish her brain.  She sent me the citations and told me her husband who is a traumatic brain injury doctor gives huge doses of Omega 3’s to his patients with amazing results.  So I felt a renewed energy and confident in my approach to reclaim the breastmilk for Charlotte- today!
Another “God thing”, the nurse who worked the weekend was still breastfeeding her one year old and nursed her first child long term.  Natalie was a friend, not a foe in my quest that day, eager to learn and help.  She was instrumental in contacting the key people and obtaining the orders to start the miracle milk once again.  I will be forever grateful to her as well.
After Charlotte started back on the banked breastmilk she was much happier.  Imagine just getting water and small amounts of food, broke my heart just thinking about it.  Now she was restored again.  I mashed up whole foods instead of feeding her the processed foods.  We had fun at mealtime as I placed the food on her fingers and hand so she could feed herself.  

I also addressed the issue of having a gastrostomy tube (GT) put in temporarily (3mo) and having the NG finally taken out. A gastrostomy tube (also called a G-tube) is a tube inserted through the abdomen that delivers nutrition directly to the stomach. It's one way of make sure kids with trouble eating get the fluid and calories they need to grow.  I reassured my sister that this is a good idea for Charlotte right now and that the tube is very small and easy to care for, nothing to be afraid of.  Charlotte will be able to do much more activity wise since it is more comfortable and out of the way.  The GT will enable her to go home and take her time when mastering her swallowing skills.   Most importantly, the GT will allow her to continue to receive the correct amount of her miracle milk!    
Since Charlotte was teething and had a day full of various therapies, I made sure not to overstimulate her.  I followed her when we were alone and engaged her gently and quietly with lots of physical contact through holding, rocking and massaging her.  When she was "into it", I would carry her down the hallway to visit everyone and take her for rides in her chair.  I also went to all her therapy sessions and cheered her on.  It was quite busy and I admit I was really tired, my back and neck ached and my arms were sore -  it was quite a workout.  But so worth it- we were together again, that’s all that mattered.

The last day and a half that I took care of Charlotte, she didn’t require any pain medication for her teething or Benadryl for sleep.  She barely cried, slept soundly, cooed and chatted and was on the verge of several smiles. (I threw my best jokes at her-Lol)   She was like "butter" ;)
Obviously, the Lord placed me in the right place at the right time, once again.  I happened to be there just in time, when she needed me the most – a little ‘rescue mission”. 

I pray the Lord will continue to use me as an advocate for her, as she is my angel on earth.  As expected, God answered my prayers for the weekend.  Charlotte and I did connect on an intimate level.  I was able to successfully read her and follow her needs.  Many of the staff commented on the special bond we have.  I know it, she knows it but it was nice to have that feedback.  Natalie, her nurse, cried the day I left saying, “You are amazing together.”  The time we spent together was an amazing gift.

Our sweet baby, Charlotte Rose continues to challenge me as a person.   Prompting me to dig deep, venture out of my comfort zone and fiercely persist when it’s easy to give up.   After all, she didn’t give up.   And as far as emotion is concerned, Charlotte elicits pure emotion from everyone she meets.   In my heart of hearts, I know she will return the gesture soon…….because my faith tells me so ;)   

Link to our position paper for use of breastmilk for Charlotte

Link to citations for the above position paper

Best for Babes is Helping to Spread the Word !  Thanks Danielle