Dioralyte or Breastmilk?

[TruthSweet]

This is a long one but if you don't have time to read my epic tale of NHS confusion my question in a nutshell is:-

Is Dioralyte better than breastmilk for rehydrating a baby? Even if no D+V?

Back story - DD3 has had bronchiolitis for the 3rd time this year and that meant another trip to local walk-in centre to see if she needed treatment or could manage without. She did need some - 2 lots of nebulisers and a transfer to the big regional hospital by ambulance.

When we got there we were seen in the childrens' A&E by a nurse who was really worried by the decrease in urine output and poor breastfeeding efforts by DD3. She said DD needed 100mls of dioralyte to rehydrate her. I offered to express some milk instead (I had brought my manual pump with me ) but just needed a bottle to collect the milk. She refused to give me one as DD needed dioralyte not breastmilk. When I said there was a box full of EBM bottles on the shelf still told me no .

The Dr came in there and checked over DD and said she needed 100mls of dioralyte at 5mls every 5mins by syringe as she had to be rehydrated. I again asked why dioralyte over breastmilk and was told bm will make her vomit. I stated bm wasn't dairy but the Dr still insisted it would make her sick.

I also queried such a large volume of liquid as when she was previously admitted she was on 23mls of breastmilk every hour by tube so not too fill her stomach up too much as this would take up space in her abdomen which could impact on her breathing ability. I was told I wouldn't be feeding her over night so that volume was ok as she needed 100mls per kg of milk a day and 100mls x 5.75kg /5 feeds a day = approx. 100mls. I again offered to express and make up any shortfall in the 100mls with dioralyte as a compromise.

The Dr then told me to take her home and breastfeed if she wanted me to and walked out.

If she was really dehydrated why tell me to take her home? I wasn't refusing treatment just querying the method of rehydrating her. I was pleasant and polite but I am my child's advocate and I have to act in her best interests so if that means clarifying the treatment options I will dammit!

I think your questions are justified...perhaps your HV could help you, or maybe you could get in touch with the patients' advocacy organisation (usually PALS) and ask about your next step.

If the doc thought your baby needed 100 mls of fluid urgently then dioralyte might be justified because it would be unlikely that you would produce 100 mls of ebm immediately.

So there may be a clinical reason for the advice.

But it does not sound as if it was as cut and dried as this.

You do deserve a clearer explanation, I agree.

Its a difficult one but i would think yes dioralyte would rehdrate her quicker, i remember DD havin to have it for 48 hrs when she was only a few onths old and we had to starve her and it was a much as poss with the dioralyte.
The body would absorbe it a lot quicker than milk hense volume!!

How does the soft spot feel, i was always advised id the soft spot is sunken then they arre dehydrated.

It is a difficult one. I always worked on the principle that if I could get dd to take adequate amounts of bmilk, then that was my first choice. Because it's a complete food and drink, easily digested, gentle, offers comfort at the same time etc.

I do wonder if perhaps they saw the poor sucking and dehydration and thought that bmilk wasn't working so wanted the next best thing.

I certainly would push for why they thought bmilk would make her vomit. Were they confusing with dairy during a gastro bug? As it's not dairy obv and no gastro bug anyway.

And to refuse you an ebm bottle, that seems very strange when it sounds as if you were trying to work with them and to understand why things were happening.

My dd2 was dehydrated once as a baby - it was a dandv, plus various other effects of a bug - and she was put on a drip. After about 15 minutes you could see a difference, so had I been with you I'd probably have encouraged you to try the dioralyte! (Vile taste though). And at the same time wondering why doctors and nurses seem oblivious to the wonders of breastmilk.

Tiktok - as the Dr said 5mls every 5 mins I hoped I would be able to keep up at least for a little bit until dioralyte had to be used.

What really confused me about this all was when dd had bronchiolitis for the 2nd time she was tube fed bm, on oxygen/in a head box and the consultant had tried to canulate her to feed dd by IV but gave up as trying to get a vein was stressing her out more than tube feeding her was. At no point did anyone suggest dioralyte as an option.

Also would bm make her vomit but dioralyte not? Does dehydration make you sick?

Nicolaplus1 - her fontanelle was fine, tongue was moist, but urine was a little coloured and scanty rather than her normal copious colourless wee! She seems fine now - feeding lots and whilst not as many wet nappies as usual still more than 6 a day.