Human milk for oral care: It has long been a part of our everyday routine, a standard of care for every baby—particularly the very low birth weight (VLBW) or ventilated patient. And yet, at the bedside, it is often easy to overlook this simple task. However, this simple, easy, small thing is quite possibly the most important part of our daily tasks. That sounds extreme doesn’t it? I mean it’s only oral care?!? It’s kind of old news, right?
A few months ago, I would have shared your opinion. Oral care had, somewhat, lost its importance to me. I knew it was something we should do, but had forgotten the depth of the “why.” It was a brilliant lactation consultant who introduced to me a new thought of the importance of this simple task. She presented me with the idea of oral care as “Immune Therapy” (Rodriguez, et al, 2008; Gephart & Weller, 2014), and as the first step in the feeding process.
So what if we changed our thinking and changed “oral care” to “immune therapy”? Immune therapy? Yes! Immune therapy!
In the NICU, we are well versed on the benefits of breast milk. We are very aware of the importance of it to our population. We clamor to use it for each baby’s first feeding because we know it is the gold standard treatment in infant feeding. However, what we may fail to realize is that priming begins in the oral mucosa, and that oral mucosa may be the first string in aiding immunity in neonates. As Rodriguez, et al (2008) explained in their study of this concept,
“There is substantial evidence from animal and human studies to support the concept that oropharyngeally administered colostrum interacts with the recipient infant’s OFALT and GALT systems, and provides protection against infection. Using mother’s colostrum in this manner requires a paradigm shift, to view colostrum not simply as a feeding, but instead as a potential immune therapy and a complement to trophic feedings.”
As I dug into these two articles, I became enamored with this view of oral care. It now becomes the catalyst for helping to build our NICU baby’s immunity. And what happens when we build a rock solid immune system in our population? It possibly sets the stage for a successful feeding journey, and gives us another tool in our arsenal to combat the disease processes that we all dread (NEC, VAP, etc).
As with most of the evidence in our specialty, more research is needed to prove these theories. But what if we started the paradigm shift that Rodriguez, et al (2008) suggest and change the verbiage of oral care to immune therapy? I believe it has some really great effect on our practice, on moms, and on babies.
Before you go, we’d love to hear from you on this topic. Take a moment and answer these questions for us in the comments section below, so we can possibly help you be more effective in providing immune therapy:
- What is your practice for using breast milk/colostrum for immune therapy?
- If you use breast milk for immune therapy, how long do you provide this care to your patients (i.e. 3 days, 7 days)?
- What are you currently using to complete oral care (i.e. cotton swab, etc)? Is it sufficient/does it fit your needs?
- Do you include using breast milk for oral care in a ventilator associated pneumonia bundle?
- When breast milk is not available, what are you using for oral care?