In the spring of 2024, East Tennessee Children’s Hospital debuted a program for the Neonatal Intensive Care Unit (NICU) that would help their parents bond sooner and more easily with their tiniest patients.
“Our whole team had the opportunity to take a course specifically geared toward very premature babies,” according to NICU Medical Director and Neonatologist Dr. Malinda Harris. Chief among the critical benefits of the new “Milk Drops” program they learned about and incorporated into their care process is earlier bonding for baby and family.
A year later, Andrew’s mommy, Emily Rathbone, who’s had over five months up-close experience with the new program, agrees completely–from the bottom of her heart.
“Those teeny drops of milk have been very personal for me and Andrew,” Emily says. “After six weeks of hospital bed rest just to get him here, it went against every instinct as a mother to not be able to care for him. His first two weeks I couldn’t even hold him. Especially in those first few days, after his birth at 26 weeks, it was the only way I could connect with him, to pump religiously and give him my milk and nutrients through the ‘Milk Drops’ program.”
“All NICU providers struggle with what we can do to help a parent feel like a parent,” Dr. Harris explains. “There are many things that physicians, nurses or respiratory therapists need to do that a parent cannot do, and when babies need a feeding tube, only a nurse can do that.
“Unfortunately, NICU babies have negative, but necessary, care experiences around the mouth,” she says, “a breathing tube, or feeding tube, a need to be suctioned or having their mouths cleaned. None of those are very pleasant. Our team learned about this process that allows the baby to have positive experiences involving the mouth. With ‘Milk Drops,’ parents are able to feed mom’s breast milk directly into their mouths and see the positive experience–even very premature babies.
“We don’t expect premature babies to be able to successfully try to eat and have the appropriate brain maturity until about 34 weeks. When babies are born prematurely, we all anxiously anticipate reaching that milestone. ‘Milk Drops’ is a way babies can start experiencing feedings before that,” says Dr. Harris.
The sensation of the taste and smell of milk in the baby’s mouth is administered a little drop at a time through a syringe. Most babies are able to also have a pacifier in their mouth as they take the milk drops. The baby works through each drop at their own pace at the same time they suck on the pacifier.
If they enjoy it, they get the full amount based on their weight to get that pleasant experience. Dr. Harris explains once they are ready to eat by their mouth, whether breast or bottle fed, they already associate that taste with something pleasant. So, they feel positive and encouraged trying to eat. If the baby is uninterested, a little milk on a cotton round is put next to the baby to smell while getting full from a tube feeding.
ETCH was the first hospital in Knoxville to create a Milk Lab in 2012. The mothers’ breast milk is stored, tracked, monitored, and appropriately prepared for their babies’ feeding. The milk lab also stores donor breast milk from a milk bank which is tested, pasteurized, and safely prepared for babies of mothers who can’t breastfeed, or don’t produce enough supply, or before breast milk comes in.
The “Milk Drops” program Dr. Harris’ team previewed was only for premature babies. But ETCH’s program, currently the only one like it in East Tennessee, is for any NICU baby who requires extra help with feeding. And, it starts quickly after admission.
“NICU babies are fed every three hours, so when parents are here, it builds that essential parent bonding,” Dr. Harris says. “But if a parent can’t be here for every feeding, a nurse or speech therapist feeds the baby.” An important part of speech therapy is eating and learning how to feed appropriately. “Our wonderful speech therapists feel that babies who were fed milk drops are better prepared for feeding attempts than babies before we introduced the program,” she says.
Each baby develops preferences over time. Andrew’s mom agrees, “He’s a very particular little boy! Andrew has grown to prefer his milk drops with a straw at the end of the syringe while he has his pacifier in his mouth.”
Born November 23, weighing 2 lbs. 7 oz., Andrew was intubated immediately and taken to Children’s Hospital the same day. She began trying breastfeeding 110 days into Andrew’s stay at Children’s, incorporating milk drops with breastfeeding.
“Along with being premature, Andrew also has Down Syndrome – so he has lots of mountains to overcome, but he has a reason to be here –a purpose. I remember in the first few days I would have a few drops left after pumping and I would soak up that little bit of milk with a Q-tip. They’d let me put it on his mouth and that was the only connection I had with him. Feeding is a struggle so he’s needed all this help and encouragement. He’s a chunker now!” Emily says, laughing. “I call his neck his roll factory! I put a few drops on my skin so Andrew recognized the smell to help encourage him.”
The first three weeks Emily never left the NICU, but with their home an hour’s drive away, she now spends three or four days and nights, goes home for a couple of days, and returns.
“Our family experience in the NICU has been phenomenal. They provide breastfeeding mothers with every meal free of charge while we are here to make sure we get all the nutrition needed. You get to pick a primary nurse, so your baby has consistency in the care of the same nurses. They know his little quirks and Andrew-isms. The staff is more than accommodating to meet specific family needs. One of the first times I held him when he wasn’t intubated, he was on my chest and his dad gave him his milk drops. It was bonding for Andrew and his dad.”
More than 1,000 babies are treated in NICU annually.
“We have a 60-bed Level-3 NICU with all private rooms,” Dr. Harris says. “We have almost all medical sub-specialties in-house which means once your baby gets to Children’s, it’s uncommon to have to go anywhere else. We are a free-standing children’s hospital which means every single person here only takes care of kids and that’s important because kids are not little adults. They require very specialized care specific to their stage of development, especially these NICU babies who are so fragile.”
Andrew’s dad, Tony, is a 16-year veteran law enforcement officer with the Knox County Sheriff’s department. His mom is a 14-year veteran dispatcher with Knox County 911. Emily says their baby is “a strong, fighting little boy. Stronger than I could have ever been.”
Little heroes like Andrew have a mighty, dedicated, expert team on their side at Children’s NICU, fighting every step of the way for the best possible outcomes for babies and their parents.
Learn more at ETCH.com
“All NICU providers struggle with what we can do to help a parent feel like a parent. When we launched our ‘Milk Drops’ program, parents were able to feed mom’s breast milk directly into their mouths and see the positive experience–even for very premature babies.”
—Dr. Malinda Harris, ETCH NICU Medical Director