Milking the System: A Case Study of Donor Milk for a Child in Foster Care

Abstract

Introduction: Use of pasteurized donor milk is recommended in many situations when own mother’s milk is not available. One existing knowledge gap is access to donor milk for infants in government custody (foster care). Main issue: The focus of this case study is an infant born at 41 weeks who was discharged from the hospital into foster care. The infant soon developed failure to thrive due to formula intolerance. Management: After trying multiple formulas, which included elemental formulas, and hospitalization, the infant began pasteurized donor milk. Within 24 hr, the infant began gaining weight. Medicaid denied two authorization requests for payment, and the state’s Department of Human Services ultimately agreed to cover the discounted donor milk fees until the infant reached 1 year of age. Conclusion: This foster child suffered through months of failure to thrive and hospitalization before receiving human milk feedings. This care violated ethical principles of beneficence, autonomy, and justice. State officials should review their policies and regulations for providing human milk to children in their care and facilitate access to that milk when needed.