It seems like we have this hungry vs starving and should we supplement 
discussion on lactnet over and over. As IBCLCs, it is our duty to 
intervene with a baby that is obviously not thriving, growing, or 
gaining weight properly. A little hungry is the baby who is gaining 
weight well and has to be held off for a half hour while mom finishes 
her shower. A starving baby are these last posts of babies who have not 
gained birth weight until 4 weeks and are clearly weak and sleeping too 
much, etc.

I also question the moms who are going on all these elimination diets 
and wonder if the basics of assessment have been done first. I would 
want 24 hour test weights done to see what the intake really is at the 
breast. I'd like mom to do a day's worth of weighing before and after 
every nursing and writing it down so we can really tell. If baby is 
removing milk in proper amounts for growth as outlined in the BAB (both 
caloric needs and growth perimeters), then I would look at other 
physical issues. I would like to see what happens first when calories 
are increased, whether formula or human milk. I would want the calories 
to be increased immediately.

And I would not make the program so hard mom will fail due to busyness. 
The diet stuff is hard, hard, hard. I know as I do not eat dairy or 
wheat and had to do elimination diet for my third child. From what I 
remember of my allergic baby, he had ear infections and a snotty nose 
from birth but huge weight gain from always nursing. Sometimes food 
allergies are intestinal but this is more rare than mucous producing 
symptoms -- aren't they? I would refer people to the old book, "Is this 
your child?" by Doris Rapp, MD for a list of common symptoms of 
allergies in all stages of childhood.

I am not saying these babies are not highly allergic, I am just saying 
that daily intake needs to be thoroughly assessed first because that is 
the real question. Are these babies just hungry or are they starving?

(I have worked with several mothers of many children who felt their 
babies were nursing well even though they were not gaining weight 
properly and when I insisted on 24 hour test weights, the moms have seen 
that intake is really terrible and baby is only eating about half what 
he needs. It was loaning my scale for a whole day that made these moms 
realize that their good baby was too good and was starving not a little 
hungry.)

Best of luck to both these moms and LCs. It can be overwhelming and 
terribly upsetting.
Kathy Eng, BSW, IBCLC

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