June

Interesting case!  Forgive me, I'm not quite sure what you mean by 
"spilly" - but it sounds like you mean perhaps that the baby is 
vomiting _after_ breastfeeding?

Looking at the weights, this baby has gained an average of 160g/week, 
or 23g/day over the last 13 weeks, which is low, but not a total 
train-smash.  But actually, you say that he has had no gain in the 
past 3 weeks, so that would mean that for the first 10 weeks of his 
life he actually gained an average of 208g/week, or 30g/day which is 
perfectly acceptable up to that point.  Nevertheless, I would agree 
that a nil gain for the last 3 weeks is definitely cause for 
concern.  And it's consistent with the other Sx you describe, that he 
doesn't sleep, and feeds constantly.

When a baby is exclusively breastfed and vomits up a lot of his milk 
I would strongly suspect a sensitivity to bovine proteins coming 
through in the mother's milk.  I'd go through the history carefully 
to see if there is a family history anywhere of asthma, eczema, hay 
fever, maternal/infant antibiotics since birth, and whether mother 
hates or craves dairy products, and whether the baby has eczema, 
snuffles, extreme irritability, mucousy stools.  The vomiting is a 
cardinal sign of sensitivity already, but there may be other signs 
too.  I'd suggest a total elimination of all dairy and beef products 
in the mother's diet (all cow's milk, beef or any products containing 
either).  And I'd probably concur with the paediatrician's suspicion 
of low supply (now.... but maybe not before in view of the normal 
weight gain up to 10 weeks) and endorse the recommendation 
(urgently!) of supplementing with her own expressed breastmilk after 
breastfeeding direct.  A baby with very low intake wants to 
breastfeed "all day long" but actually does very little swallowing 
due to lack of energy, and this will suppress lactation due to 
inefficient drainage over time - so the mother may have to take 
control of drainage and express very often and feed the EBM perhaps 
by bottle to conserve the baby's energy, offering the breast 
frequently of course, but not actually expecting the baby to "feed" 
very efficiently until his weight starts to pick up again.  A bovine 
elimination is likely to help the vomiting, to help the baby keep 
down the milk he does get....

I'm concerned that tt, lt and ptt is over-diagnosed these days, so 
I'd leave that question until last and address the symptoms that jump 
out at me first,  ie increasing baby's intake of pure, unadulterated, 
cow's-milk-free breastmilk as the first priority.

Would love to hear how this goes!

Pamela Morrison IBCLC
Rustington, England
--------------------------------------
PTP

Hello Wise Ones (Long Post)

I was contacted a few weeks ago by a mum who's baby  was 10  weeks 
old. He was born at term by spontaneous delivery, BW 3520 grms.
His history is quite intense, at 2 weeks he became spilly 
and  pyloric stenosis was ruled out, he was put on Gaviscon.
March his symptoms didn't improve, so Losec was commenced 1.oo ml 
daily, and he continued to spill 5-6 times at each feed.
May he was diagnosed with a Lip and Posterior tie, which will be 
released next week and his dose of Losec was increased to twice a 
day. He had a weight loss at his well child check and it was 
suggested   to Mum had a poor supply and should express and give 
supplement by bottle.

He has been seen by the Paed today, and is on the 9% percentile and 
still spilling? The Paed feels mum has a supply issue

My question Wise Ones, If mum has a low supply would this baby still 
spill lots after each feed? There is an issue with no weight gain for 
the past 3 weeks  and the Paed feels he isn't gaining weight because 
of the poor supply
My other question is it the reflux or tongue tie causing the poor 
weight gain He is now 13 weeks old,  was weigh (5.6kg) today and 
hasn't had a weight gain Mum is beside herself, she has a  baby that 
doesn't sleep, feeds constantly , spills constantly and has lost 
faith in herself as a mum,  she feels that she is battling all the 
time  and not enjoying being a mum:{
What am I missing? any suggestions would be gratefully received.


Sincerely
June Nicholls
IBCLC/Midwife

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