Instead of pumping which,  at best,  in the first few days produces a few
drops of colostrum which stick to the sides of the bottle or barely wet the
bottom of it, causing mom to be discouraged, I recommend that moms express a
few drops of colostrum on a small plastic spoon and give it to baby that
way.  At least 5 spoons from each breast every 2 hours will prevent
"unacceptable" weight loss and keep both breasts functioning frequently.
Mom learns hand expression which is a valuable tool. We maintain milk supply
without compromising breastfeeding.
You should find the references on the amount that babies eat in the first 3
days, and show them to this doc!!
Good luck and let us know what happens!!
Esther Grunis, IBCLC
Lis Maternity Hospital
Tel Aviv, Israel

-----Original Message-----
From: Kathy Birt [mailto:[log in to unmask]]
Sent: Friday, October 11, 2002 3:13 AM
Subject: Small for Gestational Age Baby/SGA


I have been requested by a pediatrician in my hospital to do a "lactation
consult" on a 38wk SGA baby
(wgt 5lb 2oz). The baby is 48hrs old and is acting like a "well baby". No
hypoglycemia/hypothermia. The
ped is concerned that the baby has lost 150gm since birth. Several
voids/stools. Baby circumcised this
a.m. so he has been rather sleepy today afterwards.However, baby did rouse
and breastfeed well on one
breast per feeding every 3hrs. The doctor also ordered the staff to do ac/pc
(test wgts) on the baby and if
not gaining 15gms per feed, to supplement baby with formula. I contacted her
to ask her to discontinue
the ac/pc wgts as they are not accurate prior to an established milk supply.
I also asked her what is the
"medical indication" for the supplementation. She could not give me an
answer other than "this baby can't
afford to lose any more weight".  Is there something I'm missing here? Is
there any baby that gains wgt in
the first 3 days of life realistically? She agreed to dc the wgt checks and
the supplements but left me with
a "threat" that if baby had not gained wgt by tomorrow she would definately
start supplementation. I know
full well that there will be even more wgt loss by tomorrow, so how should I
approach this? I have
instructed mom to pump her breasts after each feeding and give the baby any
expressed colostrum by
cup until I get back to work tomorrow.  Any help with research to show her
tomorrow will be greatly
appreciated.

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