Hi All,
Today at my mother's brestfeeding support group, one of my Moms of an
eight week old girl had just came from the pedi's office. She(the dr.,
who is new to the area and also newly out of residency) has been
concerned as this baby is gaining wt poorly. Birth wt was 9lb 9oz and
she is now 10lb 5 oz. Mom is an insulin dependent diabetic, one
previous child that she breastfed for 16 months. This little girl has
been a challange from the beginning, with diff. latching at first,
followed by popping on and off, short feeds, transfering 1-2 oz, with
Mom pumping residuals of 6 to 8 ounces. Mom is very determined, and has
been pumping and fingerfeeding(her choice) 1.5 to 2 oz additional EBM
after feeds that she felt were not long enough or sustained enough to be
considered her average. If she tried to give more EBM the baby would
spit it up, Mom describes some episodes of what sounded like
projectile.
On exam, baby is small, color is good, tone is ok, transfers at the
breast ok, but falls asleep and doesn't sustain a suck for longer than
10 min. Tongue is white about the last one-fourth that I can see, so
suggested to pedi two weeks ago to treat for thrush, which was done to
baby only for nine days with Nystantin. No change in tongue. No breast
symptoms.
My question has to do with the pedi today instructing the Mom to mix one
scoop of powdered formula with 4 oz of EBM and feed this to baby two
times a day. I set her up with an SNS, called the dr. to be sure this
was what she wanted, questioned her about adding the powdered formula..
It was really what she wanted, stating that that much formula would be
ok in 4 oz of breastmilk. I seem to remember that formula needs to be
always diluted with the perscribed amount of water, and had never heard
of this action, but thought I would ask you wise-ones.
Mom gives her permission to post.
Thanks for all your support--I learn so much from this.
Rebecca Garcia, RNC,IBCLC
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