In a message dated 5.13.03 5:08:34 PM, [log in to unmask] writes:
> I did have the mom doing compression, which seemed to help a bit. The baby
> was tiring too easily to do all of the position changes at first, but she
> has now gained well over a pound and mom reports that baby seems stronger
> and is nursing a little longer, so I suggested the position changes to
> her.
>
Having used the postion changes with every problem wt gain case that I have
seen for the last several years, I can honestly say that I have encountered
very few instances where the baby was "too tired" for the position changes,
*IF* the baby is latched correctly *AND* obtaining milk.
My most recent *extreme* example of this was an exclusively br fed baby (
posted on) whom I first saw at approx. 1 mth of age with nNO wt. gain. The
baby was cachectic, dry, sl jaundiced but very vigorous at the breast
(voracious!) WHEN THE MILK WAS FLOWING. As soon as the flow would subside
(which was only about 3 minutes into the feed!) his suck would change to
nonnutritive. Up until the time of my visit, Mom would feed til sleepy on
first side, change sides,repeat, then soothe with pacifier. Although this
scenario was very different in many ways, my advice to her was very similar
to what I told you ie. AS SOON AS the flow subsides and swallowing drops
off, change sides and position. This will tire the baby FAR less because he
isn't burning energy with nonnutritive suckling and will not, as I mentioned
in the first post, lengthen the feeding time at all. In fact, it may shorten
it. This feeding regime combined with compression should also give Mom a
much better idea of what feeding at the breast *looks* like!
you write
<<The baby was just taking 1oz of ABM and about 3/4oz EBM, then began
refusing the ABM. Now, just a few days later, baby is taking 3/4-1oz EBM
plus 2-3oz ABM post nursing. I suspect a growth spurt. <<
I assume you mean that the baby is nursing first.?
It could very well point to a growth spurt, (although the baby just gained a
pound over (what appears) a relatively short period of time!) BUT it could
also mean that the baby is taking less at the breast and is thus requiring
more supplement!!
This often happens with cases where the flow at the breast is not there. The
baby learns, quickly, to *use the breast as an appetizer* and save the real
feeding for the meal (the bottle!) This is why, in the cases where the baby
is taking a great deal of supplement via bottle with every feed, every effort
needs to be made to make the breast feeding as nutritive as possible AND to
make recognizable steps (however small) away from the supplement.
The good news is there is still milk in the breast. The bad news is that
there is a real possibility that the *increased amounts pumped* reflect a
diminished exchange at the breast during feeding -more from the bottle-less
from the breast- that dreaded downward spiral AND the impetus behind our
reluctance to offer bottles or even supplements in the first place!
As for the use of galactagogues, certainly there is little risk of harm in
the use of the herbal supps but I would want to be sure (before acknowledging
her desire to use reglan in particular) that you are POSITIVE that *all* has
been done to optimize the driving force behind production-milk emptying by
the baby.
Lynn Shea Rn,Bsn,Ibclc
Franklin,Massachusetts
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