This is the case I was referring to earlier, and I wanted to mention a
couple of things and then answer Julie's questions.
It seems we are working from an assumption that the poor wt gain is from
celiac or allergies. However, there are several red flags for suboptimal
milk intake instead. Namely mom had been bf every 2 hrs for 1 hr at a time,
also mom was getting very worn out from frequent long feeds and had decided
to feed ad lib but baby was feeding shorter and sleeping 4-5 hr at nite.
Weak suck and would not suck more than 5-6 sucks, also large nipples and
small baby mouth were mentioned. It was stated baby was in the FTT range.
Mom has eliminated gluten x 3 wks with no improvement and now is going to
try elimiantion diet. It appears she will now be supplementing with
Alimentum QID, amount as demanded by the baby.
Now to answer your questions, Julie:
Avent bottle - I personally do not recommend the use of this nipple due to a
very wide base that does not flange out gradually. And therefore baby will
not really latch well to this nipple.
Fortifier - I do not feel this is appropriate for a term baby with likely
calorie deprivation, unless to correct specific mineral abnormalities that I
am not aware would even be occuring.
Supplementing QID as baby demands - I do not agree with this plan. I would
be going with a plan for increasing mom's supply, and alternate feeding the
baby. I would calcualte about 75 mls x baby's birthweight or current weight
(whichever is greater) for the 24 hr intake. I would then divide this by
about 12 feeds and proivde this to baby by alternte route, probably bottle.
I would not count the amt baby is taking in at breast, unless I had some
ac/pc weights to guide me. I would encourage comfort breastfeeding or
practice breastfeedings, unless these interfere with the recovery of the
baby. I would encourage mother to look to the future, when baby is bigger,
stronger and her milk supply is higher and they can be happily nursing
again.

Since some of these cases this week seem to have alot of similarities, I
want to also mention that I believe the baby #10 case was going to be seen
and weighed again in
1 week, which I think is way too long.

Laurie Wheeler, RN, MN, IBCLC
MISSISSIPPI USA

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