OK
Soooo one of our Public Health Nurses has  been seeing two moms with babies
under 3 weeks - both lost over 10% of birth weight, both gaining less than
3 1/2 ounces per week, and their doctor is not concerned, tells them to
keep on doing what they are doing and not to supplement, that this is
normal for breastfed babies!

The PHN has been very concerned, visiting almost daily.  One mom agreed to
have me come to assess (the other said no, her doctor didn't think there
was a problem so she didn't need a visit).  I observed a lot of "tongue
sucking" at the breast.  It took many tries to teach mom the difference
between baby latched on correctly and baby not latched on (It didn't help
that he gulped air so that he sounded to the mom and the PHN like he was
swallowing milk).  We have used the pump after feeds to increase milk
production, and eliminated the pacifier.   Finally after 4 days we have
achieved what I think is a growing milk supply.  (Mom finally leaking on
one side when baby nursing on the other and 1/2 ounce gain in 24 hours) 
Baby FINALLY having yellow stools and has that relaxed hand and body
appearance after feeds.

The PHN is very pleased with this situation - and very worried about the
other mom and baby.  What are your recommendations when an MD says there's
no problem and mom assumes this means she doesn't need to see and LC or
supplement?

I'm thrilled to have an MD who supports breastfeeding, but there needs to
be some education about the "normalcy" of weight loss and  slow/no weight
gain in the breastfed baby.  Sure need WHO study now!

Jeanette Panchula, BSW, RN, IBCLC, LLLL
Vacaville, CA
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