A neighbor has been struggling to help her SIL, long distance, get
breastfeeding established with a 31 week, 3 lb premie.  They survived
a punitive NICU experience, toward the end of which the baby was
gaining 10 to 30g/day.  Home at about 36 weeks and 4 1/2 lb, the baby
immediately started gaining 60g/day, and is fully bf except for 1
bottle of expressed milk per day containing  vitamins (apparently no
iron).

The problem?  The baby had no stool during her first 10 days home.  As
soon as they inserted a suppository they prompted a half-hour
screaming session that produced an adult-finger-sized, adult-firmness
stool.  (They didn't define adult-firmness, but seemed struck by how
hard it was.)

Apparently suppositories had been used 2-3x a week in the NICU;
parents aren't sure why.  Their concern now is that the routine use of
suppositories has caused physical dependence or psychological "holding
back".  Dr has suggested bottles with karo syrup.  Any thoughts on why
a NICU would use suppositories on a fully breastmilk-fed premie, why
the baby would be failing to stool at home, what would produce such a
hard stool, and what they can do about it instead of using karo?  I
suggested wiping rectum with warm washcloth at diaper changes, lots of
time in a warm bath with mom, lots of skin to skin, possibly *gentle
and very shallow* insertion of baby thermometer bulb.   Or is it most
likely just an older-baby pattern (At 7 weeks, baby is still a week
from due date) and a questionable definition of "firm stool"?

Diane Wiessinger, MS, IBCLC  Ithaca, NY