I've recently started working with a 10.5 week old baby who was just released
from the hospital, having been admitted for FTT. The mother had Child
protective services called on her because of venomous accusations made about
her by her ped.

 At week three the baby was not gaining well and was doing some spitting, but
not projectile by any means, was put on rice cereal mixed with breastmilk for
thickened feeds. Diagnosis was Gastroesophageal reflux. (No test was done).
No breastfeeding assessment was ever done.

Mother has very small areolae with lactiferous ducts located outside the
areolar margins. She saw a "lactation specialist" in hospital right after
delivery who supposedly said as long as the aroela is in baby's mouth, baby
will do fine.

Some weeks later, mother called her doc and said her baby didn't look good to
her whereupon, the doc had a homehealth nurse come and check on baby every
few days. Again no breastfeeding assessment was done and no mention of
supplementation even though baby was still not gaining! 4 weeks later, baby
is admitted to hospital for FTT and mother is accused of starving her baby!

Mother has a history of pituitary and hypothroid problems and has every
symptom of hypothryroidism now.

When I assessed the baby, baby was not attached deeply enough to strip milk
from the sinuses and mother's milk supply was in the garbage. Baby was being
fed 12 oz. of overly concentrated formula (3 scoops to 5 oz.):. to up the
kcal count to 24 per oz. I just about fell off my chair! Mother said that doc
said that overconcentrating the formula is a typical treatment used at this
hospital.

In my office, once on deeply, the baby did great sucking, great milk
transfer, and did extremely well with a supplementer at breast.
I suspect the original lack of gain was related to poor attachment, however,
we are investigating the thyroid and the pituitary thing. No one until me has
attempted to determine mother's ability to produce a full milk supply.

I am so appalled by the way this situation was handled, I can't stand it!

Anybody have any references regarding the dangers of overconcentrating the
formula so I can give them to the baby's ped?
(You would think the warning on the formula can label would be enough.) or
perhaps I'm all wet and the overconcentration is a good idea. Anybody want to
comment?

TIA
Alison