I wondered if the tight anus was being confused with babies that were not
fed enough and therefore not stooling enough?
A mom I went to visit reported this:
Wednesday birth - little/no help with breastfeeding.
Friday AM discharge - some stooling seen by nurse, not by mom, NO
breastfeeding observation during her stay.
Saturday AM - mom calls clinic, reports no stooling, is sent to ER (clinic
closing) where she is told:
Baby is dehydrated - has lost more than 10% of weight, so they
hydrated the baby with IVs and told the mom to give pedialyte after
every breastfeeding (NO ONE has observed the breastfeeding). Use a
thermometer to stimulate stooling.
Saturday PM - dad calls the clinic and reports still no stooling - MD tells
him to get some "infant enemas" and use them to induce stooling.
Father buys them (actually a box), they use one, but decide this is
too upsetting to parents and stop.
Sunday - baby fed bottles of pedialyte, still no stooling, mom hand
expressing for comfort after "breastfeeding".
Monday - they go to WIC, who call me. I make a home visit and find
inadequate latch, LOTS of milk. We weigh baby, who is not at 10%
below birth weight, and in fact has 10 ounces more than the weight
at the ER, but as I worry about calibration of all the different scales
baby has been on, I return the next day in the AM to check with the same
scale. Mother now understands how to position baby and how it feels when
baby is breastfeeding correctly as well as how baby should look (he was
sucking in his cheeks - mostly tongue-sucking) when he is actually
getting milk - swallows observed during the feed and relaxed body and hands
after the feed.
Tuesday - weight gain 4 ounces since visit 14 hours before, and baby
stooled with no assistance from thermometer OR ENEMA....
Jeanette Panchula, BSW, RN, IBCLC
Vacaville, CA
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