LuAnn writes about a baby with an initial weight loss of 15 per cent,
recovered within two weeks, but who then over the following two weeks has
lost nearly as much again, has a fever, and seems hungry.  I converted his
birthweight of 8 lb 2 ounces to metric, 3640 g.  Fifteen per cent of that is
nearly 500 g, or about 1 lb 2 ounces.  Now he is 7 lb 5 ounces or about 3280
g, which is actually ten per cent below his birth weight.  

A couple of things in the case struck me.  One is that mother felt things
were fine until a week ago, yet seems to have waited a week before seeking
care for whatever she felt the problem was.  What happened to make her stop
thinking things were fine?  What, if anything, was done about it?  Was there
some other plan being tried before she brought him to the emergency room
with fever?

We know from studies simulating dietary conditions in concentration camps
that after losing a critical amount of body mass, the appetite center stops
triggering the individual to eat and they can show the clinical signs of
anorexia nervosa.  This baby has lost so much weight that he could have had
his 'feed me' switch turned off.  Remember, at two weeks he had just
regained birth weight.  Usually, if breastfeeding is going normally, babies
are back to birthweight within just a few days, and by two weeks they are
well above it.  A baby who takes two weeks to get back to birthweight is not
necessarily back to normal then and there.  A lot of these babies need to
continue to feed at that birthweight.  frequently until their weight is back
on their physiologic schedule, if you will.  Sometimes the parents need
specific instructions to continue actively offering feeds until the baby
starts taking the initiative himself.  We also don't know his length or
gestational age.  If he was born at 42 weeks and is 22 inches long, then he
was underweight for length at birth, his initial weight loss is even graver,
and he can be expected to need even more feeding than if he was 37 weeks and
19 inches 

The other thing is that it would concern me greatly to see a pacifier used
with any baby who lost such a large amount of weight and took so long to
regain it, because it would show me that the people caring for the baby had
not really understood his needs.  Any time this guy shows the slightest
interest in having anything in his mouth, it should be something nourishing,
like a breast or expressed milk by whatever means is most effective for
getting him fed.  A pacifier is the last thing he needs.  I think if I had
seen this case I might well have physically removed the pacifier and
discarded it in full view of the parents to underscore the point.  I would
probably try to find out whether they were using a non-breastfeeding
friendly baby care book too.

Hope they get the follow-up they need to get back on track with this guy.

Rachel Myr
Kristiansand, Norway

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