Hi,
 I have been reading Lactnet for a few years but rarely have I posted. I am
a LC in private practice and I also work as an LC on the postpartum floor
and in the outpatient clinic in our local hospital.

  I saw a mom and baby on day one through two at the hospital and then on
day 5 in the clinic. Baby is now
10 days old.  Baby had great difficulty at the breast and with a suck
assessment I could elicit no suck reflex, gag reflex or rooting, baby has
loose lips and is content to let my finger just be there.  He does show
stress when my finger goes deep into his throat.  With a bottle baby waits
for a large bolus and then swallows little tiny swallows.  Baby has not
choked or gagged during feeds. Mom states that baby does not seem hungry,
even when he has slept for 3-4 hours.  Mom reports that it takes baby 1 hour
to get down 1 - 1 1/2 ounces of EBM.  .  Mom was not willing to use any
specialty feeder such as cup, SNS or Haberman.
 I referred baby back to ped after clinic visit.  Dr. at first seemed very
unconcerned though did have them come in frequently for weight checks.  Baby
was seen in our clinic again this week to get an SNS (I did not do this
consult).  I asked that baby visit an OT, don't know if this will be done.
This week Dr. ordered MRI to be done and I believe parents are conferring
with a neurologist.  Has anyone worked with a baby like this?  What else
could I have done or should do...suggestions?

    We also, like Jennifer, struggle with an unenlightened hospital policy.
After a C-sec Mom and baby are separated, baby to the nursery for bath,
weighing and testing.  If baby shows any signs of being 'hungry' a bottle of
formula is given.  It would not be unusual for a baby hours old to be given
1-3 ounces.  If a mother is very insistent and Dad shows up to reinforce
that mom is breastfeeding, it is possible that baby will not get ABM.
However, baby will not be wheeled out to mom until she is requesting baby,
and nurses can find time to get baby to mom.  Plus, if baby is over 9lbs.
baby will automatically be giving ABM and taken for observance in the
nursery.  Frustrated doesn't begin to describe how I feel some days!

Judith Markham, IBCLC RLLL,
Oceanside CA

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