I think the focus ought to be looking at the baby.  The baby must be
expending extra calories somewhere which is causing the baby not to gain
adequate weight.  Although, I suppose I should be speaking scientifically and
practice evidence-based.  Therefore, the calorie content of mom's breastmilk
should be evaluated via creamatocrits and rid us of the guessing game.
Probably several samples should be tested.  I recall once conducting a
creamatocrit on a mom's milk while baby was still hospitalized and she was
stressed over trying to get baby home.  I'd convinced the neo to send the
baby home, and I repeated the creamtocrit once home and her level went from
something like 8 to 16; I don't recall the exact numbers.  So, this mom's
milk could be low on calorie content. I saw a 3month old baby today at my
support group with Down's whom I'd helped to breastfeed after birth.  He was
born at approx. 8 lbs. and mom says he weighs approx. 16 lbs. already!  He's
got chubby legs and arms!  It was great to see him!  She told the others that
we worked on his breastfeeding for 5 weeks before he got it!  As I manage all
of my Down's babies, I'd shared the Down's growth chart with this mom.  She
told me that he's off the chart for the Down's babies and even at around
50%-75% for the "normal" charts.  She's very proud of him and rightfully so!
He is on an apnea monitor, but no cardiac defect.
Carol Chamblin, RN, MS, IBCLC
Breast 'N Baby Lactation Services, Inc.
St. Charles, IL

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