One feature of SGA babies is that they do not seem to have had opportunity
to build up stores of glycogen in the liver, because of needing their
calories for the most essential intrauterine functions (heart, brain growth,
etc.) Low amounts of glycogen stored in their liver compromises their
ability to regulate their blood sugar quickly like a healthy term baby.

In my great-grandson's case, the primary cause seemed to be a small placenta
unable to transfer nutrients in adequate amounts for growth, let alone
storage. I was observing supply issues closely in my granddaughter, but
onset was within 3 days, and since Lactogenesis II is based in part on the
drop in placental hormones after birth, perhaps any deficiency in placental
hormones might not be detrimental to time of onset.

Logic tells me that the sheer maintenance of milk supply for any baby who
cannot nurse effectively would start out the same, in order to imitate
normal frequent, thorough milk removal. Better to err on the side of
bringing in a larger supply and then tamp down later as necessary, IMHO.

Unfortunately, that is something I did not insist on, on her behalf, with
the hospital LC's, even after I recognized his tongue tie and his
pediatrician's adamant attitude about leaving it alone "for fear of making
condition general worse with surgical stress. (Yet, I was the first one to
question whether it was better to avoid hospital circumcision.)

This delay in starting to pump was partly due to the hospital charging $90+
for flange set if supplied in house, versus $35 rental if family would go to
medical supplier 6 blocks away to rent it. Her insurance wouldn't cover
either. Live and learn. Wish I'd known then about Cathy Genna's hint of
putting 10 M & M's per 24 hours in a small cup near pump and having mom
reward herself with one each time she pumps! Just couldn't get across the
need to pump often at home regardless of whether she "felt full" or not.

Jean
************
K. Jean Cotterman RNC, IBCLC
Dayton, OH USA

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