Hello Lactnetters! I've been no-mail for a long time but now I need some help from the experts (i.e. all of you!). I have a family I'm working with who first came to me when the baby was three months old and was failing to thrive. He was exclusively breastfed and his mother reported that he nursed all the time but never seemed satisfied. His birth weight was 3.345 kg and at three months he weighed 3.7 kg. At 3 weeks he had weighed 3.543 kg but after that he lost weight and then very slowly gained. The first pediatric group the mother went to suggested supplementing with bottles of formula and the mother refused. She looked for another more supportive doctor but was not seen by anyone from the time the baby was one month old until he was three months old, at which time he was well below the 5th %ile for weight.
I observed him breastfeed and noted poor positioning, a shallow latch and a short frenulum. His primary doctor clipped the frenulum the next day. I recommended Fenugreek for the mother, a nursing supplementer with 2 oz formula 6-8x per day and pumping after breastfeeding.
The baby has had good weight gain, at 4 ½ months he is now 5.025 kg and almost back on the growth chart. The problem is that the mom's milk supply has not increased at all. I suggested that mom rent a scale for pre and post weights and we found that the baby is only getting 10-25 cc at the breast. His total intake for 24 hours was 700 cc formula in the supplementer and 200 cc breast milk from the breast.
The baby is now well positioned, being held very close to mom's body, chin into breast, lips flanged, but I'm not sure what his tongue is doing. He was unable to organize a good sucking pattern on mom's finger.
Mom is now on day 5 of Reglan but is exhausted. She finds it hard to pump because the baby, although very pleasant, never sleeps and wants to be held or nurse all the time. Thyroid levels are pending.
I was hoping that by correcting the baby's latch and suck the mother's milk supply would automatically increase. I know she had milk initially because the baby was 200 g above birth weight at 3 weeks. So what is going on now? Does a baby taking milk from a supplementer not adequately stimulate milk production? Does a baby s/p frenotomy at 3 months need to be retrained to suck correctly? What else can we do to stimulate supply? This is mom's first baby, she does not work outside the home, dad is involved and supportive and mom wants to breastfeed for a long time.
I would greatly appreciate suggestions from others who have had similar situations (Jack, if you're on line your thoughts would be welcomed) Please e-mail me privately, as well as to the group, as I am presently no-mail. Thanks so much.
Rachelle Lessen, RD, IBCLC
Philadelphia, PA USA
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