Linda, you are such an experienced LC that I hesitate to tell you stuff you
probably already know, but babies with Down often have other problems that
can effect feeding.  The cardiac issue may not be totally ruled out (I've
seen people fooled before and miss heart defects which only got revealed
when babies were so obviously failing to thrive).  Also, sometimes if their
tone is really low they will have difficulty with swallowing, and feeds will
be very laborious with fatigue setting in before they can finish.  Sometimes
the babies will have some silent aspiration as they fatigue during a feed.
This will cause them to shut down and limit their intake.  Or the Down
Syndrome could be a red herring and the baby may be self-limiting due to
something more common such as reflux.  If the mom is a super producer, you
could consider pumping off an oz of foremilk or something, but I hate to see
you waste a lot of time trying to engineer the fat content of the milk when
chances are it's not so much the content of the milk but the vol. of intake
or some underlying infant health problem.  Dr. Lukefahr's study (way back
when) describes poor growth in infants over 1 mo. of age typically being
attributable to infant illness.  I think this issue manifests much earlier
in some babies, and why make the baby wait to be re-assessed?   In such
situations I generally write the doctor a report and describe all the things
we are doing to improve intake and growth and relate that the plan is not
producing any good results in spite of our best efforts, and would he/she
like to reassess the baby?
B.

Barbara Wilson-Clay, BS, IBCLC
Austin Lactation Associates
LactNews Press
www.lactnews.com

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