I've been seeing a mom for 2 weeks now and have her permission to post.
Mom is 43 and this is her 7th child, all previous children were breastfed.
Current baby is now 6 weeks old. He was a vag delivery at 40 1/7 weeks,
birth wt 6# 2.5oz. D/c weight was 5# 9.8oz. Mom has exclusively breastfed,
and baby has struggled with 1-3oz gain every week. He also had frothy grass-
green stools.
I first saw this dyad 2 weeks ago and baby was irritable, fussed at the breast
and alternately sucked and pushed away. After about 45 minutes of feeding,
test weight showed 48g intake. I instructed mom to do a nursing vacation,
switch nurse, and use breast compression. Mom also wanted to exclude
gluten from her diet, as baby's father has allergy.
5 days later baby had gained 3.4oz. Mom had done a nursing vacation, and
had been switch nursing but not compressions. Instructed compression
technique and rationale again, test weights at this visit showed 72g intake!
However, mom nursed for 1 hour to achieve this. Baby's stools had lost the
froth and were green-yellow.
Today's visit baby had gained 5.4oz in 1 week. Yea! However, mom has
been 'marathon nursing', with feeding every 2 hours for 1 hour each feeding,
switch nursing (1st breast until baby loses interest, 2nd breast until baby loses
interest, then 1st and second again with compressions) . Mom reports that
stools had turned mustard yellow, but today they were back to green. Baby
was also very fussy today, which she says is out of normal since 2 weeks
ago. She did not wake baby to nurse through night last night and baby went
about 5 hours without a feeding, then resumed schedule.
I'm at bit at a loss about what to do now. Although baby is getting more milk
now, I can't imagine mom keeping up this '1 hour on 1 hour off' schedule,
especially with 6 other children at home, a home business, and I haven't yet
mentioned her chronically ill husband who she is taking care of. She is
obviously under much stress and I can see her just buckling and quitting
breastfeeding alltogether.
And the issue of the green stools...since they went from green to yellow and
back to green, should I consider this a low-fat problem? I'm thinking mom can
reintroduce gluten in her diet, since baby has again had green stools 2 weeks
after she excluded gluten. Should I suggest she exclude dairy? PNVs with
iron? All suggestions would be welcome!
Julie Conaway, RN
(hope to include IBCLC after my name after the exam results in October!)
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