PTP

4 mo old almost exclusively breastfed baby was seen yesterday for the 
routine well visit.

Baby is doing wonderfully developmentally, but is struggling to gain 
weight - went from 25% at birth to 3% now.

According to mom and grandma, older sibling (4 now) and mom herself were 
"slow gainers" and "poor latchers" too.

In a short well visit (anticipatory guidance and shots included) I was 
able to identify several major culprits:
- definite upper lip tie, no obvious ankyloglossia, (will do further 
evaluation for PTT on the follow-up visit next week)
- delayed letdown reflex since birth (no birth control pills because of 
the milk supply issue)
- asymmetric milk production -  one breast consistently producing about 
4 oz/pumping, another - not more then 1.
- no feedings between 11pm and 5 am
- mom is using electric pump at work, and handheld pump at home (and 
getting more milk by the hand pump!)

I will be seeing the dyad next Tuesday for a formal lactation consult, 
but meanwhile gave the general recommendations on night time feeding, 
massage, concurrent nursing/pumping combo,  continue supplementation for 
now (as we have to feed the kid :()

Any suggestions would be highly appreciated by worried physician, 
struggling mother and hungry baby!
TIA,
Alla

-- 
Alla Gordina, MD, IBCLC, FAAP
General Pediatrics
Breastfeeding Medicine
Adoption and Foster Care Medicine

Global Pediatrics and Family Medicine
NJ Breastfeeding Medicine Educational Initiative

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