Would pre/post feed weighs be appropriate in the following
>situation: with day 3 infant weight loss approaching 10% and
>mothers milk not yet in physician ordered supplement after
>breastfeeds, volume not specified.
I apologize for not reading all the post about this but yes, it would be
appropriate to see how much baby is transferring at the breast. But there
are only a few scales good enough to measure down to 1/10 of an ounce or 2
grams. For example, the Olympic Smart Scale, the Medela Baby Weigh, and the
Tanita BLB12. Most IBCLCs say test weighing is not that accurate before day
3. Intake is so small before that. Also, I would want to assess baby for
such things as how many BMs has baby had since birth and when was the last
one, and what color, same thing for urine diapers, how many feedings is baby
getting per day and how much of that has been formula. If feedings are poor,
baby sleepy or crying alot, diaper counts look bad, still scant and
meconium, and baby was either slightly premature, induced, mom had a long
epidural or c-section, and if the epidural was used post c-section, I would
be suspicious of baby's ability to transfer milk at that point.
When the doctor orders supplementation:
Depending on if this baby appears to be heading in the wrong direction, I
would suggest a little supplement at the breast to teach baby to suck
actively and transfer milk. Only a little bit might be needed, say 10-15 ml
divided up between the two sides and for the next 2-4 feedings. A 20 ml
syringe with a #5 French feeding tube attached (cut off above all the side
holes so you have just one hole) is often easy to use at the breast. Or a
periodontal syringe to do the same thing. Put the tubing into the corner of
baby's mouth when latched on and push the plunger gently to get baby started
sucking and maybe again after 4-5 sucks so he keeps up a long pattern of
sucking. Then recheck baby in 12 hours and see if he has learned to actively
suck and transfer milk on his own. Many babies born under epidurals or those
c-section babies where mom keeps her epidural in for 2 days afterwards will
be disinclined to actively suck. They often need some help learning this.
Especially if bottles are routinely given in your hospital like they are
here.
I give this information for an imperfect world where the nurses and doctors
go to formula and bottles right away rather than looking to improve the
breastfeeding. Other things work well also, like spoon/cup/finger feeding
some expressed colostrum, skin to skin contact, feeding 12 times a day. But
one's hands are often tied when the doctor orders supplements.
Kathy Eng, BSW, IBCLC
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