I've found that a use of pacifiers and 'sleeping through the night' tend to
be big culprits in the area of "slow gainers" at this age.
Melissa Senf

On Wednesday, November 13, 2013, Alla Gordina MD, IBCLC, FAAP wrote:

> 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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