Hi Cindi, When there is an issue of weight gain, there is a problem in
one of three places, to my way of thinking. It's a problem with the
baby, a problem with the mother, or a problem with the transfer, or a
combination therein. This sounds to me like a problem with the baby,
and a problem with the transfer. There is soemthing going on with this
baby. Has he been checked for UTI? Neurological exam? For a submucosal
cleft of the palate? Heart defect? Something is making it hard for him
to coordinate flow and suck/swallow. Does he have any periods where he
organizes and sucks/swallows effectively?..alertly? Was he suctioned at
birth? Thyroid checked on baby?
There is a red flag going up here. I'd recommend another thorough baby
workup.
Kathleen
Kathleen Bruce RN IBCLC
Listowner Lactnet listserv
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Hi all,
I'd really appreciate some suggestions for this mom & baby...
35yo g3,p3 -- 8 wk old boy, vaginal delivery, no complications Mother
slightly hyperthyroid (was hypothyroid, meds adjusted after delivery and
are being adjusted down now). According to MD, pituitary is normal &
normal prolactin levels. Mother has had two rounds of Reglan and has
been taking Fenugreek. Baby wasn't gaining enough weight -- 4 oz in 2
weeks and it was assumed that production wasn't enough. Mother has been
pumping with PIS. 3 weeks ago started using SNS, but states that even
with largest tube, baby doesn't take supplement -- she states it's "too
hard" for baby to get. Feedings are becoming an ordeal. Breastfeed x 40
minutes, pump x 15min and bottle feed x 20 minutes and start the whole
thing over again a few hours later. Baby doesn't seem hungry. Falls
asleep at breast after only a few minutes. Mother uses compression (and
uses it well). I was skeptical myself about what she was telling me,
but actually saw a feeding and nothing we could do would keep this child
awake to breastfeed. It was like a switch was flipped as soon as he
'hooked up'. However, he did transfer approx 26ml in that few minutes.
Mom proceeded to burp, wake, and put back to breast at least 5 times,
using compression the whole time and he transferred a total of 2 ounces
in 45 minutes of off and on, off and on. Mom is able to pump approx 1
1/2 ounces after feeds, and since for his weight he should be getting a
little over 24 ounces per 24h, I don't think she has a production
problem. He plays around with the bottle too, falling asleep as well. I
saw this baby last the day after a ped appointment and he was given a
clean bill of health except for his weight gain. He appears 'normal'
whatever that is, but I've not had experience with babies who don't seem
to want to eat. Other than hang in there, I'm at a loss as to what to
suggest. Anyway, Mom is just about at wit's end -- she has a 4 year old
as well and he is a typical 4 year old, so she has a challenge there
juggling baby and pre-schooler. Does anyone have any suggestions I can
relay to her? She is a real trooper about this, has been in twice for
outpatient visits... she really wants this to work -- 4 year old weaned
at 6 weeks because she 'didn't have enough milk'. She's not just
looking for permission to quit. Thanks in advance, Cindi Swisher, RN,
IBCLC [log in to unmask]
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