In a message dated 3.1.03 12:22:32 PM, Kathy Leeper writes:


> What is this baby's weight in relation to birthweight?  I have seen
> babies who are not back to birthweight by 3-4 weeks, and appear content
> to starve.  Often 3rd, 4th or 5th children, and mom is astounded to find
> there is a problem.  Baby doesn't demand to eat, and when he does,
> sleeps at the breast for the most part.  I would be more aggressive
> about supplementing in this situation...and limit time at the breast
> until it is productive, so mom doesn't completely burn-out.  Calculate
> the baby's needs, and ask the parents to get that much into him after
> ~20 minutes of switch nursing/breast compressions for a few days.  When
> the baby catches up to where their weight should be, a lightbulb often
> goes on, and they wake up and start asking to eat, and refusing so much
> supplement.
> 
I would agree that some babies do present like this but It looks to me from 
the consult description that the above is Exactly how they have been handling 
it (other than abbreviating the time at the breast). Didn't she say that she 
was trying to supplement either via bottle or SNS but baby refuses? The baby 
is 8 weeks old and has spent at least some of that time with all the milk 
that it wants availabe to him,   and STILL remains unable to sustain himself. 
I do accept the idea that this may not be pathological and COULD be an 
extreme variant of normal in an otherwise healthy baby BUT i   also agree 
with Kathleen and would want to look closely at this child 1 more time.
I would also be interested to hear a little more info from the consult ie. 
what did it look like when the baby used the SNS vs. bottle, are there times 
where he feeds better than others.... etc.

Lynn Shea Rn,Bsn,Ibclc
Franklin,Massachusetts



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