carol
those gray zones are tough! yes we can leave moms/babies alone to figure it
out, but then they need close f/u too becoz some don't figure it out. we
have to all strike a balance between intervening/interfering too much/too
soon and not intervening when we really need to.

it seems most of the time supplements are used too soon but occasionally
i've had parents who did not want to pump or supplement when i thought it
was clearly indicated, like you gave the example of weight loss and low
intake at breast. i try to address it with parents comparing it to an
adult's calorie intake. an adult who needs 2000 calories to maintain current
weight will lose weight on 1800 cals a day. An 5 lb. infant who needs about
13 oz a day will lose weight on 10 oz a day, which does not seem like much
of a difference but it is. Just imagine if the same infant is only getting 4
cc's at a feeding? This usually conveys the situation to the parents.

This brings up another gray area - when should milk expression begin in
earnest (I'm not talking about a sick/premie baby), becoz you never know if
the baby will 'get it together' at 24 hrs of age or much much later. It is
always a judgement call.

Laurie Wheeler, IBCLC, MN, RN
New Orleans Louisiana, s.e. USA

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