In the last 2 mths I have seen 2 very interesting infants that illustrate 2
very different HCP approaches to "failure to thrive"! The first baby (I'll call
her Anna) was seen by me at 4 mths and 6 mths in our hospital based
outpatient clinic. She came to me on her first visit because her family practice MD was
requesting supplementation to her exclusive breastfeeding d/t "poor" wt gain.
The baby had initially (1st 2 weeks)gained about an ounce/day, since that
time had gained consistently at a little over 1/2oz/day. Mom was wondering if
there were any changes she could make...my suggestions consisted of changing
positions at breast (she had been using cradle only), compression, switch nursing
when swallowing diminished, pumping after feeds. These recommendations were
made despite the fact that the baby looked GREAT. An absolutely beautiful
baby-chubby in all the right places, content and developmentally on target.
Unfortunately when she saw the MD 2 weeks later-wt gain had continued at the same rate
/supplementation was started. When Mom came back in to see me at 6 mths. she
was attempting to relactate after not nursing for over a month d/t the baby's
refusal of breast after supps were increased and solids started. She was very
upset AND despite the change in regime- baby's wt gain had increased only
slightly to 3/4oz/day.
The second baby also came to see me at 4 mths. This contact was made at Mom's
request - as pedi was only marginally concerned by baby's 1/2oz/day wt gain.
This baby, however, did NOT look great. He had that perpetually hungry look of
the under fed baby along with minimal fat deposits and an unhealthy sallow
color to his skin. As with Anna's Mom, this babe's Mom was given instruction
regarding improving technique and further increasing supply with
pumping/galactogogues. Unlike Anna, I am confident that this baby needs more milk and
hopefully we can get it to him at the breast. I really wanted to share this because of
the rare viewpoint that these 2 extremes offer.
Lynn Shea Rn,Bsn,Ibclc
Franklin,Massachusetts

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