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Sun, 29 Apr 2007 20:32:27 -0500 |
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This is a situation where test weights come in very handy. I suggest
doing them every 10 minutes to see what the pattern of milk removal is.
I would do each breast twice, with test weights before, at ten minutes,
and then ten minutes later or whenever baby pulls off. Sometimes I do
each breast once with test weights and then go again to see when baby
tires. And have mom pump with a rental quality pump afterwards, double,
for 10 minutes and see what she can remove. I try to compare what baby
is removing with his actual caloric needs as set forth in the BAB. If
mom is willing, I might try an SNS type device and see if baby can
remove milk better or goes to a more rhythmic pattern of sucking with
supplementation at the breast. Oral motor problems can run in families,
or tongue tie -- especially those sneaky posterior tongue ties. I like
to watch the sucking pattern closely and then try to correlate the
sucking with the intake. I have seen a baby be very disorganized at
first, with poor intake, and then go into a very loud gulping sounding
sucking with 3 ml intake. Mom is then instructed to stop nursing when
baby starts getting to the ineffective pattern. I also like to see how
baby sucks on a wide based slow flow bottle, how the lips grip, if there
is spilling of milk out of the mouth, choking, etc. I would want a
careful weight history so see if there was a time when weight gain was
good. Some babies live on an abundant milk supply but it down regulates
after a while when baby is not doing his part with proper sucking. If
mom is on birth control, this could lower her supply.
Kathy Eng, BSW, IBCLC
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