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Date: | Wed, 18 Jul 2007 23:13:09 -0500 |
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It seems like we have this hungry vs starving and should we supplement
discussion on lactnet over and over. As IBCLCs, it is our duty to
intervene with a baby that is obviously not thriving, growing, or
gaining weight properly. A little hungry is the baby who is gaining
weight well and has to be held off for a half hour while mom finishes
her shower. A starving baby are these last posts of babies who have not
gained birth weight until 4 weeks and are clearly weak and sleeping too
much, etc.
I also question the moms who are going on all these elimination diets
and wonder if the basics of assessment have been done first. I would
want 24 hour test weights done to see what the intake really is at the
breast. I'd like mom to do a day's worth of weighing before and after
every nursing and writing it down so we can really tell. If baby is
removing milk in proper amounts for growth as outlined in the BAB (both
caloric needs and growth perimeters), then I would look at other
physical issues. I would like to see what happens first when calories
are increased, whether formula or human milk. I would want the calories
to be increased immediately.
And I would not make the program so hard mom will fail due to busyness.
The diet stuff is hard, hard, hard. I know as I do not eat dairy or
wheat and had to do elimination diet for my third child. From what I
remember of my allergic baby, he had ear infections and a snotty nose
from birth but huge weight gain from always nursing. Sometimes food
allergies are intestinal but this is more rare than mucous producing
symptoms -- aren't they? I would refer people to the old book, "Is this
your child?" by Doris Rapp, MD for a list of common symptoms of
allergies in all stages of childhood.
I am not saying these babies are not highly allergic, I am just saying
that daily intake needs to be thoroughly assessed first because that is
the real question. Are these babies just hungry or are they starving?
(I have worked with several mothers of many children who felt their
babies were nursing well even though they were not gaining weight
properly and when I insisted on 24 hour test weights, the moms have seen
that intake is really terrible and baby is only eating about half what
he needs. It was loaning my scale for a whole day that made these moms
realize that their good baby was too good and was starving not a little
hungry.)
Best of luck to both these moms and LCs. It can be overwhelming and
terribly upsetting.
Kathy Eng, BSW, IBCLC
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