Hi Barb,
 
This baby was quite small at birth - do you think there is any relation
here.  Was she term (and perhaps some restricted growth in which case
you would think she would be growing fast) or more 37 - 38 weeks and a
"waterlogged" baby at birth,  with a water loss giving the appearance of
a slow weight gain.
 
 What day did the stools change to yellow and did the mother experience
obvious signs of lactogenesis 2 at around this time.  Could this be a
case of a slow start with the necessary catch up needing to be
encouraged.
 
Do you think the baby may be losing calories any other way.  With these
smaller babies I tend to keep their temperature between 36.8 - 37.0
(even if it means the parents taking a temperature several times a day)
to prevent any heat loss.  I am not sure what climate you are in at
present but if this baby has little fat stores, she may be burning up
what she has to keep her core temp up.
 
Otherwise, to quote a visiting IBCLC to our waters recently (thank you
Diane) - "give it the tincture of time".  I would think about getting
mum to pump several times a day and cup feeding these extra feeds in
after a breastfeed.  Can't do any harm and if the baby is truely full,
she will spill it out!
 
As a midwife and LC I know what it is like to do the "package" of birth
and baby so you are in a wonderful position to know the full story. 
When I have a difficult case, I still ask one of my colleagues to take a
look for me and vice- versa.  Two heads are better than one.
 
Let us know how it goes.
 
Karen
New Zealand

>>> [log in to unmask] 12/06/2007 13:54 >>>

Hi, I'm looking for some advice/opinions.  permission from mom to post:


here's the story;  Mom, first baby, healthy, no problems during
pregnancy or labor (I also delivered this baby at home, no problems,
perfect birth).  Baby is a voracious sucker, has some problems clamping
down and also with some tongue curling.  Teach her tongue training,
palate seems fine, frenulum looks good. Some issues with moms nipple
size and small baby mouth.  Wants to suck and nurse most of the time. 
After a few days, mom's nipples start cracking/sore.  She has been doing
breast compression (aka jack newman), one-sided nursing for 2 feeds in a
row, and basically nursing on demand as much as she can tolerate.  No
nipples or pacifiers.  At one week, she gets some nipples shields to
help nipples heal, that works great, gradually weaning back off after
about 3 days of use.  
Birthweight: 5lbs 14oz
Weight at ped (different scale than mine) at 3 days: 5lbs.8.5oz. 
Weight today at 14 days: 5lbs.5oz. 

Baby nursed at office, reweighed, 2oz gain.  No jaundice (never had,
always looked good), good poops, obvious letdowns, mom on no meds, good
diet, no excessive fussiness, developmentally OK, awake, alert, no
lethary.  Doctor and nurse watch nursing and say baby looks good and
they can hear swallowing. 

They are freaked about the weight loss and want her to see another LC
(apparently they don't think I'm doing a good job) and they want to
admit tomorrow if no weight gain.  

What am I missing?  What else should she be doing?  I don't have a
problem with her seeing another LC, I am friends with them and I know
they will do a good job, I told her maybe someone else with fresh eyes
might have some insight, but she doesn't want to go sit at the hospital
with baby (I have home office and do home visits). 

I am open to any and all suggestions!  Also, any studies to support
normal weight loss?  I admit, I am puzzled and not sure what else to
suggest.

TIA, 
Barb Cavanaugh RN, BSN, IBCLC, Midwife
Centralpabirthlactation.50megs.com
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