The cases this week on LN about babies who are not gaining as expected
seem to me to be true cases of babies not getting enough food. I
don't pretend to know the cause, in any of the cases. But the baby
who lost fifteen per cent of his birthweight and then didn't make it
back to birthweight until he was two weeks old, whereupon he proceeded
to take off ten percent again over the ensuing two weeks, that is not
a baby I would be in any doubt about feeding. I would give him
unpasteurized hamster milk if that's all I had available. It sounds
like he just plain needs food. Caveat: my response is colored by the
memory of the one really starving baby I have ever seen, and the only
reason for it was that his mother didn't realize it was important to
feed him every time he showed hunger cues. She was even pumping to
treat her engorgement and freezing her milk because she didn't realize
it would be better put into the baby, and he was getting a pacifier
because he was inordinately fussy. I never want to see a baby like
that again.
The other baby, the tenth one in the family, also sounds like he
mostly needs food. I would be far less concerned about elimination of
things in the maternal diet, and more concerned about including more
FOOD in the infant diet. It was Barbara Wilson-Clay who always
reminded us that a baby who is already depleted, will not be giving
his or her best performance at the breast. They can't suck their way
out of a paper bag, is what she used to say. So putting a baby to the
breast who is *trying to breastfeed* is not a good strategy to remedy
the situation unless it is done as recreation and cuddle time, in
addition to actively feeding the baby, and taking steps to protect
mother's supply from the downregulation that inevitably results when
stimulation is inadequate.
An aside, about being realistic with mothers... if a woman with PCOS
who had needed help to get pregnant asked me what her chances of
bringing in a full milk supply were, I would tell her what I know - I
can't predict the future, and these are the things most likely to lead
to success (Ten Steps etc). I might well mention some things likely
to undermine her, such as supplementing out of fear, expecting the
baby to feed for 20 minutes 6 to 8 times a day from day one and every
day after that for the first six months, sending the baby elsewhere at
night in order to sleep, putting up with bad positioning, getting a
late start, all those things we know aren't good. Kathy's example of
mothers who are dismayed at how hard it is to bring in a supply for a
premature baby after doing absolutely nothing to get started in the
first week of the baby's life, only underscores what I said. One of
the Ten Steps to Successful Breastfeeding is to begin expressing milk
early and often if a mother and baby must be separated or the baby is
unable to come to breast. There are reasons for all the things in the
Ten Steps, as these mothers so painfully experience.
Again, unless my plans for following up the mother and baby would be
changed substantially in light of the risk factors present, I would
not mention them per se, because the standard care will catch them in
plenty of time to deal with things.
Rachel Myr
Kristiansand, Norway
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