continued from first post Three week old with precarious weight gain
At home, baby is pretty yellow and looks smaller than in hospital. Some latch
problems, he can't seem to get the latch deeply enough (not surprising, with
lethargy and vigorous suction) after 24 more hours, Mom getting very sore,
and still Uric Acid being passed, we go to 24 mm shield so baby can get more
areola in mouth more easily. (I did a digital-oral assessment, baby is not only
using a shallow latch, but clamping, on and off, for at least first 20 seconds
until he can latch.) We get baby on comfortably, and hear good swallowing
(kid is a quiet swallower)
Weights now:
Birth 9 1
Discharge (3 days of age) 8lb 1oz ~
5 days (my scale) 8 lb 1 oz ~ (8 lb 3 oz on Ped scale same day)
(Mom is now only using shield for 1 to 2 feeding a day. baby is nursing every 1
to 3 hours, with one 2 to 4 hour sleep stretch at night, between mom and
dad. She still has to wake him for at least half of feedings.)
10 days 8 lbs 5 oz~
15 days 8 lbs 9 oz~ (8lb 9 oz on Peds scale)
19 days 8 lbs 7 oz~ (Growth spurt occurring)
21 days 8 lbs 10 oz ~
22 days 8lbs 8oz ~
At two week check up, Mom finds out that babies first visit to Ped, where
Baby weighed 8 lb 3 oz at Peds, someone misrecorded the weight as 8 lbs 8
oz! (Dad writes EVERYTHING down, as did I.) Ped was not concerned at two
week check (without no one has looked into ABO incompatibility, baby is still
yellow, but NOT lethargic.) Ped seemed OK at two week check, but this see
sawing of weight is bothering me.
Both Mom and Dad were thin long babies. Mom has her baby book, but not
with complete weights, Dad was 5th child, no book. We do have pics, both
WERE long, thin babies. (Dad is now 6 ft 4 inches!)
Baby is very alert. VERY active, beyond milestones, holding up head at 3 days,
making good eye contact before one week, he is starting to coo (thinks my dh
is the funniest thing on the planet!) starting to smile, (not just sleepy
smiles.)
Is tracking with eyes, then with head and entire body. Seems to recognize
myself, my children, and husband, not just Mom and Dad. Hears Dad's voice
and immediately quiets and looks for him. In other words, with the exception of
still being yellow, and weird gaining pattern, child is doing OK.
I sat down with Baby and Mom last night, to reassess. Baby is long and legs
are actually off Mom's lap. I did have to remind her to make sure his lips were
flanged properly. (He tends to suck bottom lip in mouth while nursing.) Mom
has gone from barely B cup to about a C+, small areola, large nipple for areola
size. Baby sometimes "slurps" (which he has been doing since birth, mom and
dad eradicated pacifier, after a only a few uses in car started baby sucking
air, clicking ect while nursing.) She is working on OPEN mouth latch, and
recognizing when he isn't on correctly.
From Assesment last night, it appears that he may be "Living on Letdown" a
little. He's such a quiet nurser, that I wanted to get a steth just to hear what
he was doing. He lets Mom know he wants to nurse by vocalizing, if not placed
on breast, he cries a little (she usually tries to get to him before full out
screaming) then I had to remind her to take him off and re-latch him, because
he was slurping, and hurting her. This was during his Evening Cluster Feed,
but he was doing great during Ejection, then just kind of hanging out, drowsing
ect, until next Ejection (approx 3-5 minutes later) then good suck-swallow-
breathe pattern, but for maybe only a minute or so, then the hanging out
again, until next Ejection.
Readjusted position again. Kid is moving a lot, refuses to have his hands
swaddled, and moves UP so his latch degrades a bit. Mom was not really
aware he was doing this, as it wasn't hurting her. I had to keep gently
grabbing him and pulling him towards his feet, as he was inching up so he was
almost looking down at her breast. (*Nothing* bothers this kid when he is on
the breast. Not a washcloth, not rubbing, not foot tickling, not noise, he just
hangs out or nurses.) Repeated that Baby needs to "Watch the Sunrise" to
latch, and stay watching it. I, again, showed her how to "make a breast
sandwich" and use Breast Compression, these also helped baby start
swallowing again. Also, repeated showing the gentle under chin rub, so he will
swallow. (Baby will often come off the breast, completely satisfied, and let
milk
fall out of his mouth.) But, when he is on, the seal is good, Mom needs to work
on taking him off to re-latch, without being clamped, however.
Mom admitted to me that the first week she had a serious case of "Mommy
Brain." (I KNOW! Everything I told her, I also told Dad, because he was writing
things down. She seemed a bit dazed for at least the first 10 days, and
forgetting a lot.) Told me she felt like she was on "Information Overload" at
that time, as many friends and family members (including some who didn't
or "couldn't" nurse were giving her info, of course.)
Mom, Baby and Dad are all highly motivated to breastfeed. (Dad brings me the
AIM samples, as soon as they arrive, "Don't even want this in the house!" and
is reading Sears ect! Now, I have a Library full of AIM samples, wow, they
send a lot of AIM if you tell the Maternity store you will be "exclusively
nursing!") Mom and Dad are intelligent, educated and have good insight. Baby
is nearly always in someone's arms, sleeps Between Mom and Dad, with one
stretch in the Side car, Mom will be staying home for the long haul. Mom is
regularly coming to LLL meetings. Brought Baby at two weeks of age. He was a
hit! Cute as can be.
Baby had plenty of wet and stool diapers. (Disposable) I've changed a
number, myself, and they are either puffed and full of urine, with a smear, or
stool the size of the palm of my hand. (I have small hands, but you get it.)
(We tried Triple Ointment at about 18 days, Mom thought maybe it was
thrush, I thought maybe it was still poor latch. He went on Growth Spurt same
day as Triple Point was started, so Mom felt she didn't "have time to give it a
chance." After Spurt, soreness much better.)
Anyway, Mom needs to work on getting Baby to nurse better BETWEEN
Ejections, and work on the latch. But, I am still frustrated at the weights.
Next Ped visit one week from today, told Mom if Baby still see sawing we might
want to do some "Creme de la Mama" therapy for about 3 days before the visit
and see if he can't gain a little faster. (Pump several times a day, let rest,
skim cream, feed to baby on spoon. Mom doesn't seem really enthused about
this idea. Thinks her Ped (who she has known for years) "won't be too
worried." I think the Ped *will* worry, because I am worrying, and don't do
that all that often. This baby needs to grow just a bit faster!) I am hoping
once he goes beyond his birth weight, things will even out, but I'm frustrated.
Mom wants to try fenugreek. I don't know, she seems to be making what he
will take, but he is still "Living on Letdown" I think. (Mom says "he's a little
lazy, isn't he? I don't mean that in a mean way. He just likes to......hang out.
He's his Daddy's boy.....")
Am I too close to this case, and missing something? Help?
Thank you for your patience.
Mary Jozwiak IBCLC, RLC, LLLL
Private Practice
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