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From:
Rachel Myr <[log in to unmask]>
Reply To:
Lactation Information and Discussion <[log in to unmask]>
Date:
Thu, 4 Dec 2008 19:11:20 -0500
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Alice Roddy posts and asks for input on a week-old baby who isn't latching.  
I didn't see any mention of the baby's current naked weight nor any weights
other than the birth weight, and given that several days had passed since
any stools have been observed, I would want to know just how far below birth
weight the baby is.  If he is below 5 lb 8 oz, he is more than 10% below
birthweight, and at a week, such a deficit would alarm me.  I would also
want to know his gestational age, since his size makes me wonder if he is
'near-term' rather than 'full term', in which case maturity may be the cause
of his not latching so far.
Unless the baby has been given kangaroo care until now, I'd want to increase
the skin-to-skin time in between feeds, but without knowing baby's current
weight I would not feel comfortable without actively feeding the baby until
he is gaining well.  It is likely that he needs more milk than is practical
to feed by spoon, unless these parents are a lot more adept at spoon-feeding
than I am, which is certainly possible.  By using his birthweight to do a
rough calculation of need, I figure he should be getting about 425 ml or 14
oz per day.  That's a lot of spoonsful - is this the best use of everyone's
time?   I'd be tempted to try finger-feeding and/or supplementing him at the
breast, if he latches on at all. Giving the formula by cup might show
whether he is able to get his tongue far enough forward.  I wouldn't give
expressed breastmilk by cup because so much of it ends up not in the baby's
mouth and I wouldn't want to waste it.  Formula is another matter - can
always get hold of more if need be.

Meanwhile, the cause of the baby's failure to latch needs to be determined,
and I agree with Jennifer Tow that it could be a tongue tie.  It could also
be that the baby is simply not up to it, after getting too little food for
the first week, and once the baby has started to gain weight, he may be able
to feed perfectly normally.  Keeping him skin-to-skin will ensure that when
he starts to show active interest, he'll be in the right place to do
something about it. It will allow him to put all his energy into growth,
rather than burning it to keep warm or being afraid. It should also help
mother's supply.  

My hunch is that the supply problem is because of his non-latching, and not
the other way around.  It is such a short time since he was born that the
supply problem should be turned around within a very few days of systematic,
frequent and effective emptying of the breast.  Until he is getting enough
food, he won't get any better at feeding.  If there is some other cause of
his feeding problem, he won't get better even after he gains his weight
back.  While it may be necessary to take further steps to get things on
track again, I would hold off on the more intricate things for a couple of
days and see how he does with Alice's current plan.  I wouldn't let more
than a couple of days pass without seeing them again, because I would want
to start decreasing the supplements as soon as possible, and until I knew
the baby was putting on weight, I would not feel OK advising them to cut
back.  But I'd be very optimistic that this will sort itself out in the end.

Good luck, and let us know how it turns out.
Rachel Myr
Kristiansand, Norway

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