Hi everyone,

I have been frequently seeing a mom/baby through VNA since about 5 days 
post partum.  He was referred from pediatrician newborn visit after losing 
almost 20% of his birth weight, jaundiced, having difficulty latching and unable 
to stay awake for feedings.  Mom started pumping regularly, waking him 
regularly and per her choice was giving EBM supplements via bottle after 
feedings, 1-2 ozs.  A tongue tie was noted and monitored.  He was quick to 
gain weight with supplements, however after weaning from supplements, was 
quick to lose weight again.  A frenotomy was done and latch was improved 
and baby more able to stay on the breast.  Baby is content at breast, enjoys 
being at breast, latch is much improved, deeper and more coordinated, 
however feeds are long, lasting a minimum of an hour with much 
encouragment.

In the past week, days 10-17, he has gained 11 ozs.  He is able to take up to 
2 oz transfers at the breast, although feeds are still long and suck is still sort 
of poor.  He is still quite sleepy and lazy!  Mom says he won't wake for 
feedings and she will pump and force a feeding into him via bottle.  After 
a "good" feeding, she is frustrated, reporting that he has not emptied the 
breasts, leaving 1-2 ozs. and will insist on giving a supplement, saying he 
sucks it down.  

  He is just about back at his birth weight and with supplements is gaining 2 
ozs per day.  Mom is extremely stressed out about the situation, she 
percieves her milk supply to be low, regardless of my reassurance.  She 
started taking a kitchen scale and weighing baby before and after every 
feeding as well as weighing baby daily for weight gain, against my better 
judgement.  I am trying to explain that breastfeeding is natural, not calculated 
and should be regulated by the newborn.  Considering the above average 
weight gain, I would like Mom to discontinue supplements and see how he 
does on his own, however she says he would sleep for hours on end.  She has 
little confidence in herself or her baby to regulate his own feedings.  He is 
officially healthy and thriving.  I had her waking the baby to feed him regularly 
due to weight loss, however, I feel that if given the chance he will wake on 
his own and be more alert at the breast when able to feed on demand.  
Perhaps his atypical feeding schedule is normal to him.  She says he has a 
period of alertness for a few hours during the day and cluster feeds for hours 
at night.  My gut feeling is that although he may only gain an acceptable 1/2-
1 oz per day without the supplement, he will not allow himself to lose.

So, my question is, is it good advice to allow the baby to set his own feeding 
schedule, even if he will at times sleep up to 5-6 hours during the day?  I'm 
afraid if I push her to "experiment" and allow her baby to regulate feedings and 
he loses weight, she will truly lose all confidence in herself and me.  I feel the 
more time he spends at the breast and without the bottle supplements, his 
suck will improve.  He needs a little suck workout.  The bottle supplements 
were only to be a short intervention to get him gaining weight and able to 
keep gaining on his own.  Now that he's gaining, I can't get mom to ditch the 
supplement and I think he's confused.

Unfortunately, I think I've allowed her lack of confidence to reflect back on my 
confidence.  In my experience, once a baby really establishes weight gain, the 
sleepiness usually improves and the baby will become a more vigorous nurser, 
as naturally they have more energy to do so.  He is gaining weight, however 
he is still sleepy and rather lazy at the breast.  He sucks, it's just not vigorous.

Any advice?  What would you do?

Thank you,
Laura Miller, RN, LCCE
future IBCLC (in July :) )

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