Hi all,

 

Well, I have a case that I am working on that I think is actually way
outside my expertise!  I'm kid of enjoying the challenge actually.  I have
not yet seen baby in person but will do so in the next couple days.  I'm
going to try and give the details as concisely as possible: (I have
permission to post)

 

Baby born 2-11-09 weight 7'3" (3450 gm?)

Current weight as of 7-23  11'5"  (5430gm?)

 

Weight gain over this time period avgs out to about .5 oz per day - EXCEPT
that in tracking the weight gain baby is NOT gaining appropriately at all.
From day 5 to 15 she put on 20 ounces - mom supplemented with a little ABM -
perhaps 2 ounces per day.  Avg gain - 2 oz/dy 

 

After day 15 weight gain dropped to .5 oz through the next 2 months (thru
4-13-09).

4-13 / 6-12 weight gain dropped to .3oz/dy

6-12 / 6-26 weight gain dropped more to .16 oz/dy

6-26 / 7-23 weight gain up to .3oz/dy

 

Points of interest:  Baby had yellow seedy stool for first 3 weeks.  Stools
then became dark brown and much more firm - this lasted several weeks.  Mom
reported this as being 'constipation'.  Mom took citrus out of her diet and
stools became looser and went to lighter brown - mom reports them as
"light-medium brown diarrhea like", foul smelling (smells like "poop" not
like breastfed stools) - never went back to yellow seedy.  She asked Dr
about it and he said no big deal - but she has been concerned.  (she feels
seriously blown off here)

 

Plenty of nursings per day.  Plenty of wet diapers (pale yellow urine -
heavy wet).  Several stools per day - 3-4 per day or more.  Baby started
spitting up excessively until mom took most dairy out of her diet in May (3
months) and this reduced baby's spitting tremendously.  Baby seems happy and
satisfied after nursing.  

 

Dr concerned about weight gain in June and sent mom to a ped. Nutritionist
who wanted baby OFF BREAST and to be fed 1tsp of nutramigen powder in bottle
of breastmilk each feed.  Nutramigen suggested due to possible lactose
intolerance.  (mom refused to follow this advice)

 

Points of interest re: Parents:

 

Dad has Von Willebrand's syndrome (not ruled out in baby yet)

Dad has ulcerative colitis and history of GI issues

 

Mom has history of GI issues, dairy issues, gall bladder and appendix
removed, wheat intolerant, odd side effects to meds, herbs, etc, history of
allergies ranging from foods to pollens, molds, prenatal vitamins, calcium
supplements, etc.  Mom is not taking any meds or herbs that would reduce
supply.  

 

My suggestions to her:

 

Get baby tested for:  Von Willebrand's, Celiac disease, blood in stool (due
to possible injury to gut from ABM supplementation, mom wheat intake, dairy
allergy causing bleeding in intestines due to possible von willebrand's), 

 

Mom:  test for Celiac - elimination diet NOW - absolutely NO wheat, gluten,
dairy, citrus.  Get mom and possibly baby on Probiotics now to help heal gut
(this is not my specialty so I am looking for any information to help with
this particular issue).  Rent a scale in the process to do pre/post weights
with baby's feeds to look at true intake at breast to rule out actual lack
of intake issue.  Change Docs if Ped won't do testing or blows her off again
(gave referrals to a few who would listen and test).

 

Am I missing anything here?  Am I on the right track?  I think I am.but
wanted to get more input.  I know something is really not sitting right
here.the weight gain, the stools, the smell, the history - doesn't quite
smack of a true breastfeeding issue to me but something else that
breastfeeding may be getting blamed for.

 

Please respond privately and to the list.  Thank you for ALL input and help!

Warmly,

Jaye

 

 

 

 

 

 

 

 

 

Jaye Simpson, IBCLC, CIIM

Breastfeeding Network

Sacramento, CA

www.breastfeedingnetwork.net

 


             ***********************************************

Archives: http://community.lsoft.com/archives/LACTNET.html
To reach list owners: [log in to unmask]
Mail all list management commands to: [log in to unmask]
COMMANDS:
1. To temporarily stop your subscription write in the body of an email: set lactnet nomail
2. To start it again: set lactnet mail
3. To unsubscribe: unsubscribe lactnet
4. To get a comprehensive list of rules and directions: get lactnet welcome