Liane, I don't think you should feel relieved at all (and it sounds like you don't) after getting this report from the mother. I agree with Eileen that 0.5 oz/day weight gain is actually another red flag for this baby, not a positive thing at all.
When I have seen moms whose babies are more than 12% below birth weight, their milk supply is often compromised if the baby is more than 10 days old. Once the baby is being supplemented with the mother's own pumped milk or donor milk (or formula if necessary), they often gain 3 - 5 ounces *overnight*. This baby is not doing well. I'm stunned that the mother is reporting that two doctors and a midwife are not concerned about this baby's weight gain and lack of stooling. This just does not make sense. Is there anyone at all in her area who could make a visit to her so you could find out wha the baby actually looks like?
When mom has come to see me with a baby who is not gaining well and/or not stooling, I find it is helpful to have them keep a detailed record for at least 24 hours to show how many times they are feeding the baby, how long the baby is at breast, how many times the mother pumps, how much she pumps each time and how much supplement is given to the baby at each feeding. Remember, this baby needs to be getting at least 25 - 30 ounces of breastmilk, EBM and/or formula per day to get back on track. Sometimes mothers hear "feed the baby 8 - 10 times a day" and think 6 is good enough. They hear, "supplement with 1 - 2 ounces per feeding" and think it is OK to give a couple of extra ounces per day. And, then even if they follow instructions with ranges, and go with the low number in the range, it can be a difference of 8 ounces or more over the course of a day. With this mother, I would advise her that the baby needs to eat *at least* 12 times a day.
I'd be surprised if this baby has the energy to feed vigorously 12 times a day. I hope the mother is pumping her milk to stimulate her supply. She needs to be supplementing at the breast (if the baby is suckling well) or with some other supplemental feeding device in order to ensure the baby is getting enough to eat.
It is often helpful to remind moms that the feedings don't need to be evenly spaced. If the baby has a wakeful time during the day, that is when she may be able to feed the baby every hour in order to be able to get a 2 or 3 hour stretch of sleep during the night while still managing to feed the baby 12 times a day.
I hope you will continue to follow up with this mom and let us know how the baby is doing.
Sara Dodder Furr, MA, IBCLC
Quality Improvement Specialist
Office of Research, Policy & Quality Improvement
Health Licensure & Investigations Unit, DHHS Division of Public Health
P.O. Box 95206
Lincoln NE 68509-5026
Phone: (402) 471-4973 FAX: (402) 471-0383
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Website: http://www.dhhs.ne.gov/crl/crlindex.htm
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