Susie,
I can't help you with research on negative outcomes due to rigid
scheduling. But if the outcome is very slow weight gain, or failure
to thrive, perhaps you could focus on that and the likely
consequences of malnutrition/marasmus/kwashiokor for the baby. These
most definitely should be of concern to the mother and if they are
not then perhaps a referral needs to be made to child protection services?
I enjoy working with low gain and failure to thrive situations. The
causes can be many, and often the parents simply don't see that it's
happening so that it takes someone else - a friend or a grandparent -
to alert the parents to the fact that there really is a
problem. Some of these cases also begin because the mother seems not
to perceive how very vulnerable her young baby is to inadequate
intake in the early weeks. One thing leads to another, and then even
the most dedicated mother may be powerless to stop the baby's slide
down the weight chart because the baby becomes unable to breastfeed
effectively due to lack of energy. She may need concrete care plans
to increase the baby's intake and boost her flagging milk
supply. Advice to feed more often may not work past a certain
stage. I recently worked tangentially with a case where a baby
younger than 6 months, who was currently being exclusively breastfed,
was diagnosed with marasmus and I have to say that from the reports
etc that I saw the baby's healthcare providers were not without blame
because they provided reassurance to the mother that low gain was
fine when it clearly was not.
If you have access to the baby's weights from birth, and if you
compile a careful chart, and make an assessment of the average daily
rate of gain, you should be able to make a fairly good assessment of
what's going on. As a rule of thumb a baby should gain 30g/day from
0-3 months, 20g/day from 3-6 months and 15g/day from 6-12 months. If
you plot the chart and see the baby falling down the percentiles, or
if you make the assessment and see that the baby should weigh xxxx
and he weighs an appreciable percentage less than that, then there's
a duty to discuss the numbers with the mother. When a baby is
failing to thrive, it doesn't really matter when it started or the
reason for it (though that is of interest to prevent it happening
again in the future, and it's helpful to go through the chart with
the mother so she can SEE what has happened). You can then focus
less on the rigid scheduling and more on the baby's current poor
physical condition and the fact that the baby is not developing
normally for his age. What is of the utmost importance is to
identify for the mother that this baby has a problem NOW. Then you
can let her know what changes need to be made in order to remedy the
inadequate weight gain - starting immediately, and including a
referral to a paediatrician - so that the baby's current nutrition
and future growth and cognitive development are not permanently
compromised. Eventually, once the mother starts feeding the baby
more milk, and more often, she will see for herself that the rigid
scheduling was perhaps the cause, or at least one of the causes, of
his failure to thrive.
Some refs you might like to check out are:
Krugman, SD, and Dubowitz, H. Failure to Thrive. Am Fam Physician.
2003 Sep 1;68(5):879-884. available at
<http://www.aafp.org/afp/2003/0901/p879.html>http://www.aafp.org/afp/2003/0901/p879.html
Wright CM, Garcia A. 2012. Child under-nutrition in affluent
societies: what are we talking about? Proc Nutr Soc. 2012
Nov;71(4):545-55. doi: 10.1017/S0029665112000687. Epub 2012 Sep 7.
From ENN
<http://www.actionagainsthunger.org/sites/default/files/publications/Summary_Report-_Management_of_Acute_Malnutrition_in_Infants_MAMI_Project_10.2009.pdf>http://www.actionagainsthunger.org/sites/default/files/publications/Summary_Report-_Management_of_Acute_Malnutrition_in_Infants_MAMI_Project_10.2009.pdf
Shields B, Wacogne I, Wright CM, Weight faltering and failure to
thrive in infancy and early childhood. BMJ 2012;345:e5931
Desmarais L and Browne S, Inadequate weight gain in breastfeeding
infants; assessments and resolutions. Lactation Consultant Series
Unit 8, La Leche League International.
Riordan J & Wambach K, Breastfeeding and Human Lactation, Fourth
Edition, 2010, Jones & Bartlett Pubs
Walker M, Breastfeeding management for the clinician; using the
evidence; published by Jones & Bartlett 2006.
Hope this helps.
Pamela Morrison IBCLC
Rustington, England
-------------------------------
At 19:35 04/12/2013, you wrote:
>Date: Wed, 4 Dec 2013 19:35:38 +0000
>From: Susie McCulloch <[log in to unmask]>
>Subject: Research on negative psychological/physical effects of
>rigidly scheduling and limiting breastfeeding?
>
>Hi Everyone,
>Does anyone know of any research on the negative outcomes for baby
>when breastfeeding is rigidly scheduled/limited due to parenting
>beliefs? I don't have permission to post so I won't go into
>details, but I think giving specific research to a mom that I am
>working with might help her if she can see the long term
>consequences of what she is doing, because the very slow weight gain
>is not that concerning to her.
>
>Warmly,
>Susie McCulloch, IBCLC retired LLLL
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