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Date: | Wed, 13 Nov 2013 16:03:47 -0500 |
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PTP
4 mo old almost exclusively breastfed baby was seen yesterday for the
routine well visit.
Baby is doing wonderfully developmentally, but is struggling to gain
weight - went from 25% at birth to 3% now.
According to mom and grandma, older sibling (4 now) and mom herself were
"slow gainers" and "poor latchers" too.
In a short well visit (anticipatory guidance and shots included) I was
able to identify several major culprits:
- definite upper lip tie, no obvious ankyloglossia, (will do further
evaluation for PTT on the follow-up visit next week)
- delayed letdown reflex since birth (no birth control pills because of
the milk supply issue)
- asymmetric milk production - one breast consistently producing about
4 oz/pumping, another - not more then 1.
- no feedings between 11pm and 5 am
- mom is using electric pump at work, and handheld pump at home (and
getting more milk by the hand pump!)
I will be seeing the dyad next Tuesday for a formal lactation consult,
but meanwhile gave the general recommendations on night time feeding,
massage, concurrent nursing/pumping combo, continue supplementation for
now (as we have to feed the kid :()
Any suggestions would be highly appreciated by worried physician,
struggling mother and hungry baby!
TIA,
Alla
--
Alla Gordina, MD, IBCLC, FAAP
General Pediatrics
Breastfeeding Medicine
Adoption and Foster Care Medicine
Global Pediatrics and Family Medicine
NJ Breastfeeding Medicine Educational Initiative
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