Nice work Julia!

Gail Hertz
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On May 17, 2013, at 9:16 PM, "Julia A." <[log in to unmask]> wrote:

> Hi all,
> 
> Thank you ALL for your guidance and suggestions with the case of the “unexplained” weight loss! Just to recap, baby was born at 8lbs 4oz and by day 10 was reweighed at 7 lbs 1oz. Needless to say, pediatrician expressed concern because of the 15% weight loss and wanted supplementation. He also asked mom to pump and dump her milk (!) as he was worried about celiac disease.
> 
> I confirmed with the pediatrician that the baby’s weight was consistently going down since birth, and not just on the upswing. Every single weight check had been lower than the last. I spoke to him about celiac disease and how my understanding was that gluten antibodies take some time to form and begin circulating in the blood. We agreed that baby needed to be supplemented based on the numbers, but that sensitivity was unlikely a real issue at this point and that mom could breastfeed and supplement. Mom did not receive any fluids in labor (it was a home birth).
> 
> I finally saw mom and baby 3 days ago. Baby has completely normal mouth, no tongue tie, strong suck. Mother tells me she never wanted to breastfeed but knows it’s the best thing for her baby (big red flag for me). I noticed that her breasts were leaking a lot of milk before she began feeding the baby.  Baby latched perfectly right away, mom had no pain whatsoever. Everything seemed completely normal to me until about 5 minutes in, when baby took her first “break” and sort of paused and began non-nutritive sucking. Mom immediately removed her from the breast (and her breasts were still leaking significantly). Apparently, the reason baby wasn’t gaining was that she didn’t have sufficient time at the breast. I talked to mom about satiation cues and about how the baby will have short pauses and will work towards initiating another let-down, maybe even several times during a feed. Mom put baby back to breast and I showed her how to identify swallows; baby actively fed on that same breast for about 12 minutes before self-detaching and the mother told me that baby has never self-detached before! What makes me sad is that nobody that this mother had encountered up until now had watched her feed the baby and see that the simple issue was timing and that her supply was actually fine. Mom called me today (3 days after our consult) to tell me that baby has just been reweighed and has gained 4 oz. on breastmilk alone.
> 
> So sorry for the long post, just wanted to update everyone who was interested.  Thank you all again!
> 
> Julia Amos, MPH, IBCLC
> Milwaukee, Wisconsin
> [log in to unmask]
> 
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