PTP. I saw a Mom and baby today for a consult because mom is concerned that her 4 month old is not gaining. She says that he has not gained any weight in 5 weeks. She says her pedi is not worried about it, but she is. He is a large baby, was 9+ lbs at birth, now 16.5 #. Mom says his head and length have not changed either. Now she has noticed that his wet diapers are not as heavy wet as they used to be. Reports 1-2 dirty (yellow, mucus) per day. He is long, and a large baby with fat rolls, smiles, looks developmentally appropriate.
I saw this mom and baby early on and discovered baby had a ULT and TT, ENT release TT, but did not touch the ULT, said it would not effect breastfeeding, ugh! Mom initially saw me early on, for an uncomfortable latch. So things did improve, baby was gaining well until around 10-12 weeks. She reports he became fussy and his stools changed to green and mucus like cooked spinach. They later went back to yellow, seedy with some mucus.
I know this kid is older and lots of patterns and things have gone on, but I find it hard to follow how things have progressed. The mom mentioned eat, sleep, play, (Babywise I believe), but tells me she always fed baby when he was hungry and never made him wait. According to this mom the baby never gives any hunger cues, or really fusses. She just feeds him every 3-4 hrs. AT times it was every 4, he was sleeping throughout the night, slept 9 hours last night. She said she started waking him every 3 hrs to feed, but that did not make much difference. She had been taking fenugreek, per pedi's recommendation, this seemed to boost supply and baby fed for a shorter time, 30 min. OH, yea, forgot to mention, baby has always nursed an hour or so at a time.
So long feeds, I look at this tongue and mouth, I believe the frenulum was not fully released, still has ULT. Baby is very distracted at the breast, latches and unlatches a bunch. Mom says he only nurses now when all the lights are off and it is pitch black. Baby was on and off of breast, not looking very hungry, but transferred 70mls in about 30 minutes. He seemed content with what he had, but did not even seem hungry to start with, even though it had been 3 hours since last feeding. Mom has tried to offer some pumped milk, but baby refuses the bottle, or any other method tried.
It just seems very odd to me when parents tell me their baby does not give hunger cues, and seems like if mom did not just feed, then he would not feed. Is that from the Ezzo method? Is that what it does to them? Mom swears the baby was not on a schedule, and he always ate when he wanted to, but keeps mentioning the eat, sleep, play, so I do believe there is a schedule. I did mention that I have seen some babies quit gaining weight when following any kind of scheduling. Mom tells there is not schedule, yet she is having to wake him for every feeding, or just feed at x number of hours, to me that is a schedule. I think it's could that she is feeding him even though he doesn't seem to be hungry ever?? but that is not normal.
I do think this baby still has some restriction in the mouth, i wonder about the GI incident around 10 wks, and I wonder if some rigid scheduling has made this kid complacent about eating?
Sorry for being all over the place with this, just trying to put all the pieces together, and not to leave important things out.
Your wise thoughts on this one would be appreciated?
P.S. the fenugreek came in a while after the green stingy poop, so I figure that was unrelated
Karen Lavergne RN, IBCLC
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