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Sat, 12 Apr 1997 14:24:23 -0400 |
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I had an interesting case this week. I was a mom and her four month old
because her doctor told her the infant wasn't getting enough to eat and
she was concerned about her milk supply. The infant was born with a
ventricular septal deformity and was taking Digoxin and Lasix daily. No
surgery is currently planned to close the hole. He has been gaining
about 4oz a week. He has appropriate linear growth and head
circumference. There were no signs of congestive heart failure. No air
hunger following feeds, no circumoral cyanosis, no diaphoresis. My
usually routine is to visit with the mom and infant first, then to weigh
the infant, have mom feed the infant, weigh the baby again and during
the feeding we usually talk about what she thinks is going on. When I
asked her to feed the baby, she laid him on a pillow in front of her and
without holding him or bringing him to the breast, she offered the
breast to him, holding firmly to the areola just behind the nipple.
We discusses her positioning, she has never held him close to her,
except when burping. She was agreeable to positioning suggestions. He
took in 115cc at that feeding. She had also been; substituting rice
cereal for one or two of his feedings per the doctor's suggestion. I
suggested that breastmilk had significantly more calories and that
solids are offered in addition to feedings at breast, not in lieu of.
This infant is very stiff. Not easy to hold, not "cuddly". I have
notice this stiff posture with several other infants who were slow
weight gainers. Don't know it there is a connection. I will follow
with her through the month. Any other ideas?
Karen Titus, RNC, IBCLC
Hudson Falls, NY
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