I'm an LC at a WIC program.  A mom called after her 2 mo checkup to say the
MD had recommended formula.  After crying all afternoon, going out to get
bottles(and crying more), she recalled that WIC had called her the first
few weeks after the baby arrived offering help, and gave us a call.  She
had lost the numbers we sent due to a recent move...
        She caught me as I was just stopping by the office after a clinic, 15 min
before closing.  After a brief assessment, I arranged to meet her at a town
Knights of Columbus building where she was helping out.
        Baby born at 6#8  7/16
        at disch        6#5
        at l week       6#2
        at 2 week      7# l
        at WIC at l month--wt done by nutri(baby with clothes on) 6# 8
(no referral to MD or to me)  YEECH
9/16    at 2 mo         6#8

I gave her a breast pump.  Did assessment of latch on the best I could in
the parking lot.   Poor latch.  Milk transfer questionable.   Showed her
how to do
milk compression--Gave handout (Newmans)  Urged use of brpump after each
 feeding, and giving any milk pumped via cup.  Gave instructions and
handout. Suggested Mothers Tea 2-3 X/d
        Followup 9/17    Getting v. little milk via pump.  Still feels she does
not want to use formula or bottles.  Baby taking 2--3 oz via cup, nursing
>10/d, makes a fuss if formula is given in cup.
        Followup 9/18     Was able to provide Medela Lactina and gave demo.
Once again helped mom with latch, and compression techniques.   Suggested
giving formula since baby's wt is still 6#8 tho on a different scale.
        Followup 9/19   Brought mom video on latch to enc. continuing education
for baby.  Did suck assessment--initial few sucks strong, tongue in appro
position, then relaxes into flutter when there is no reward.  When mom
nursed, swallows are audible, visible, and jaw movement is deep when there
is milk coming down.   After a few min, when milk decreases, she stops or
goes to flutter sucks.  With compression we can get her sucking again.
Today I gave her SNS with instructions to use every feed with 2 oz of brM
or ABM, but not to start it flowing until the baby slows after the letdown.
        Followup 9/20    "bad night"  Baby cried and fussed all night did not
nurse well more than l X.   Tried with and without SNS.   Did not pump
because her criteria for using pump is pumping AFTER each feed.   Did not
have excessive fullness this am.  This could mean she still has a low
supply or may mean she gave the baby more BrM than she thought.
Wt check today at MD   6# ll oz.  Naked and on same scale as the 9/16 wt.

Asked mom to have MD call me for consultation "to see if I can be of any
help" and hopefully he will.   He did have the heart to allow her 5 days to
cont to try to BF before insisting on formula, so that is truly positive.
My suggestions to him would be to do some blood work on baby and mom for
electrolyte level on baby and especially for thyroid levels on mom.
Lactnetters, what else would you do?   Are we making progress?   This baby
still looks v. thin, not very responsive to eye contact, tense with tight
fists.  I'm having trouble sleeping.
Michelle Scott, RD,MA,IBCLC    in NH