Hi..From Kathleen Bruce

>
>I saw a mom a week ago with a 2 wk old baby who had down 6 1/2 oz from birth
>wt.  Mom was not feeding frequently enough and baby had a nibble latch on
>taking in only the nipple not the areola.  Baby was having few wet diapers and
>had stooled only 2-3 times in the 2 weeks.  We corrected l/o

What do you mean corrected i/o?

and positioning
>and baby was quite willing even while in the office to take in the whole
>areola.  Increased bfings to q 2 hrs during the day with one or 2 3 hour
>periods at night.  Mom definately complied with instructions and kept a log
>which I saw when they came in today.  Baby's bms have increased to several each
>day often one with each feeding, though they still are somewhat dark in color
>and not quite the mustard I would like to see.  Plenty of wet diapers, but baby
>only gained 1 1/2 oz in this one week period.

Hmmm ..what color are the stools now? Is the baby medicallyok? Is the mother
ok? Could it be low thyroid, or low supply? Retained placenta? I don't
know..I have had some mothers with this...lots of nursing, but low gain
still. The problem lies with milk production, milk transfer, or baby. : /.
How long is baby nursing per session?


 Baby was wedging mom's nipples
>when I first saw her and while she appears to be on the breast correctly I am
>still seeing some wedging of the nipples

Please explain wedging?

 I think this is happening near the
>end of the feed when the baby starts to pull back.  I have sent mom home with 2
>hour feeds around the clock and using an electric breast pump with double kit
>for 10 min. after each feed during the day to see if we can get the baby's
>weight moving up.  I do see nice deep sucks and hear swallowing when baby is at
>breast and mom confirms she is seeing that at home, as well.  I am seeing them
>again on Fri. - 3 days from now.  Any suggestions?
>
>I would suggest feedings on CUE not q 2 hours, since mothers often have a
better feed if their babies are fully awake for the feeding. I describe cues
in detail to the mother, and then I recheck positioning...If she pumps at
least 6 times a day, with the double system...then feeds the baby the milk
either at breast witha periodontal syringe or supplemental nutrition
system...this should increase stim to breasts, and amount ingested, with
ultimate inc in weight gain.

Kathleen

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Kathleen B. Bruce RN, BSN, IBCLC
Williston, Vermont USA
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To err is human, to really screw up you need a computer...*wink*
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