I was curious if the baby has been gaining weight at a normal or slow
pace. If the baby began in the lower percentile of not. Has baby stayed
within his own gaining curve? Or did baby drop from a high curve or lose
weight? Someone has to be in the 5th percentile so if the baby is gaining
weight and maintains his own growth curve then there is no problem, right?
Other than the fact that some pediatricians seem to feel that a baby is not
gaining well unless the shoot up to the 50th-100th percentile, regardless of
where they started... and, that is the doctors problem and not the baby's.
I can not imagine the doctors reasoning, I mean, if he/she determines
that the fat is too low then what? Have mom supplement with formula? Does
he/she realize that the baby would not utilize as much of the fat from
formula even if the formula had more fat? and that the fat changes
throughout the day so that is not much of an indication of the total fat
intake of the baby in a day? There could be other issues at work here,
metabolic or allergy.
Mom's supply could be the issue, but what caused the decrease in supply?
It could be any of the things you mentioned, or it could be an OT issue,
baby's suck coordination. Also, if the supply is so low then how does that
explain the baby's spitting up? could it be overactive let down? What about
doing a feeding assessment to include a pre and post weight check to get an
idea of how much baby is taking in at an average feeding, then check weight
in 2 days to see if baby is gaining weight. If you after the assessment you
feel that there is a decrease in supply and it is not from an uncoordinated
suck, then, along with the usual protocol for increasing milk, I would ask
mom about her vitamins, B6 is taken by a lot of active people and can
decrease a milk supply ( as discussed recently here I think ).
I wonder what would happen if she brought in milk expressed after the
feeding from the emptiest breast? If the crematocrit was really high in fat
what would the pediatrician think then?
I am interested to read what is said about this situation and your clients
outcome.
Pam Price IBCLC, CBE
Lactation Services Coordinator
Women's Health
Trident Health System
9330 Medical Plaza Drive
Charleston, S.C. 29406
(843) 824-5013 office
(843) 728-9640 pager
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