PTP.  I saw a 2.5 month old girl (38-6/7 wks, vaginal delivery) whose weight gains were 1.5 oz/day, then 1 oz/day, then 0.58 oz/day, then 0.42 oz/day.  I saw her because she gained 3 oz in 7 days, "decreasing height/weight ratio".  Peds told mom her milk was "probably drying up" even though she pumps 8 oz after mid-morning feed and 4-6 oz one other time/day.  Mom is on prozac.  Feeds on demand, 6 x/day, pacifier use after feeds introduced a month ago.  Doesn't spit up a lot, happy, alert and engaged baby transferred 122 cc at the visit, struggled to control rapid flow (looks more like oversupply) and had gained 2.9 oz according to my scale since peds visit the day before. I had mom feed more frequently, offer breast instead of pacifier and block feed.  Baby takes 3 oz EBM/feed when at daycare and yesterday received formula when they ran out of EBM (mom hadn't brought more, even though she has tons stored).  Weight check today was only 1.1 oz gain in 3 days, she has been feeding more frequently, approx q 3 hr even overnight.  Suggestions?  Thank you


Before I became an IBCLC I was a pediatric nurse for many years and saw many cases of FTT. When I am referred a baby who is not gaining at 'normal' rates (20-30grams during the first 3 months) I can not just sit back. I think the reason why is because I have seen what happens to these babies by the time they are 6-9 months old. They may be smiling and appear content but their skin and bone mass and developmental skills show another picture - plus the thought always hits me that the head and brain does a large amount of growth during the first 2 years - if the body is missing out on nutrition so isn't the brain. 
This baby here was gaining weight of roughly 45 grams per day and then down to 10 grams per day. On the growth chart I am sure this baby has dropped in percentile. I believe the term for Failure to Thrive is used when a child falls 2% marks. If this child isn't there already then she will be there soon at the rate she is going. 

There are a couple of red flags to me - why is mother only breastfeeding 6x per day (that sounds like formula instructions), why did she decided to use a pacifier - was the baby crying a lot especially after a feed and did mother think that the baby just wanted to suckle (missing on hunger cues), if the mother had tons of stored milk why didn't she think to bring more (when packing a diaper bag most parents pack diapers, clothes and food) is there something going on that mother forgot food - is she showing signs of PPD or overstressed with other needs at home? 
Has mother been charting the times that she feeds the baby - because every 3 hours to her may actually be 3 hours after he finished eating (where you are thinking that he is getting 8 feeds he may only be getting 6-7 feeds). Did she put the pacifier away?
You mentioned that you did a pre/post feeding weight - was this done early in the morning or late in the day? Did you 'correct' any part of the latch or have her do breast compressions any anything like that? If you did and she isn't doing this when you are not around then the baby will not be transferring the same amount. Usually on my first pre and post weight I have the mother do what she 'does at home'. I observe the latch but don't say anything. I find when parents see the difference of the amount transferred by changing the latch then they are more receptive to do it at home. I have the mother feed for 10 minutes and then weight the infant. I then have mother place the infant on the second breast and show her a 'correct latch' and have her do breast compressions and after 10 minutes weight again. Mother sees the difference of the amount consumed. Of course this is depending on how early I am too see them before milk supply has decreased. 

Just some thoughts, 

Jessica Callahan RN, IBCLC
USA, NC

             ***********************************************

Archives: http://community.lsoft.com/archives/LACTNET.html
To reach list owners: [log in to unmask]
Mail all list management commands to: [log in to unmask]
COMMANDS:
1. To temporarily stop your subscription write in the body of an email: set lactnet nomail
2. To start it again: set lactnet mail
3. To unsubscribe: unsubscribe lactnet
4. To get a comprehensive list of rules and directions: get lactnet welcome