Do we know how much the baby is taking? Does he devour all feedings offered?
Melinda Harris-Moulton,
ANRP, IBCLC


On Wed, Nov 13, 2013 at 1:03 PM, Alla Gordina MD, IBCLC, FAAP <
[log in to unmask]> wrote:

> PTP
>
> 4 mo old almost exclusively breastfed baby was seen yesterday for the
> routine well visit.
>
> Baby is doing wonderfully developmentally, but is struggling to gain
> weight - went from 25% at birth to 3% now.
>
> According to mom and grandma, older sibling (4 now) and mom herself were
> "slow gainers" and "poor latchers" too.
>
> In a short well visit (anticipatory guidance and shots included) I was
> able to identify several major culprits:
> - definite upper lip tie, no obvious ankyloglossia, (will do further
> evaluation for PTT on the follow-up visit next week)
> - delayed letdown reflex since birth (no birth control pills because of
> the milk supply issue)
> - asymmetric milk production -  one breast consistently producing about 4
> oz/pumping, another - not more then 1.
> - no feedings between 11pm and 5 am
> - mom is using electric pump at work, and handheld pump at home (and
> getting more milk by the hand pump!)
>
> I will be seeing the dyad next Tuesday for a formal lactation consult, but
> meanwhile gave the general recommendations on night time feeding, massage,
> concurrent nursing/pumping combo,  continue supplementation for now (as we
> have to feed the kid :()
>
> Any suggestions would be highly appreciated by worried physician,
> struggling mother and hungry baby!
> TIA,
> Alla
>
> --
> Alla Gordina, MD, IBCLC, FAAP
> General Pediatrics
> Breastfeeding Medicine
> Adoption and Foster Care Medicine
>
> Global Pediatrics and Family Medicine
> NJ Breastfeeding Medicine Educational Initiative
>
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