Dear Ann,
It sounds like your case of a 1 yr old Failure to Thrive is very
complicated. Did you examine the baby or watch her nurse? Is the mother
anorexic, depressed, or unattached to the baby? How can appropriate guidance
be provided in a situation like this without seeing the mother and baby? Has
anyone done pre and post-feed weights? Is there milk transfer? Is it
possible that the baby’s developmental delays are related to insufficient
caloric intake? Did you do a thorough history? Did you suggest to the mother
that she should do one sided nursing and continue night nursing in
opposition to the specialist’s orders? Or did you refer her back to the
specialist for dialogue and a discussion of her discomfort with his
recommendations/orders? Did you discuss the consequences of disregarding
physician’s orders with the mother, including the risks of involvement of
child protective services?  Did you provide a written report discussing your
consultation with her health care provider? Did you follow the standards of
practice for an IBCLC and an RN in doing this consultation?  If not, you may
be at risk of an ethics violation. 

It seems to me that this baby needs a very thorough examination and
evaluation, preferably by a physician who is very knowledgeable about
breastfeeding.  Perhaps you could help identify such a person in her area.
You may be right that breastfeeding may be keeping this baby going, but it
may also be related to the root of the problem and we can’t ignore that
possibility.  I sincerely hope this mother and baby receive the care they
need and deserve and that the outcome is satisfactory. 
Good luck, Cathy Liles
 

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