Okay, I'm here now at their house.    Baby is working hard hard hard
with a beautiful latch and is rarely swallowing.   There was a 5 min
period with pretty consistent suck/swallow pattern but otherwise suck
suck suck, arches back, comes off, goes back on happily. She's been
nursing intermittently,  more on then off for the last three hours
She's patient with it all.   Mom and dad report that this is typical
for evening.   Around  11 pm she generally goes to sleep and sleeps
until 4 or 5.    So she's sleeping 5-6h at night, wakes to feed, goes
back to sleep for four more hours, then is essentially awake the rest
of the day nursing as much as is desired.  She really does not sleep.

Six weeks old, rolls over front to back and back to front.  Has been
rolling over front to back since three weeks.   Incredible head
strength, leg strength...she stands, fully supporting her body weight
if you just balance her upper body.  Sits upright in the front facing
kangaroo carry in a sling.  Coos, interacts, smiles, babbles. .

As is commonly the case, it is reported that morning feeds seem to
involve more sucking and swallowing....i'll see soon.

I finally got to the core of the peds concern after talking with dad
who had taken the last call from the ped....they do chart weights but
he and his partner really want to see about an ounce a day and
definitely not less than 6 oz in any given week regardless of
averages.  So there you have it.

Baby looks fabulous.   Dad feels *very* confident (overly so) that
things are not only fine but great and that supply is a total
non-issue......baby is just small like they all are.  (definitely some
truth to that) Mom feels confident most of the time but wonders at
times (afternoon and evening)  I think it's pretty clear that overall
based on both weight, gains, development, output, latch etc that they
are doing fine but that it's a close call.  This past week mom went to
a couple of meetings, brought the baby who slept through it all.  Mom
realized feedings were missed....no engorgement

I encouraged her not to miss feedings - she's already getting 5-6h at
night.   We talked about using higher nighttime prolactin levels to
her favor, using domperidone along wtih slight adjustments to latch
(deeper, more asymmetrical...though latch was definitely acceptable by
general standards) and breast compression.

Baby is calm and determined like both parents.  Looks like and is
built *exactly* like dad.   She is a darling and fierce creature who's
definitely getting enough milk in a 24h period, but maybe not as much
as she'd like for significant parts of that 24h period.   Mom has
enough, but the balance could be fairly easily upset if feedings were
missed, if baby started to rely on a pacifier, or if they are
separated.  This baby will sometimes let you know if she's hungry, but
she definitely has a hx of being 'happy to starve'.

Baby nurse put mom/baby on a four hour schedule.   Baby was willing to
oblidge and did not ask to be fed more frequently.   Ped put a stop to
that, but it took some time to reverse the downward trend- even once
mom was feeding more frequently - starting on day 5, it took a week to
see any improvement in weight.  Mom thought the 4h schedule was okay
b/c hospital instructions were to nurse 'every 2-4 hours on cue'
(wait, is it every two to 4 hours....or is it on cue?)   B/c baby
wasn't asking, 4 hours seemed as often as needed plus she was sleeping
6h at night from the beginning.  It's easy to see how the difficulty
came up.

At a hospital sponsored bf support group, the IBCLC encouraged her,
based on concerns from the mom and ped, to nurse for 15 minutes each
side, then pump for 15 minutes, then feed the supplement.  She
couldn't make that work....that's when she called me.

We have a doc willing to write domperidone, she's eager to try it so
we'll see.  She's appropriate doses of fenugreek as well.

re baby nurse<< I think I can honestly say I have not come across any
situation where
> this has been helpful to the bf (I am speaking of a skewed sample - the
> people who call for bf help - so maybe there are other families where the
> maternity nurse has been an angel. Maybe).>>

2nd.   This mom was frustrated b/c the baby nurse did everything
rather than taught mom to do things herself.


<<My question now is whether US paeds and others use charts to assess growth
> rate of newborns? >>

Yes, at least around Atlanta the docs do at every visit.

<<Because doing so is a useful way of getting away from the
> question of 'how much weight does a baby gain per week?'. The baby in
> cillakat's scenario was born on the 9th centile, and at 5 weeks was still on
> the 9th centile  which is perfectly normal - 9 per cent of healthy babies
> are there!  I don't understand why there is concern about this (though I
> agree bf after reduction does merit close attention>>

Exactly.  I really love this doc.  He was concerned b/c of the
problems in the beginning so now it's firmly planted on his radar.
In combination with that, he's convinced he needs to see at least 6 oz
per week and preferably 8 oz.  But this baby looks *fabulous*.
Amazing.  Ideal. And at this time  is gaining well.
Katherine

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