I would agree with Rachel.  There is a lot more detective work that
needs to be done.  I would want to know about anything else taken by the
baby including all snacks, foods, and any vitamin supplements and
anything taken by the mother.  I have found that you have to
specifically ask about birth control pills because moms often don't
consider them medication.  It might be helpful to ask the mom open ended
questions, to have her walk you through one of her days (in narrative
style)--when baby wakes, what happens next, etc..., where, when and how
baby sleeps.

Find out what goes on in this baby's life and what issues are present
for the family in general.  Interspersed it can also be helpful to have
her track meal patterns and detail what she eats and drinks over a day
and what she feeds the baby one meal/snack at a time.  For instance, it
can be surprising to find out how many cans of diet soda or coffee are
consumed.

I am thinking of one particular mom we worked with.  After some
discussion, it became clear that a combination of birth control pills, a
busy mom who ran a daycare in her home, a passive baby who would take a
pacifier almost constantly, and seemingly permanent residence in the
dreaded plastic infant container added up to an increasing weight gain
deficit and compromised milk supply at 5 months.

It was very subtle.  The baby was developmentally ok, (not great, but in
the normal range), very quiet so did not seem hungry.  It wasn't until
the growth curve was watched, compared to previous chidren in the
family, bloodwork done, and some discussion with the family all came
together to give us the whole picture.

It turned out to be a happy ending but the mom had a hard time
re-training herself to not put the baby off.  Interestingly, she found
that everyone became happier and the family stress level went down when
she stopped overdoing it.

Karen Seroussi, LLLL, IBCLC
Volunteer and Private Practice

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