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Subject:
From:
"Barbara Wilson-Clay,BSE,IBCLC" <[log in to unmask]>
Reply To:
Lactation Information and Discussion <[log in to unmask]>
Date:
Sun, 7 Dec 1997 16:04:15 -0600
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Thanks,  Pam Morrison,  for presenting a wonderful protocol for dealing with
the poorly-growing infant.  I use this protocol myself.  It works well,
problems resolve quickly unless infant is ill, and successful outcomes give
confidence to mothers and doctors that this is not an insurmontable
situation requiring weaning.  I repeat what Pam put so well:  the poorly
feeding infant is generally a hungry infant.  The use of supplementation
(ideally with own-mother's expressed hind-milk) is a quick, effective way to
give the infant more energy to apply to feeding. I often supplement at the
beginning of the feed to achieve a more alert, calmer, teachable infant at
breast. Certainly, an individual assessment needs to be made to determine
which is the best way to "jump start" these babies with some caloric energy.
I rarely use the SNS, because it is complicated to use and  won't help with
the baby who won't/can't latch, and is useless with the baby who is
deliberately self-limiting intake (the hardest kind of situation I work
with.)   I think that everyone working has developed some sense of what
equipment they are most comfortable with, and which things mothers will/can
tolerate.  I don't think the specific method is as important as getting the
baby quickly stabilized and maintaining feeding at the breast during the
whole time -- even if intake is poor.  The nursing and skin-to-skin must not
be interrupted or baby will forget.  I see lots of babies being supplemented
all sorts of ways, and they usually do fine with a gradual weaning away of
all supplementation as things improve  so long as nusing has never been
discontinued.

With poorly feeding babies, the milk supply is in danger.   If  breast
drainage is not augmented by effective post-feed  hand-expression or pumping
with an effective pump, quite often the supply will be permanently
compromised.  Positioning and latch should ALWAYS be adjusted.  I continue
to be desperately saddened by the generally voiced opinion that latch-on is
entry level knowledge, that everyone already knows it (and hence general
disinterest on workshops on technique.)  After 20 years I am just now
beginning to feel confidant that I understand how the baby's oral-motor
function at breast works and how body-position impacts it.  So often,
problems can be fixed JUST by fixing the positioning and latch.  That's the
first line of defense, of course.
Barbara

PS
Also thanks to Dr. Dettwyler for her insightful remarks about
constant-contact mothering in Mali.  I read the business about defecation
and urination signals in The Continuum Concept years ago, started looking
for the signs, and can usually tell when an infant is about to go.  This has
saved me a lot of laundry woes in the course of my work.

Barbara Wilson-Clay, BS, IBCLC
Private Practice, Austin, Texas
Owner, Lactnews On-Line Conference Page
http://moontower.com/bwc/lactnews.html

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