Lisa writes:
<< I am a new PHN and have a mother of a two week old who was 8 lbs 7oz at
birth. Infant was sent home "breastfeeding well". By day 12 baby was not
nursing as well and she began pumping after nursing and giving infant EBM by
bottle (Avent slow flow nipple). At 13 day MD appt infant had lost a pound. MD
suggested supplement with 1 oz formula after each feeding. >>
I wonder how they assessed "breastfeeding well", if just by looking at the
mom and baby, it could have been going wrong right from the beginning. Sometimes
with short tongues-flat tongue, etc baby surfs off a good supply, which then
ratchets down with time as the mom's supply begins to respond to what the baby
is actually doing ( or not doing), and as baby's caloric needs come up. I
would start with consistent weight checks on the same scale ( I'm assuming the
birth weight, and the 2 week check-up weights were on different scales.) It is
also possible that baby had lost more and had already begun to gain again, so
it would be helpful to do same-scale weights, and pre and post-feed weights to
see what the baby is getting at breast, and where you want to get to. I trust
the MD is open to the extra ounce being mom's if the supply comes up. Is the
mom against all galactogogues or would she try something simple like MMilk
tea? If it's low milk on mom's end, not in response to baby but primary, then
peri syringe at breast might help, if the baby stays awake and actively feeding.
If the moms see this, she might go for the at-breast supplement route, but
then again she may still hate the idea. Also it's frustrating when mom's don't
want to try the assistive feeding devices/strategies that we think might work
best, but paced bottlfeeding can help baby learn to actively feed, and keep him
interested and well-fed but not overfed. Some babies just fatigue out before
they get enough ( tracheomalacia, laryngomalacia) and need extra help for a
while. Any thing like that going on, some anatomical disadvantages have the same
effect, short tongue, tongue=tie, recessed jaw etc....
I'm sure other -people have other thoughts...:)
Judy LeVan Fram, PT, IBCLC, LLLL
Brooklyn, USA
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