Thankyou Barbara for posting this sort of information. I have a personal
reason for being glad that Lacnetters share so generously of their expertise
and experience.

I'll share the story. Late last year one of my sisters in law gave birth to
her second child. Her first child had been small for gestational age, had
breathing difficulties, flown to Sydney and in NICU/special care nursery for
several weeks. Breastfeeding was initially difficult as you would expect but
she went on to breastfeed for over 2 years and was a great mother to a very
high needs child (I think she was afraid of losing her mother again so had
to sleep with the breast in her mouth all night for a couple of years).
However, this baby was term a good size and did well initially putting on
nice weight gains and looking great with chubbiness and fat rolls. At 4
weeks I got a call from my SIL, the baby had lost weight on the scale and
she could see that she had lost weight, she just didn;t look good, she had
an appointment to see a Dr, just wanted to make sure that it couldn't be
that her milk wasn't rich enough. I could reassure her of that and
encouraged her to breastfeed more frequently (I had heard via my mother in
law- who was quite happy about it- that they were stretching feeds, not
creating a rod for their back like last time). She was described as a very
"good" baby. Christmas busyness intervened, I went away on holidays and
didn't see my SIL until a couple of weeks ago. The goss through the family
grapevine was that she was doing OK. However, when I did see them baby was
now 11 weeks old AND HAD NOT GAINED ANY WEIGHT IN 7 WEEKS. This child
frightened me, she looked terrible, all big eyes and skinny limbs with skin
hanging! My SIL had seen early childhood nurses, her GP and a paediatrician
every week. They had had blood tests etc done but had no answers. I tried
very hard not to show my SIL how scared I was (woke my up in the night
worrying) and after talking to her about it arranged for her to see an ABA
friend and have her watch her breastfeed (since I lack those hands on
skills). I had a niggle in the back of my mind that perhaps she was one of
those babies who coasts on the initial abundant milk supply but is not
suckling well and as milk production switches to supply/demand regulation
falters (as discussed on Lactnet). In fact this ended up being the case. My
ABA friend could see that she was not breastfeeding well. I was furious! My
SIL was very upset, she felt she had been starving her baby. However,
finally there was an answer and since working on making sure attachment is
good and that milk is being transferred she has finally started gaining
weight. How on earth she could see so many health care professionals and her
feeding not be assessed I don't know. What would have happened to her had I
not known enough to refer her for assessment of feeding I shudder to think.
The paediatrician has made some complimentary statements about ABA
counsellors but not apologised for his incompetence.

The complicating factors in this case:
1. She was a second baby, hcps assumed that having breastfed her sister for
2 years that she knew what she was doing. However, she had not breastfed
this baby, she had not breastfed a newborn for 3.5 years and when she
breastfed her first child she had had every feed watched over for weeks and
adjustments made.
2. The baby was not well attached but she had no pain (my SIL puts this down
to the fact that her daughter had a breast in her mouth almost constantly
for a long time and even after weaning is still pretty obsessed and twiddles
a lot!)
3. My SIL stated that she thought she had plenty of milk and that she was
breastfeeding well and HCPs accepted her assessment which is perhaps an
acceptable excuse for when she initially presented with weight loss but not
over nearly 2 months!
4. My SIL refused to supplement. If she had the baby would probably have
gained weight, breastfeeding would have failed and problem would have been
solved according to the HCPs. I suspect that they do not see many mothers
who refuse to supplement and insist on solving the problem.

Anyway, I apologise for the length of this but I am extremely grateful to
those of you on Lactnet who gave me enough knowledge to be able to help my
SIL and neice.

Karleen Gribble
Australia


>  As the work of feeding increases for a small, immature baby, there is
> greater risk for feeding-related fatigue.  The baby may feed ok for a few
> min. but will tire quickly and cease feeding before really getting full.
> As these infants consistently fail to access much more than the first
> letdown, they start to hibernate to save energy.  They become harder and
> harder to rouse.  Their weight drops;  fatigue and energy deficits
increase,
> and they become less and less capable of reversing the downward cycle
under
> their own steam.  They tend to leave so much residual milk in the breast
> that there is a build-up of FIL and a subsequent down-regulation of milk
> supply.

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