I'm still nomail, but this week I have been experiencing Lactnet right in my
actual living room, as opposed to the virtual one.  Karleen Gribble came for
a visit, which was made even more fun because Marit Olanders, editor of
Swedish 'Amningsnytt', followed by Mia Westlund, my IBCLC/midwife partner in
crime from Gothenburg, also managed to get here for overnight visits.  It
was a mini-retreat for me - or maybe I should just start something called
Rachel's B&B, where one of the B's is for breastfeeding discussion.  

Because of all these bothersome distractions I had not read anything at the
archives in the past week, until today.  Mary Jozwiak's case caught my eye.
I noticed that this baby was long for his weight even at birth.  Both his
parents were long, lean babies.  Is it possible to measure his length now?
I am willing to bet he is at least an inch, and probably two, longer than he
was when he was born.  I say this because all of the other things in the
description of him sound like a thriving, healthy baby.  The pediatrician
isn't finding anything the matter.  The baby is happy, developing normally
in all other ways, he has unlimited access to the breast, he is producing
urine and stools and mother is feeling no pain with feeds.  

I agree that when a baby hasn't regained his birth weight by three weeks, we
need to investigate.  But when investigation fails to show anything other
than a lean baby, there isn't much to do about it.  Every once in a while
you meet someone who falls outside the bell curve, be it in income,
niceness, number of books read in past year, how fast they can run 1000 m,
or as in this case, weight.  It doesn't have to be pathology.  Some of us
are just statistical outliers, and there is nothing to be gained by trying
to make us be closer to some arbitrary average.  

Mary, while I would be concerned about all the finer details of his feeds if
I felt there was a problem other than the slow weight gain, when I read your
post, my concern vanished.  Therefore, I am not sure it is necessary to try
to get him to swallow more milk than he is already doing or to behave in
some other way at the breast - his behavior at the breast sounds entirely
physiologic to me when I read your very clear description.  Babies latch on,
they place their order for an MER and when it arrives they drink it down.
If they want to order another MER serving, they hang out for longer, and
unless the milk continues to flow rapidly between MERs so that they need to
keep swallowing in the meantime, they just wait.  If they can't wait til
that breast can muster a MER, they twist around to the other side and hang
out there.  When they have had their fill, they come off.  It sounds to me
like that is what he is doing.  I can understand your friend not being
enthused at the prospect of trying to manipulate the composition of his
feeds when it sounds like there may not be any reason for concern other than
the percentile in which his weight falls.  Get a length measurement - and
consider the possibility that there was something wrong with the scale when
he was weighed at birth, or perhaps with the recording of that weight.  (But
I bet the parents have a picture of him on the scale with the weight
showing!)

Just because the parents are good friends of yours doesn't mean that you are
*missing* some glaring pathology due to your closeness to the family.
Sounds like you have been extremely stringent in your assessment and they
couldn't be getting better care anywhere.  So, maybe you deserve to just
relax now?

As far as his jaundice goes, as long as he is behaving as you describe I
would not be concerned if the pediatrician isn't.  ABO incompatibilities
rarely pose any threat to term babies and the ones with pathological
jaundice don't act the way this baby does.

Cheers
Rachel Myr
Ready for the next influx of Lactnetters, whenever that might be, in
Kristiansand, Norway  

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