Andrea writes;
>>Baby had
eated 1 1/2 hours before the consult.  What struck me about this baby
was his behavior.  Mom undressed him for a weight and he immediately
started grunting.  I thought he was going to poop, but he kept grunting
the entire visit. <<
Assuming that the remainder of this babes physical exam was normal, I would
then zero in on the stooling pattern ie. last stool?, frequency? is this
behavior consistent  with straining etc.?.....while at the same time
stressing the laxative properties of breast fdng and br milk vs. ABM.
Based on your description, I have seen this type of behavior before but since
you were unable to evaluate latch it is difficult to determine whether the
latchon diffs are a part of a bigger pix ie. r/t the grunting/arching or
whether they are independent and this is a nl newborn who just needs more
breastfdng! I would wait on the PT/OT til the bigger pix is a little clearer.
I find it helpful when scheduling consults to instruct the parents to try
their best to have a hungry baby at the time of consult. This often means not
feeding ABM for many hours prior.
she also writes;
>>My need for a pep talk has to do with my outpatients.  It seems if
things don't turn around immediately they give up. I try to get a sense
of what they are able to do and what they are open to, and I try to give

them realistic expectations.  But in 7 years I think I have had one or
two Mother  who I really felt like stuck with it for the long haul.  <<

First of all, I commend you for following up enough so that you actually know
who sticks with it and who doesn't!  I think many of us don't; we either
don't take/have the time or don't see it as a priority.  The fact that you
stress the need to assess the client's own abilities, expectations etc. is
key and perhaps that could be tweaked a bit? I am focusing in on that because
I have found, from my years of doing this (16), that my own perception of
just what that means, has evolved and changed a great deal! Generally
speaking, I have become much more flexible in my approach, MUCH less
"preachy" and adaptive to the situation I am presented with. After "tweaking"
the positioning etc., I find I spend a lot more time  sitting back and
admiring the interaction of mom/baby, offering lots of positive strokes,
stressing the benefits of skin/skin, give and take etc. This, of course, is
an AHA! moment for some and for others makes seemingly much less of an impact
and it takes a lot of TIME, which we are often short of but for many whose
committment may be waning or iffy in the first place, it becomes the ideal to
strive for.
I do think that 1-2 mothers in 7 years is not very many but then again I
don't know the severity of problems you are dealing with. If you would like
to dialogue more, feel free to email me privately as I am trying to keep this
a "readable" length!
Good Luck!
Lynn Shea Rn,Bsn,Ibclc
Franklin,Massachusetts

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