I appreciate everyone's input on this and apologize for maybe not providing enough information. Apologies now for the really long post:
This is my original posting that I tried to cut down:
PTP. I saw a 2.5 month old baby girl whose pediatrician was concerned with a 3 oz weight gain in 7 days and "decreasing height/weight ratio". This baby was 38-6/7 wks gestation, always fed on demand, pulls off when full. Mom has consistently pumped 8 oz after mid-morning feed, and 4-6 oz after one other feed. Her peds told her "her milk was probably drying up" and suggested feeding q 3 hr "to make the baby hungrier so she'd eat more". When mom offered EBM after feeds, she only takes 1/2 oz. Mom taking Prozac and PNVs. She is understandably very upset and surprised because she is very responsive to her baby's needs and describes the baby as very happy and interactive. Baby does not spit up a lot. Birthweight 7#7; at 4 days, 7#,0; at 15 days 7# 14, at 1 month 8# 14; at 2 months was 10# 1, then one week later, 10# 4. So the overall was 0.8 oz/day, but started 1.5 oz/day, then 1 oz/day, then .58 oz/day, then .42 oz day. When i arrived the next day, baby was 10# 6.9 oz (so 3 oz overnight gain). Baby had even slept 7.5 hr the night before, which was unusual and as a result, mom was even more full.
Baby fed well but struggled to manage flow even in biological nurturing after letting flow slow. Transferred 100 cc in about 10 min, refused more initially, settled with a pacifier, which was introduced a month ago, only used after feeds. This baby is very alert, active and engaged. Before I left, we put baby back to same breast and she transferred additional 22 cc in about 6 sucks. Mom says baby feeds about 6 x/day, takes 3 oz EBM/feed at daycare.
So I thought this is simple, she just needs to 1) feed more frequently, 2) offer breast instead of pacifier, 3) offer breast whenever she feels full especially overnight, and 4) try a couple days of block feeding.
The next day follow up call, mom reported at least q 3 hr feeds around the clock and sounded really reassured. At daycare yesterday baby drank two 3 oz bottles EBM plus formula, only because she hadn't brought enough EBM. Imagine our surprise today when I went for weight check, expecting great gain, and she was 10# 8 oz (1.1 oz in 3 days).
She had fed an hour prior to my arrival, but I asked to put her back on; she sucked but was on/off, clearly didn't really want to feed, transferred 20 cc.
What am i missing? Thank you
So the reasoning behind block feeding was because baby struggled to control flow DT what seems to be oversupply (clearly not inadequate supply). Baby pulled herself off a lot with milk pooling in her mouth and flowing out of her mouth, as mom sprayed. I figured having mom feed more frequently (which she has been doing), offering breast instead of pacifier, offering breast when full (rather than let baby sleep) and block feeding to help baby manage flow which might help her stay on breast longer and get more hindmilk. I also know that babies struggling with rapid flow often seen with oversupply also then get frustrated with slower flow, so I encouraged compressions during the subsequent times on same breast to encourage swallowing and better emptying. The baby clearly pulls off on her own; the mom is not "timing" feeds (although she keeps track). After a few minutes on pacifier (because she was refusing more breast), I had mom put her back and baby transferred 22 cc, so i figured just offering breast more at each feed (esp. at night, the "dream" feeds) and more frequent feeds would get the baby gaining.
I have seen FTT babies and this does not "look" like one. I have seen babies with TT who initially do well and then fall off the chart when supply reduced DT poor emptying and they are no longer gaining simply by swallowing during letdown. There is no TT or LT that I can see and this baby seems to have no trouble transferring.
Update: I just spoke to mom who reports q 2-3 hr feeds around the clock, feeding completely one side, doing compressions when needed, and offering other at same feed, that baby feeds well during night (which she hadn't done before I visited because peds had told her to let baby sleep). She is offering the breast much more frequently; this morning, baby fed 3-5 min but mom offered more in various positions and baby just "didn't want to be near her nipple". Mom sounds more confident and feels she was just misinterpreting when baby pulled off as being "done" - now she is offering much more and baby seems to be responding to this.
Thank you again for your valuable feedback!
Laura
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