Hi Heather,
Thanks for your feedback. At the point at which the mom called me and I
observed the feed I was worried about the baby's listlessness, the further
wt. loss, crystals in the urine and no poops. I did recommend supplementing
with mom's own milk based on what I saw. As the baby further progressed,he
was more active, less needed to be coaxed into nursing so at that point I
did recommend more on demand feeding, especially when after a week or so
when poops became more plentiful. Now my thoughts are why did the baby lose
wt. in the last week and could it have to do with the spitting up and I
wondered if it could be overactive letdown in spite of baby not having
reached birth weight? Now the ped wants her to step up the supplementing
again. I do wonder about the possibility of over intervening having an
effect on whats going on. Any more thoughts? Thanks again.
Barbara Holmes RD, IBCLC
Brooklyn, NY
Date: Fri, 14 Sep 2007 11:17:34 +0100
From: heather <[log in to unmask]>
Subject: Re: Suspect overactive letdown in baby who hasn't regained birthwt
> Baby was discharged from
>the hospital at 9lbs. 6oz. and peds wasn=92t worried.
>
>
>
>Mom called me on day 9 and I saw her on day 10. Baby had got down to 9lbs.
=
2
>oz. and had crystals in urine and no poops for a few days.
This description does point to a need to check=20
the effectiveness and frequency of milk transfer=20
ie 'is this baby getting enough milk? ' I=20
agree....but if the baby appeared healthy, I=20
would respectfully wonder at the justification=20
*at this stage* for intervening beyond observing=20
the feed, adjusting attachment/latch if=20
necessary, and checking the mother is feeding in=20
a responsive way and not scheduling or limiting.=20
You may have investigated all this, sorry,=20
Barbara, but you did not mention if you did in=20
your post.
Breastfeeding effectively and ad lib, including=20
at night, keeping mother and baby close - that=20
is, feeding physiologically - can turn these=20
situations round fairly quickly, without the need=20
for the massive hassle of expressing, using an=20
SNS, and formula supplementation (not to mention=20
the health impact of using formula). At least,=20
I do feel these are massive hassles, and my=20
experience is that mothers, even the determined=20
and motivated ones, feel they are massive hassles=20
as well!
The fact that this baby's weight appears to have=20
dropped a couple of ounces once she reduced the=20
supplementing makes me think that there is an=20
issue with supply/attachment/access to the=20
breast, that can be masked by the interventions=20
of SNS, expressing and supplementing.
Would it be appropriate now to encourage=20
physiological feeding only, with adjustments to=20
attachment if needed?
Heather Welford Neil
NCT bfc, tutor, UK
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