Pat I'm glad you managed to turn your scary case around too.  I absolutely
agree that the baby being a breast is *not* a good indicator of whether the
baby is *breastfeeding*.  One of my favourite teaching slides comes from
Debi Bocar and says precisely this too (more neatly!).

I managed to phone the mom of the starving baby.  He was discharged from the
hospital today weighing another 130g (gain 65g/day, yesss!).  She tells me
the baby is *Breastfeeding* (really properly) and becoming insatiable.  8
good wets and 3 yellow stools in the last 24 hours tell us he is "getting
enough", but could obviously do with more now he's got a taste for it
(excuse the pun). Mom tried him with some formula last night, but said he
"didn't like it" and she doesn't know if she can keep up. I've urged her to
*expect* very little sleep for the next couple of nights and just to *keep
going* with very frequent feeding and twice-weekly weight checks for now
(contrary to advice of the penultimate paediatrician who only wants to see
them in 2 weeks (sigh!). Crossing fingers now and hoping they will bring the
baby for me to weigh later in the week.

But apropos of babies "getting enough", Pat you also asked , "How
come we can recognize that satiated look and others can't?"  I've pondered
this too and I wonder what exactly are the visual characteristics which
indicate satiety?  Debi Bocar has another teaching slide in the same set of
a baby just off the breast with that "drunk" look - it's unmistakeable; the
cheeks look fat and "full", and the mouth is very relaxed and the baby looks
kinda stuffed up to the eyebrows.  In practice I've noticed that even though
babies go to sleep at the breast, their body tone is still tense until they
really have had "enough". The elbows are flexed and if you try and lift the
little arm away from the body there's a strong resistance.  When the baby is
really full the arms spread outwards and the whole body tone becomes very
relaxed.  One of the paradoxes of low-weight-gain or FTT babies I've noticed
is that the thinner the baby the *stronger* he is, the little muscles like
iron, little hands scrabblng and clawing to grip on *anything*.

Pamela Morrison IBCLC, Zimbabwe
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