Greetings,

I'm coming out of "lurk-and-learn-dom" to ask for some strategies to help with 
a baby who is not gaining weight well.

Baby was born weighing 6 lbs 4 oz, healthy, no apparent medical issues.  Mom 
had breastfed one child previously.  This baby was exclusively breastfeeding - 
eating every 2 hours or so, seemed to be breastfeeding well, and making 
plenty of wet and soiled diapers.  Mom had a strong letdown.

At 2 1/2 months the baby weighed 9 lbs 2 oz.  At that point she was 
hospitalized and worked up for failure to thrive.  I don't know exactly what 
tests were done.  A pediatric GI consult was done.  Of course, 
breastfeeding/milk was the first suspect.  Baby was put on every formula 
under the sun from similac to alimentum to neosure.  She vomited up every 
one of them.  The GI said baby had reflux, but keep breastfeeding since baby 
couldn't tolerate anything else.  The doctors questioned mom's supply.  She 
pumped 6 oz every 2 - 3 hours.  They all agreed her supply was adequate, 
just keep breastfeeding.  When baby left the hospital one week later, she 
weighed 9 lbs 6 oz.  Five days after that she weighed 10 lbs.
Now, 12 days later she is back down to 9 lbs.  The peds office had her call me 
to see what tests could be done on the breastmilk to see if there was 
something that was making the baby not gain weight.

The ped says the baby looks fine otherwise - meeting all developmental 
milestones and "acting right."   Right now he is suggesting fortifier in her 
breastmilk.

I don't know what to tell this mother.  The ped did not call me, she did.  My 
opinion of this ped is not very high, but the baby did have a battery of tests 
and I'm assuming things like CF were ruled out.  The mom is experienced, 
knowledgable, and extremely concerned.  When I asked what she did in the 5 
days after hospital discharge when the baby gained weight she said she fed 
the baby every hour.  

Has anyone had a similar situation?   All ideas are welcome!

Thanks in advance!

Angie Daniels, RN, BSN, IBCLC, LCCE
Newark, NJ

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