There is a *lot* to consider in Heather's question about the slow-to-gain
baby. I will gently suggest that filing a report to community or social
services about a young, low-resource mother of three with a slow-to-gain
baby, **who has a pediatrician following the baby,** is not warranted given
what you've told us. I will also gently suggest that a lot of what we know
about this case is based on your presumption of the mother's veracity, what
she wants, and is able to do ... and there is more you can do at your end
to ferret out more facts.
Here are the pieces of the puzzle I would like to know ... and they have
more to do with the clinical situation, and creating a care plan *with* the
mother, as our IBLCE Code of Professional Conduct and Scope of Practice
require and ILCA Standards of Practice encourage.
Here goes, and this is just off the top of my head.
(1) How old is the baby? We know it is something over 4.5 months, but how
old NOW?
(2) How often is the baby feeding, and what are the pees and poops like?
Up until your first first, this was an exclusively BF baby, right?
(3) How much did the baby transfer during the subsequent visits?
(4) If this baby is under 6 months of age, and weighs 11.1, how much do you
think the baby *should* have transferred at visit 1? 3 ounces (95 cc) at a
feeding seems just about right to me -- assuming there are frequent enough
feeds throughout the day.
(5) Have you discussed pacifier and swaddling as
feeding-opportunity-reducers? The swaddling part is what concerns me for a
baby who is at least 4.5 months old, and should be engaging with the
outside world with hands and arms and toes and feet.
(6) Any solids yet (again, not knowing baby's age ...)
(7) What guidance have you offered her to boost her own supply?
(8) What in her history suggests IGT; how does your care plan or referrals
address that?
(9) What breast changes occurred in pregnancy or in immediate post-partum
period?
(10) LT and TT on baby? What referrals and follow up there?
(11) Did you teach how to offer the formula supplement in a baby-led way,
and observe that she knows how to do it?
(12) Did you or the pediatrician suggest a 10-12 ounces supplement every
day, right off the bat?
(13) I known you plan a call to the MD next Monday/business day ... but
have you picked up the phone *before* this? (The penultimate ethical
obligation of the IBCLC is to share health care concerns with the primary
HCP.)
(14) It sounds like this mom has access to WIC services -- do you know if
she has barriers obtaining them (like, I am thinking, traveling to the
office, in your remote location, with three kids in arms, is problematic).
(15) Have you discussed with the mother how to recognize "baby states" and
behaviors for what they are ... or perhaps shared Jane Heinig's webiste or
its information: http://www.secretsofbabybehavior.com/
(16) Did her other kids BF? What was their weight gain history; how did
those BFg relationships go?
(17) Is Mom being encouraged simply to BF *more?* Again -- a third baby in
a few years means there are LOTS reasons feedings might be delayed or cut
short.
(18) How's about offering the supplements *between* feeds, rather than
right after? Maybe this baby isn't "hungry for more" before it is being
offered right after a feeding session -- 95 cc seems like
(19) What about this baby's health? Any issues you know of? I'm thinking
reflux-type stuff that might cause the baby to limit feeds.
(20) Has the baby been in to see the pediatrician since you began your
involvement? What did the doc say to the mom about baby's profess?
(21) Who does mom have available at home either to help with the baby, help
with the other kids, or help with the household chores?
(22) How have you adjusted the original care plan given to this mother; did
you take into account her BFg goals and wishes, and ability to follow
through?
If you have a mother with suspected IGT, and a baby with lip and tongue
restriction, and a baby getting a lot of pacifiers and swaddling, in a
household where there is a LOT going (and I am simply here referring to the
other kids, not the cleanliness) ... I will again gently suggest that there
is a lot more to be done to offer evidence-based information and support to
this mother's BFg goals and baby's appropriate weight gain than reporting
her to CPS. That seems like a drastic, "shame-and-blame," punitive step to
take at this point. Your concern that she will know you filed the report
makes me know you realize this is would be a significant and life-changing
event for this young mother who is following your care plan to the best of
her ability.
I should think your assistance in helping her to access the services she
can use will go a lot farther in maintaining the trust she has with you.
Picking up the phone and talking to the primary HCP about his evaluation
of this baby will go a lot farther to informing you what knowledge he has,
and what care plan he has initiated, rather than assuming he is being
cavalier.
--
Liz Brooks, JD, IBCLC, FILCA
Wyndmoor, PA, USA
IBCLCs empower women and save babies' lives!
Learn more <http://tinyurl.com/3nj2p3c> and visit www.ILCA.org
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