Dear all:

I would like to share more details of the case of the baby with metabolic disorders since the mother long ago gave me permission to share information about her case with others.

What is very interesting about this case, is the baby in question was a stealth feeder.  She would feed for a very long time and did NOT look like she was swallowing.  I've seen other babies like her before I had the scale where I would be biting my nails worrying about the baby because I did not see or hear swallows.  Yet the post feeding behavior looked like satisfaction.  I worked for many years without a scale and was trained by some of the best in the business at detecting swallows.  I would bet my annual salary that 90% of the really good lactation consultants I know would have thought this baby wasn't swallowing.  The mother was a second time mom and she too was firmly convinced this baby was NOT swallowing.  She had zero problems with her first.  We were both astounded at the results of the test weigh.   So this was important for both of us.  The mother felt much more confident in pushing further to get to the endocrinologist who finally diagnosed the condition.  Without the information, I myself would probably have recommended supplementing this baby after every single feed.  It turns out this baby drank far LESS from a bottle.  So, had I tried a supplemental nursing system, the baby would have probably been flooded with milk.  Had I suggested a bottle, the baby would have actually received fewer calories.  And I'm sure it would have taken far longer for this baby to be diagnosed.

For those of you who have not already done so, please do read Laurie Nommson-Rivers work.  If you are statistically challenged, I will be happy to explain the statistics to you off list.  She really shows that diapers do NOT predict weight gain with sufficient accuracy to be used in isolation.  Neight do diapers do accurately predict milk intake.  I have tons of data in my clinical files of babies who were not transferring sufficient milk and had a perfectly fine diaper count -- and vice versa.  And no, many of these babies did NOT have major health problems.  Some did have anatomical issues.  Some did have iatrogenically induced issues that could have been prevented by baby friendly practices.  We also know that milk intake does not accurately predict milk production because we have all seen mothers who could easily produce enough milk for many babies coupled with babies that cannot transfer enough milk to thrive.  So therefore diapers cannot accurately measure milk production either.  While milk production will ultimately decline if a baby has an inadequate intake -- it won't decline if milk is expressed to compensate until the baby can take more.  Diaper counts are but a crude yet very visible indicator of a baby that is seriously in trouble.  

While I consider diaper counts useful, I do not consider them sufficient on their own to diagnose anything.  And my conclusions are based on the evidence I have read.  I prefer to use as many of my senses as possible to assess a situation.  And certainly I would never use any indicator without thoroughly talked with and LISTENING TO the mother.  She can often be the most crucial asset in detecting what may help her and her baby to breastfeed better.

Sincerely,
Susan E. Burger

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