Kathleen writes;
>>If the volume of milk taken from
the breast is appropriate then the baby needs to be checked further for
problems of metabolism and supplementation might be fruitless as it was with
her siblings.<<
And might it not be that this is the "expected" growth curve for this
particular baby and really isn't FTT at all. FTT is a medical diagnosis that
can't be made if this is at all a possibility.
I worked with a family a while back with a similar presentation. The baby
complicated the matter even further by looking "a little funny", and was
worked up for genetic, metabolic issues d/t his appearance, hypotonia and
resulting feeding issues. All negative and with help (a lot, SNS etc.), he
did well at the breast and gained borderline ok (this despite a LARGE caloric
intake). It seems his older brother, mother, mother's sibs and mother's
sisters children all gained extremely slowly as infants. One cousin was NG
fed at night etc. We spent much time discussing whether the increased cals
and all of the other hoops that the increasing number of specialists wanted
her to jump through in order to up this baby's wt. gain would make a
difference at all.
As an aside, this particular babe provided me with some valuable insight into
use of the SNS.
Due to his hypotonia (poor muscle tone) he would latch well to the breast but
suck was very weak and ineffective. Despite compression of a full breast, he
would elicit little or no flow than fall quickly to sleep. Once we began the
SNS this changed dramatically. With even the slightest flow through the SNS
his sucks became much deeper and more effective and post fd wts. would reveal
lg. amts. taken from the breast. The second we turned off the SNS, his suck
would switch back to the nonnutritive! It literally was like a light switch.
He also sucked much more effectively with the breast/SNS than with any bottle
tried!
Lynn Shea Rn,Bsn,Ibclc
Franklin,Massachusetts

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