Dear Lactnetters,

I just wanted to say a collective thank you for all of your comments and 
suggestions. This mom will be coming to visit again tomorrow and we will use 
some of your suggestions to reevaluate the situation.
What we do know is that there can be several reasons for this very thin 
baby.

And it may be more that this second time  mom is concerned about the baby 
not breastfeeding well that keeps her from offering the "plenty of bottles 
of breast milk" she is storing in her freezer that she has pumped in the 
last 4 weeks. Why she wouldn't ask her pediatrician why he recommended 
formula for the 35.4 week baby over her own pumped milk, until breastfeeding 
was going well I'm not sure despite urging from us to do so.  What I do know 
is that since last Thursday one of her pediatricians told her to give 
formula separately from breast milk so they could see what the baby was 
taking in and despite a very thin baby, she barely gave any, saying the baby 
"didn't like it", and she still did not try to give her pumped milk to her 
baby.

Her current LC plan is to nurse 10-12 x per day for as long as baby desires, 
as her pre and post test feeds were fairly decent.  She is to also give her 
pumped milk in sufficient quantities to
more than adequately meet his growing needs, document all she has done and 
since our initial consult. If her baby does not gain on mom's milk doing the 
above then I am ready to ask more in depth about mom's dietary habits.  Her 
other health history is fairly normal. To me something does not sit right 
with me; a gut feeling. Maybe because she was quick to point out her exact 
weight gain in pregnancy (only 19 pounds) and exactly what she had to eat, 
even though mom herself is very tall, long and lean. I do know that she got 
poor advice from her pediatrician early on.  Typically we are the ones to 
see these early ones in 2 days and the peds in 4, but due to distance from 
the LC's  this did not occur, feeling she would be taken care of by her 
pediatrician.

I remember some years ago,  we talked about keeping breastfeeding going at 
an area conference,
At that time, we decided that unless you had a totally friendly 
breastfeeding doc it was better to keep them out of the peds office and have 
them evalauted by an experienced LC.  And that my friends is a whole other 
topic...... Vacation beckons and I for one am ready to not hear the words 
"supplement with formula" for an entire week!

LuAnn Smith RN, BSN, IBCLC

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