For what it’s worth, I am VERY impressed with all the responses I read! I didn’t have time to give my 2 cents before this, but now I don’t have to because you all nailed it! I don’t know the ages of those responding, but what you wrote was words of the wise.
Having been an RN and shortly there-after an MD/pediatrician, and a while later and IBCLC, I can speak from both sides of the fence as I share my tidbit and praises to you all.
As residents in training, pediatricians spend an enormous amount of time in the NICU caring for SICK babies because the facilities need the cheap labor! The feeders/growers are in such systematic care routines that the newby doctor doesn’t really make big decisions — it all just happens. Then when we are face to face with a struggling mom in the clinic, in a 15-20minute time slot and more patients waiting in rooms, it’s very hard to parse out the details of how a “breastfeeding” mom is really feeding her baby. It takes so much time to get all the needed info about pumped volumes and volumes fed of breastmilk/formula if needed, especially when the mother is so distraught and spewing out random information! My partners are quick to refer to me to sort this out. Like you all, I am blessed with more time with these mothers, because I only consult my partners’ babies, and I don’t have sick children in the next room waiting for my time. I’ve thus gleaned a ton of experience, as all of you have, spending ample time and follow up, learning how special babies grow best. My partners are EXCELLENT physicians and could certainly do what I do, but they don’t have time, which is unfortunate but reality. It’s not that these babies aren’t important and deserving of their time.
You’ve been very gracious with your comments about the MD and dietician, and that’s very appreciated! It does take a team, and I’m sure they appreciate your input in these scenarios, because we all just want what’s best for the baby but sometimes we feel stuck as to what to do next! So perhaps my point is this…..we need more of you all, at the same time that physicians are gaining their experience and hopefully getting more education about breastfeeding/nutrition in general.
It’s kind of like psychiatrists who prescribe the psych drugs, and the psychologist/counselor who spends the time with the patient making sure that progress is being made.
Thanks everyone for what you do every day!
Kay Anderson, MD, IBCLC
Nebraska
> On Nov 2, 2018, at 11:33 PM, Tricia Shamblin <[log in to unmask]> wrote:
>
> Thank you for all your great posts. I will share these great thoughts with the mother. I think she will be reassured.
> It would be nice if we had more research about nutrition for IUGR babies. I also would recommend they feed ad lib at this point, like many of you have stated. I would say that I have definitely found though, that recommending target volumes for jaundiced, preterm babies, or poor feeders has helped many mothers in the beginning get the baby feeding better. They often really appreciate getting specific guidance and dislike vague responses when it comes to when and how much to bottle-feed a baby that is bottle-feeding poorly.
> I also feel hospitals in recent years, have often been pushing way too fast with large volumes in the first few days of life. This IUGR baby actually worried me quite a bit on the first day because he was such a poor feeder. We were giving colostrum and small volumes of donor milk, but having a hard time getting him to bottle-feed. It took 30 minutes to get him to take 5 or 10 ml. I wondered if we were going to need to put an NG tube in him. But after the first day, he started slowly bottle-feeding better. It just made me think about the fact that it's probably normal for babies to given 24 hours to wake up and figure out how to feed at breast or bottle.
> I think the Pediatrician and Dietician are doing the best they can with the information they have. It's hard because there is limited research and more is needed. Sometimes we have to rely on common sense as well to fill in the gaps. I think that is right about IUGR babies making up for lost time. I have a friend that is a NICU nurse and she said that typically when they figure out how to feed themselves they make up for lost time and eat like they've been starving. I also had thought that he would probably need to catch up a little more before he's a great breastfeeder. Term IUGR babies seem to catch up faster than the typical preterm infant.
> Yes, 25 to 30 ounces daily total volume is typical by about a month. I bet this baby will take about 2 months or a little more to get there. I remember a study that looked at preterm infants who were bottle-fed breast milk and they found that by a year they had all caught up and met their developmental milestones, but the formula fed babies didn't. We know that the milk that a preterm baby's mother makes is different and helps them catch up. Could the milk for an IUGR baby also be different and help them catch up? As soon as the baby is going to breast well, it's going to be taking as much milk as it wants anyway and we won't worry about it.
> Thanks again for all your helpful posts.
> Tricia,
>
>
>
>
>
> ***********************************************
>
> Archives: http://community.lsoft.com/archives/LACTNET.html
> To reach list owners: [log in to unmask]
> Mail all list management commands to: [log in to unmask]
> COMMANDS:
> 1. To temporarily stop your subscription write in the body of an email: set lactnet nomail
> 2. To start it again: set lactnet mail
> 3. To unsubscribe: unsubscribe lactnet
> 4. To get a comprehensive list of rules and directions: get lactnet welcome
***********************************************
Archives: http://community.lsoft.com/archives/LACTNET.html
To reach list owners: [log in to unmask]
Mail all list management commands to: [log in to unmask]
COMMANDS:
1. To temporarily stop your subscription write in the body of an email: set lactnet nomail
2. To start it again: set lactnet mail
3. To unsubscribe: unsubscribe lactnet
4. To get a comprehensive list of rules and directions: get lactnet welcome
|
