Today I got a phone call from a nurse wanting my opinion on a case. She starts telling
me the following:
A 15 day old fully breastfed baby-girl, who didn't have a bowel movement for 11 days...
WHAT? Well yes, 11 days, but the mother saw a bowel movement in hospital, so she
thinks this is OK, meaning there is no congenital anomaly, but the nurse is calling
because there was no wheight gain the last 4 days. I tell her that the baby has to be
seen by a doctor immediately. Well - the doctor HAS seen the baby, and told the
mom that bf babies can go ten days, and even more without bowel movements, and
she should go on nursing, and return in 3 days if there still is no bowel movement. On
further questioning the nurse tells me that the baby is a slow gainer, she has gained
50 grams (less than 2 ounces) in the two weeks of her life. Of course she has not
regained birthweight (3600).
By now I was really worried. The nurse goes on telling me the baby is sleepy, but does
wake up for feeds, and she does have 5-6 wet diapers a day.
There was no way I could see this baby, nor anyone else who knows anything about
bf.
I told the nurse that until proven otherwise the baby is STARVING (yes, I did shout),
and FEED THE BABY, with whatever means she can. The nurse told me the mother
is not motivated to do anything special, and that a previous baby also failed to gain
weight while bf and was bottlefed, and the mother is just waiting for the OK to give
formula.
I felt that at this stage the most important thing was to get food into the baby, and
told her to go ahead and give formula in a bottle. I made it very clear that if the baby
doesn't start eating well from the bottle, doesn't start having bowel movements,
doesn't start to gain weight within a day, they should go to the nearest emergency
room.
I feel so bad about this case that I couldn't fall asleep and had to share with you all. I
know I didn't ask all the questions - how often was the baby fed, was there a let-down
feeling, etc., but I didn't think it mattered - if I couldn't see the baby, she had to be fed
as soon as possible.
The baby's doctor is very pro bf (I know him), and so is the nurse.
This is really frightening - neither the nurse, nor the doctor were concerned about this
lack of bowel movements. They remembered that this is OK for bf babies.
Did I over-react? Could this be normal - no bowel movement for 11 days in a 15 day
old baby who is not gaining wheight?
I will keep you posted. I hope the nurse will be in touch with me.
Thanks for listening, and sorry this was so long...
Mira
Mira Leibovich, MD, IBCLC
Israel
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