Hi Kika

I know just what you mean.... something makes you 
anxious about the baby, but you're not 
sure.  Being "just" an IBCLC, I would make an 
"excuse" for the mother to take the baby into the 
paediatrician (suggest a normal weight check or 
something) and then phone the paediatrician 
myself and tell him what I'd seen, and what I was 
concerned about, and leave him to check it out.

There were several couldn't-put-my-finger-on-it 
situations I can recall where this strategy 
turned out to have a) not freaked the mother out 
at the time but b) assured the baby of medical follow-up asap:

- a 3 day old who wasn't stooling... he turned 
out to have imperforate anus which the 
paediatrician had missed at his newborn exam 
after birth - he was very grateful and I was very relieved.

-  a newborn with Down Syndrome who was 
breastfeeding amazingly well, but he looked a bit 
blue around the mouth and fingernails.  Again the 
paediatrician had checked him in the hospital and 
ruled out any cardiac abnormalities, but he just 
didn't look quite right.  Turned out his heart 
was affected after all and he eventually needed surgery.

- a "colicky" baby's (as diagnosed by her GP), 
mom described the baby stopping nursing, going 
red in the face, stiffening, waving her hands and 
legs in a bicycle type motion, and then suddenly 
crying.  By good chance I actually observed one 
of these spells while I was doing a breastfeeding 
exam in my office. It didn't look too dramatic, 
but it didn't look "normal" and I question the 
diagnosis of "colic" every time I hear it!  I 
described what I'd seen to my favourite 
paediatrician the next morning during his 
hospital rounds.  He said it sounded like 
convulsions, and he would see her asap.  I phoned 
mom back and suggested that the paed could give a 
second opinion.  Baby was examined, then sent for 
an MRI which showed some serious things wrong in 
the brain and by 9 months, when mom brought the 
baby back for a friendly visit, it was clear that 
she was by now very badly brain damaged.

- a baby who just didn't like being held and 
preferred to be laid down alone. Very odd, but a 
kinda subjective observation too - could this be 
"normal"?  Sent mom back to her very clued-up GP 
and it turned out eventually that this little one was quite severely autistic.

Kika, this must be so difficult for you because 
you ARE the doctor!  Perhaps you have specialist 
consultants you can "consult" about these 
hard-to-pin-down situations where something about 
the baby makes you uneasy.  I NEVER tell the 
mother that there's anything I suspect about her 
baby - I'm only an IBCLC and I can't 
diagnose.  But I do wangle things so that the 
baby is medically checked, and I follow up to see 
what the doctor found.  Also, I had a personal 
experience of how it feels to be the mom. When my 
twins were 9 years old, they had routine hearing 
tests.  One needed to be repeated for an unsure 
result.   After the repeat test the audiologist 
came out to the waiting room and told me my son 
had an "island" hearing loss which might be due 
to a brain tumour!  As you may imagine, I 
freaked.  My wonderful doctor was furious and 
said he should have told her and she would have 
checked it out before giving such a diagnosis. 
Years of tests and two MRIs followed until he was 
pronounced "clear" at age 17.  He's 33 now and absolutely fine!

Pamela Morrison IBCLC
Rustington, England

 > On 9/11/2015, at 6:14 am, Carmela Baeza <[log in to unmask]> wrote:
 >
 > Hi all,
 >
 > I´d like your experience on this one...
 >
 > Sometimes (fortunately, very infrequently) a mother will come to the clinic
 > with breastfeeding problems, and as I look at the baby I´ll immediately
 > think "There´s something I don´t like about this baby". It won´t be
 > anything spectacular, just baby´s skin color a bit off (not jaundice, just
 > something about the tone), something about his body posture, something
 > about the shape of his face or head, something about his features... As if,
 > *if* these signs were more important, he would have a syndrome of some
 > kind. But they are only small things that come to my attention simply
 > because I see so many "normal" babies.
 > Obviously this baby has been seen by at least one pediatrician at hospital
 > discharge, more times if the baby is older than a week.
 >
 > My dilemma here is, do I tell the mother anything? If yes, what? and how?
 >
 > I´ve faced this situation a few times. The first time, I told the mother
 > gently about my impressions. She of course was worried and went to the ped,
 > who agreed with me (but hadn´t done anything before), and the baby got all
 > sorts of tests (genetic, bloodwork, gut...) for a period of several months,
 > and nothing came of it. So the poor child suffered tons of things and the
 > parents months of anguish for nothing...
 >
 > Second baby I told the parents nothing but I had them come in frequently to
 > check weight and latch so I could keep an aye on him. Turns out he had a
 > rare malabsortion syndrome which was diagnosed a month later. Baby had FTT
 > despite mother´s great milk supply and his good sucking skills. So no harm
 > came of my not telling the parents about those little tiny signs, but maybe
 > if I had he would have been diagnosed sooner or parents would have been
 > ready.
 >
 > Neither option, the telling and the not telling, felt right to me!
 >
 > So how do you handle these situations? How do you say to the parents "look,
 > there is something about your baby that seems to be off, but its just my
 > impression" ?
 >
 >
 > ​Thnks,
 > Kika​
 >
 >
 > --
 > Dra. Carmela Baeza
 > Médico de Familia
 > Consultora Certificada en Lactancia Materna IBCLC
 > www.centroraices.com
 > http://www.facebook.com/Consulta.Lactancia.Raices
 > 
<http://www.facebook.com/pages/Centro-de-Atenci%C3%B3n-a-la-Familia-Ra%C3%ADces/274415189309122>
 >
 > Autora de "Amar con los Brazos Abiertos"
 > 
http://www.amazon.es/Amar-con-los-brazos-abiertos/dp/8426904688/ref=sr_1_1?s=books&ie=UTF8&qid=1420813499&sr=1-1&keywords=amar+con+los+brazos+abiertos
 > <http://www.ediciones-encuentro.es/libro/amar-con-los-brazos-abiertos.html>
 >
 > Comprometida con el Derecho a Vivir
 > http://derechoavivir.org


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