Laura

Thank you for correcting the assumptions I was making and for adding 
more information to the pot.  I think, as experienced breastfeeding 
counselling people we would call what has just happened successful 
"reflecting", yes?  Where one person re-states what she _thinks_ she 
heard, enabling the describer to clarify!  A win-win situation.

I'd join the others who are saying how lucky this mother and baby are 
to have you in their corner.   It sounds like you've identified the 
reasons for the baby's fatigue, and have been able to fine-tune the 
quantity of supplements that he receives so that he can gain just 
that little bit extra to enable him to start catching up.  And I love 
it when paediatricians and IBCLCs and mothers are able to work 
together in a team like this.  Bravo!

Pamela
----------------------------------
Date:    Thu, 27 Feb 2014 11:46:26 -0500
From:    Laura Spitzfaden <[log in to unmask]>
Subject: Re: Help needed with failure to thrive case

Hi Pamela,

Thank-you for such a long well thought out description of the failure 
to thrive baby!

That is one of the unusual things in this case that this baby did not 
present the way you describe. He had normal behavior. He is very 
happy, relaxed, social and smiling all the time. He did not look 
worried. He had wet diapers and normal color frequent, daily, bowel 
movements even while he was gaining very slowly. He did not ever 
appear to be dissatisfied.

To be more clear, this baby's pediatrician is completely in the loop 
and is overseeing all the interventions taken by the mom. It was the 
gastro who suggested hospitalization or 24 ounces of formula and 
fortunately this baby's pediatrician did not agree with this advice 
and fully supports my suggestions.

This little guy just got so tired at the breast and his latch and 
suck were very inefficient. Mom had the milk but he just couldn't get 
it all out. His suck has completely changed since the revisions and 
the CST. Mom says that he is a new baby at the breast. He gets 
excited about nursing where before it was just a chore for him. He is 
finally able to get enough milk to grow at a regular pace for his age 
but Mom still does not yet have an oversupply needed to get this guy 
back on track. She has been switch nursing with breast compressions 
12x a day in order to increase her supply and is expressing after feeds.

We have been going for at least an ounce a day weight gain and he was 
doing that until Mom's stored milk ran out. She has decided to help 
him catch up using some supplemental formula. We have already 
determined that 4-5 ounces extra keeps him gaining above an ounce a 
day so that is what she is choosing, along with her doctor's support.

Laura Spitzfaden, LLLL, IBCLC, APL


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