Yasmin writes:

>Baby's birth weight was 2.88 kg and lost less than 5% of birth 
>weight at discharge after 3 days.


>Baby took 3 weeks to reach her birth weight and continues to gain 
>only 100 gms a week or even less and baby is at 3.08 kg at 6 weeks 
>check up. Mom is not convinced that her baby is not getting less 
>since baby output is more than 3 yellow seedy stools per day and 10 
>to 12 wet diapers clear urine with no smell.



>She also says baby is active and seems satisfied many times a day at 
>breast although her only concern is she feels baby's latch is not 
>deep enough and sucking feels superficial (termed used by her) most 
>of the time. She continues to breastfeed on demand and exclusively 
>and wishes to continue but also fears severe malnutrition. Have 
>anyone seen such slow gain in a baby with good output of stools and 
>urine?


I can tell you what we would be asking about here.

What does the baby look and behave like? Does the baby *look* scrawny 
and not like a 6 week old baby should look like? This is always 
difficult to quantify of course, but when you have seen a lot of 
healthy 6 week olds you get to know what they ought to look like. 
What about behavhiour? Is this baby miserable and grumpy, in a way 
that might make you think she is always a bit hungry, or does she at 
least sometimes show signs of happy, deep contentment during and 
after a feed?

What does the mother mean by feeding 'on demand' - really good 
listening and the right, sensitive questioning sometimes reveals 
some strange notions about feeding on demand.  Is the mother, for 
example, only ever using one breast and never switching? Is she 
waiting for the baby to cry before she feeds her instead of feeding 
truly responsively and unrestrictedly?

Stools and urine are not much of a helpful guide beyond the newborn 
(and  while they can be a useful part of the jigsaw then, they are 
only a part of it) and at 6 weeks they mean very little (apart from 
obvious anomalies we'd all know were red flags).

I'd also be wondering about this dramatic 'fears severe malnutrition' 
- why is the mother so very fearful?  The weight gain is a bit slow, 
but not disastrously slow - she's gained 640g from the lowest point 
which is not so terrible or scary. This baby is nowhere near 'severe 
malnutrition'......this fear may be making the mother feel the sucks 
are 'superficial'.

So if everything checks out ok - baby does not look scrawny, baby is 
basically happy and active, mother is not withholding breastfeeding 
in any way but is feeding truly actively and responsively, there is 
no concern from the medical or healthcare people about the baby - 
then I would observe a feed to rule out anything unusual, and then 
I'd try to find her a breastfeeding support group (happily,  we now 
have lots in the UK) which will build up her confidence.

Heather Welford Neil
NCT bfc, tutor, UK


-- 
http://www.heatherwelford.co.uk

http://heatherwelford.posterous.com

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