Dear all:
I just thought I would back up my statements about the implications of Laurie Nommson-Rivers research some clearcut examples.  

I have had at least three clients in recent history  whose babies were in a serious situation of failure to thrive.  These babies were either at birth weight by six weeks or really seriously dropping down from around the 50th percentile to below the first percentile on the charts.  Not one of these babies had metabolic disorders or malabsorption.  All were producing the requisite number of diapers.  In all three of these cases, I would say that the situation would have been entirely prevented had someone looked closely at multiple indicators and really talked to these mothers about their babies' behaviors.  There were clearcut signs of inadequate intake had the practitioners listened to the mothers descriptions of behavior and/or really looked closely at these babies' patterns of growth (or really lack of growth).  In all of these cases, the weights were dismissed as "well the baby is gaining slowly but looks all right".  All of these babies gained beautifully once enough calories were added into the picture. In all of these cases, the supply improved with pumping --- though not all of these mothers got to full supply.  

One situation emerged when a practitioner recommended severe sleep training.

One situation emerged when a lactation consultant recommended only feeding from one breast (and then yelled at the mother when she followed the pediatrician's advice of offering some formula when her baby was at birth weight -- and similarly told her not to express milk even then).

Another situation emerged when the mother had used some formula in the hospital (and she had heard she was not allowed to pump for the first month from someone) and then when the baby gained weight on formula, she was told she didn't need to supplement anymore.  

All these mothers were told that the diapers indicated their babies were fine.  Looking at diapers alone in these cases was not enough. Intake was not adequate.  Fixing intake fixed the problem.  In cases where inadequate intake decreased supply -- expressing extra milk increased supply -- albeit not fully for one of these mothers.

The take home message is to never rely on a single indicator and really listen to mothers.  All these mothers were incredibly frustrated because their concerns about their babies were repeatedly dismissed.

Best, Susan Burger

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