In a message dated 6/8/0 5:28:30 PM, [log in to unmask] writes:
<< I am an L&D RN and have been lurking on Lactnet for about 15 months. <snip>
I also clandestinely toss any formula paraphenilia that finds its way to our
unit. >>
Nice to know you are there cleaning up the environment.
<<Mom is a 34 yo g3p3 who delivered at 38 wks by scheduled RCS. Baby went
to the NICU for 3-4 hours for IV antibiotics secondary to fluid in her
lungs. Baby weighed 8-8 at birth and had lost "about a pound" by
discharge on Day 3. >>
So baby had been at about 7-8 at day 3.
<<Baby was sent home with iron drops, though mom
doesn't know why. Mom d/c'd them at about 2 wks of age. Mom was put on
Atenolol, 50 mg qd, on Day 5 (same day Dad went out of town for 4+
weeks) for elevated bp. Baby had hearing test at 1 week. No wt was done.
Next follow up was at 5 weeks, baby wt 8-0. Not even back to
birthweight!!?? Mom said ped was unconcerned as baby is in 50th
percentile for wt. >>
What is that supposed to prove?! So, at what point does the baby drop off the
charts w/o ever gaining weight before we worry? Did you speak to the ped?
This baby went from about 7-8 to 8-0 in 5 weeks and that is of no concern!!!
Is this mom on birth control pills (maybe only this time, but not w/ other
2)?
Mom reports more than 5-6 wet diapers a day, 1-2
poops, a good amt each time. Baby is alert. Fontenel not sunken. Baby
nurses 5-10 minutes every 1.5-2 hrs during the day, until she falls
asleep, one side per feeding generally. Mom denies sore nipples. At
night she goes 4 hrs between 2 feedings. Mom stopped taking Atenolol
today. Baby uses a pacifier. Mom says she gives it to her when baby
starts "gumming" at the breast. Mom successfully breastfed older 2 kids
for 9-10 months. States she feels letdown but does not notice milk
coming out of other breast when nursing and never got "engorged or full
like other times". Output sounds fine, pedi is unconcerned. I am
concerned, so I am asking you who are wiser to validate or relieve my
concerns. Any advice or opinions?>>
Sounds like this baby is getting just enough to keep going, but not enough to
thrive. Did you see the baby nurse? Did you ask if her other children gained
this way? Do you think she assumes this would be different b/c of the early
intervention? She would be incorrect--but might think it would be true. How
does the baby look to you? Have you asked about baby's disposition? I once
knew a mom through a mutual friend whose baby never fussed, nursed every 4
hours from birth for about 10 minutes each feeding, had a pacifier, gained
poorly and didn't really grow well until she started solids. She just never
seemed to protest and it always amazed me. The ped also never pushed the
issue w/ her. My point is some babies don't fuss and protest even when not
taking enough milk to flourish, esp when a pacifier is used.
Sounds like low milk supply headed towards FTT. I wonder if she would
need to pump to visually see what her milk supply is like. I would try to get
this mom to increase her milk production and have her use breast compression
at every feeding until the baby's weight gain is w/in normal range.
Jennifer Tow, IBCLC, CT, USA
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