Dear Lynn,

The baby was actually already at home by the time I saw them. Born on 11.28 and discharged on 11/29. I am the office pediatrician and I had to decide at that point whether or not to rehospitalize. I evaluated the infant's suck on 11/30 and on 12/1 and both times the suck looked adequate with a properly positioned tongue and both lips phalanged. The problem was that the infant was too tired or weak to suck- probably because of dehydration. My problem was that at this point, hospitalizing the infant means sending them 40 miles to the hospital where I don't round on my own infants (it's too far). THis would mean sending them into the hands of a less breastfeeding friendly doctor.Because this very well might have been the end of breastfeeding, I chose to keep them at home with the help of a lactation consultant but you can bet that if that baby had lost ANY more weight (or even hadn't gained) he'd have been in the hospital pronto.
    The mom KNEW there was a problem but she was already at home. She called me- I listened. She knew when the suck was effective and that when the baby latched the suck was good- the problem was that the infant was sleeping all the time and not waking to latch well. She let the infant go 4-5 hours between feeds at home and then the problem got worse.

I hope this clarifies.

Kate
Kate McIntosh MD FAAP
Benzonia, MI
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