Cheryl...wow. Guess I hit a major nerve! I have read
my original post several times, trying to figure out
what I said that conveyed the idea that I advocate
supplementing "slow gainers". It could be an
inconsistency in definitions: to me, a "slow gainer"
is within normal parameters of growth, just at the low
end. I breastfed my own "slow gainer": she eased her
way from 75th percentile at 4 months old to the 25th
by 15 months, and there she sits today, all 28 lbs. of
her, coming up on her 4th birthday. I never
considered supplementing her, despite the "slow
gainer" label (courtesy of her doc). She was ever
active and alert, with sparkling eyes and rosy cheeks
(all four of them ;)!), and not the least bit
bony...just a bitty kid.
I was talking about supplementing babies who have a
medical need for it, for numerous reasons.
Scenario/example:
A baby with an 8 lb. birthweight suffering a 10%
weight loss at 3 weeks of age, weighing in at 7lb.
2oz. Current standards of optimal weight gain in
breastfed infants are: regain to birthweight by 2
weeks of age, and a gain of 5 to 10 ounces a week
thereafter (for the first 3 months); this is per the
text COUNSELING THE NURSING MOTHER by Lauwers and
Shinskie (2000); some other sources I have read say
that a minimum of 4 ounces a week is okay. So,
theoretically, our 8lb. baby should weigh, at 3 weeks
of age, 8lb., 5oz. Am I going to instruct/encourage
this mom to supplement this little one whose gain is
now lagging by over one pound? You betcha.
Okay. On to the tube...you voiced concern over a
"less than perfect latch for having a tube in the
mouth while latched". A #5 French feeding tube is
very fine, about the size of that on an SNS. When
supplementing in this manner, one must FIRST AND
ALWAYS ensure that the baby is latched on correctly.
The tube is then carefully slipped into the corner of
the baby's mouth without breaking off the latch. Many
babies are able, via this small, soft tube, to create
enough suction to empty a 20 cc syringe on their own
(with no one pressing down the plunger). In this way,
as with an SNS, a baby needing supplementation can
receive breastmilk and be supplemented at the same
time (either with Mom's milk or artificial baby milk),
AND the breast is being properly stimulated/emptied,
AND the baby is spending much needed time at breast.
I am not trying to sell anyone on supplementing! Just
trying to convey what I see as a great way to do it
when it is medically necessary. Yes, stimulating
supply in Mom is vital to optimum infant growth, but
with all due respect, sometimes that is only part of
the problem.
Thank you for giving me the opportunity to clarify my
previous post!
Carole Jernigan, RN, BSN, CLC-to-be
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