The baby who is below birthweight at 8 wks is not a slow gainer. He is not
gainingat all, and has lost weight. I agree totally with Sharon's assessment
and feel this is quite the emergency situation.
My guess, based on the history of this and earlier babies, is that mother
could very well have primary lactation insufficiency or insufficient milk
supply syndrome, whatever you want to call it. As Sharon said, there could
be some anatomical finding in baby or a low tone issue that is genetic but I
think more likely it would be a maternal finding. Just my hunch. What is
usually very telling is breast growth and changes in pregnancy, but
especially on day 3-5 postpartum. If a mom tells me "I'm not sure my milk is
in" or "I think I have milk" or something vague and unsure, I worry. Usually
when I ask "Did your milk come in" they answer "OH YEAH" or "I feel like I
have implants" or something like that. I find the milk surge is usually a
very obvious phenomenon. Of course the milk could have come in with
abundance, but if the baby was transferring poorly it usually down regulates
very quickly.
I also don't trust wet diapers alot. I've seen quite a few poor gaining or
losing newborns with a good wet diaper count per the mom. I find the stools
are much more telling and I like to see an abundance. Since I believe babies
can have a normal decrease in stool frequency after about 6 wks, I would not
find that the stool count would necessarily be very helpful at 8 wks out.
An average sized newborn needs about 20-25 oz of milk per day, so if mom is
supplementing a few ounces or, say, 1 - 2 oz after 8 feeds, that is only 8 -
16 oz per day. If she is putting out only a few cc's, which can certainly be
the case, you can easily see how this baby would be starving. I have seen
this before, but never in an older baby. I am following newborns and
intervene very early. I have also had moms who were very very reluctant to
supplement until they saw a milk transfer on a digital scale and had it all
laid out for them in terms of what a baby needs etc. Of course it is
difficult for the mother and disappointing if primary insufficiency and she
needs emotional support. Of course, I will help the mother optimize the milk
production and milk transfer with the usual array of strategies. I offer
options and the mother chooses the method of supplementation.
Overwhelmingly, mothers choose bottles.
If you can, Fio, let us know what the resolution of the situation is.
Laurie Wheeler, IBCLC, MN, RN
New Orleans Louisiana, s.e. USA
***********************************************
To temporarily stop your subscription: set lactnet nomail
To start it again: set lactnet mail (or digest)
To unsubscribe: unsubscribe lactnet
All commands go to [log in to unmask]
The LACTNET mailing list is powered by L-Soft's renowned
LISTSERV(R) list management software together with L-Soft's LSMTP(R)
mailer for lightning fast mail delivery. For more information, go to:
http://www.lsoft.com/LISTSERV-powered.html
|