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Date: | Sun, 19 Jun 2005 20:21:40 -0500 |
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I joined in this discussion late so forgive me if this was already said. I
get a little nervous when the baby has lost over 7% and very nervous when it
becomes 10%. WHY? Because around here, there is no one teaching mom how to
breastfeed properly and the babies are so drugged up (epidurals and
c-sections). Also, many are induced a bit early and totally clueless about
sucking. What I observe is many babies aren't sucking effectively at the
breast, therefore not removing milk. The pediatrician sees the baby in the
hospital and then says come for a check up at day 14, which I feel is too
late.
I do look at the total picture: how many BMs in the last 24 hours, what
color, how big, etc. I watch baby at the breast and see if there is active
sucking. What is common for my practice is to get babies with over 10% loss
who are totally lethargic, can't wake up to feed, no BMs in 2 days, etc.
What others have called a train wreck. These babies are beyond being able to
suckle properly and remove milk.
This is why I LOVE test weights before and after nursing. Baby does have to
be a few days old to really get a good test weight. I check the baby and see
what he can remove. If it is a good intake, I don't stress too much at the
weight loss -- as long as the BMs increase and the weight jumps back up
quickly. I teach mom how to do breast compressions or possibly use a
periodontal syringe at the breast to encourage more active sucking.
Encourage her to nurse more often, wake baby up, skin to skin contact, etc.
And get another weight check in 2 days with baby wearing only a fresh
diaper.
I am very uncomfortable about allowing a poorly feeding baby to piddle
around for 2-3 days to see if things improve. I feel I am often a safety net
for these babies. I also see quite a few babies with oral motor difficulties
that are FTT (or very close to it) by the time I get them at 2-3 months old.
All of these babies have had weight losses more than 7% in the first week.
And I am always astounded that their pediatricians allow such huge weight
losses and slow slow weight gain.
Kathy Eng, BSW, IBCLC
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