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Sun, 17 Jul 2005 12:25:38 -0400 |
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Nils Bergman would call this "shutdown" protest-despair dissociation. It
is meant to prolong baby's survival in case of seperation from mom, but
has lasting structural effects on the brain.
Infants skin to skin with mom who are not waking to feed are not in this
state, they are in an energy conservation mode. While I agree that it is
more productive to wait for feeding cues in infants, some of these
starved babies are in danger. In my private practice, I have seen
infants with hypernatremic dehydration and infants with bilirubin levels
in the 20's and 30's from poor feeding. So my approach is a little more
pro-active. If baby isn't feeding well at breast and is in that energy
conservation mode, we feed another way. I can safely fingerfeed an
infant in their sleep with a syringe and tube, and have taught parents
to do the same. We get mom pumping, and baby getting calories, and baby
wakes up.
For "sleepy" babies in the first days of life, colostrum on a teaspoon
followed by skin to skin contact is usually enough to get them up and
eating, but if a baby is still not feeding well after discharge, and
becomes lethargic, I don't think this is a normal situation, and I want
to intervene with calories (from ebm if at all possible), *then* fix the
breastfeeding.
Catherine Watson Genna, IBCLC NYC
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