I want to add something to the recent conversations with the babies who
are not gaining weight, pinching the nipple, tongue tied or whatever. I
feel strongly that test weights need to be done before and after
feedings, and before and after interventions are added. Just observing
is not good enough for problem situations.
I have seen babies look better with a nipple shield but the test weights
show no intake -- worse than when we didn't use it! So we have to be
sure what we are doing is actually going to help baby remove milk and
get enough calories.
Babies who have lost too much weight, or aren't gaining well, are often
weak. Once they are being fed enough calories per day, they should gain
strength. Weak babies often can not remove milk well enough to feed
properly but once their weight is up and they are gaining well, then
they should improve on their feeding technique.
For example, if mom can pump 4 ounces but baby repeatedly self limits to
1.5 to 2 ounces at each feeding, and tires out after 10 minutes to have
zero intake at that point, then oral motor problems needs to be
considered. I have found that the babies who can not remove a normal
amount, when mom can pump adequate amounts, do very well with an
assessment by a Speech Language Pathologist or an Occupational Therapist
who is experienced with babies, especially BF babies. Someone who can
assess the mouth, cheeks, tongue, palate muscles for weakness.
To really know what is going on, we must do test weights on an
appropriate scale. I often follow these babies for 2-3 visits. The first
one assesses what baby can do on his own and a care plan for supplements
(at breast or bottle to increase caloric intake as needed) and
increasing mom's milk supply is begun. The next visit, usually one week
later, is to assess how much baby can take in now that he has gained
weight vs mom's milk supply. Sometimes I do a third visit and if baby is
not "cured" by then and mom has an abundant milk supply, then I refer to
a good SLP or OT. I have seen some "miracle" cures for babies who
undergo SLP or OT treatment.
Kathy Eng, BSW, IBCLC
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