On Fri, 20 Oct 2006 00:19:22 +1000, Theresa Klein posted re:  question about
tongues

  I have a mom (permission to post. Her baby is 14 weeks of age. SGA at
birth 5lbs 5 oz. She is now a little over 8 lbs. slow to gain. Mom has a
fast let down.

  She visited her Pediatrician yesterday followed up with 2 wk appointment
because she didn't feel the weight gain was good. Gained 6 oz in the 2 wks
her lowest wt was 4lbs. 8 oz. Mom has alot of milk. Baby nurses freguently
but most of the time one side only. The baby choked during the let down in
the Ped office as the Ped came into the room. She scolded the mom for low
weight. Told her to start supplementing formula to get more calories and
wanted her started on Prevacid in case she has acid reflux. The mom is a
pharmacist and breastfed her sibling over a year. The baby is very content
following a feeding is retaining all feedings. Mom is at work so she gets
bottles of breastmilk from caregiver. I neglected to ask mom how much she is
feeding at daycare. Mom states she has several soaked pale urine diapers and
three very large yellow seedy stools every day. She called me probably more
to vent. Said that if she were a first time mom would have went right to
formula. She  wants to continue to breastfeed. Let me know if I'm in error
here. I suggested that she let the baby nurse as long as she wants to on one
side if she is nutritively feeding. If interested in feeding other side let
her. I wouldn't start the Prevacid yet until she starts showing more
symptons. She could express milk first until she gets the first let down and
then let baby nurse to be able to get more high fat calories in case she
does have alot of milk that baby is filling with more foremilk. Your
suggestions are welcome and appreciated.

 

Hi Terri,

Going from her lowest weight (4-8) to a little over 8 lbs in about 13 wks
isn't bad (not counting the first five days when she was probably losing);
however, gaining 6 oz in 2 wks isn't great until the baby is over 4 months
old (adjusted age?...if it was early because labor was induced?).  The baby
gained well in the previous weeks.  Has anything changed?  What is her
heredity?  Are the parents small?  How did they gain as infants?  How did
the sibling gain?

The mother may have had a superabundant milk supply and baby was getting a
high ratio of foremilk:hindmilk; your idea of letting baby nurse after
expressing until the let down is a useful approach; the mom could even try
longer until she is closer to getting to the hindmilk.  Down-regulating the
supply, if it is still superabundant, would also ease the milk ejection
reflex; however, the baby needs to be watched closely for getting enough
nutrition.

Has the baby's suck been evaluated?  An ineffective suck could explain low
weight gain because the baby might not be bringing out much hindmilk (that
might be a result of superabundant supply; baby might be in the habit of
waiting for the easy flow of milk and might stop when it is not there
anymore; baby does not have the correct suckling skills to extract milk
properly).  Might the baby have a short frenulum?  That might cause some/all
of the baby's problems.  What kind of bottles is baby getting?  Does the
caregiver follow paced bottle-feeding techniques?  Might the mom save the
foremilk for other uses and provide a lot of hindmilk in the bottles.

What about the breastfeeding when mom is home?  Is it frequent, leisurely,
during the night when more prolactin is produced?  Hopefully, some of this
may help.  I'm sure others on this list will have more ideas.

Lee Galasso, MS, IBCLC, RLC

Lactation Specialist

Westchester County in NYS


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