I would want real test weights with a good scale, like a Medela BW or
Tanita BLB12 and see if this is a normal intake amount. Baby might need
24 hour test weights at every feeding just to see what is going on. I
suspect baby is not removing milk this well. If baby was weighed on a
regular pedi office scale, it may only be 1 ounce gain. I would do a
history of how often, how long she is nursing, diaper counts,
engorgement or breast fullness, and I would ask mom to keep a written
record because sometimes her recollection is different than reality. I
would want to know every nursing session start time, every bowel
movement change in diapers. Watching the baby nurse is not accurate. I
have seen babies look really good, chomping away, loud gulping sounds
and 3 ml intake. I would expect this baby to be weak and needing
supplementation. I would probably supplement 1 ounce per nursing session
to get the weight up. I might have mom use a supplement at breast and or
pump with a rental pump after most nursings to see if she can increase
her supply. I would have her nurse on each side about 10 minutes so that
each breast is nursed twice, right 10 minutes, left 10 minutes, right
5-10 minutes again, left 5-10 minutes again. I would prefer supplement
at the breast with a SNS type thing or periodontal syringe. If mom
prefers bottle, I would have her start with bottle after nursing but
once baby perks up, try the bottle first.
Good luck, I think the pedi is grasping at straws in recommending
another LC or should be terribly concerned about this drop in weight and
how the baby has not regained birth weight by 10-14 days. If the mom
told them that you, her LC said this was fine, the doctor would
naturally think you are lax. Not saying you are, but sometimes the story
gets told differently than it really happened.
Good luck, Kathy Eng, BSW, IBCLC
PS: This is why HCP reports are vitally important. When we send a HCP
report expressing our concerns on the initial consult we did, the doctor
would know our side of the story.
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