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Date: | Mon, 14 Jan 2008 20:05:50 -0500 |
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1) Immediate indicator while on the breast): Duration & rhythmicity of swallowing using
visual, auditory, sensory (what mom feels while baby is on breast) cues
2) Immediate response to intake: Behavior: Lethargic, sleepy, quiet alert, fussy
including duration and frequency of feeds
3) Medium term response to intake: Output (stools and pees), skin turgor & color
4) Longer term response to intake: Weight loss, weight gain and rate of weight velocity
(rate of loss or gain over time)
I'm sure you can add to the list. What becomes evident if you look the least bit beyond
the superficial is that you have checks and balances that come into play with all of these
indicators. One responds to another to compensate and keep the baby in healthy
homeostasis --- and they can go either direction. It is when the homeostasis is pushed
beyond a limit that things break down and the baby is no longer in a healthy state and
cannot be determined by one indicator alone.
Most important of all --- listening to everything the mother is telling you carefully ---
neither providing unwarrented reassurance nor reacting with unwarrented alarm as you
process her concerns.
I have seen complete and total train wrecks when health care practitioners looked at only
one the above indicators without looking at the total picture. I still think about the
mother whose baby was drinking huge amounts from the breast and no one believed her.
On the basis of the weight alone, her pediatrician told her she didn't have enough milk
(even though she could later pump 2x per day and get over 32 ounces total). She made
her pump and bottle feed even though the baby could not feed well from a bottle and took
less than half as much from the bottle as from the breast. A resident at the hospital
made her feed formula which this baby promptly vomited right back up. The baby had a
rare metabolic disorder. No one listened to the mom except the endocrinologist she
finally insisted on seeing.
Best, Susan Burger
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