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Wed, 17 Nov 2010 17:40:34 +0000 |
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Yasmin writes:
>Baby's birth weight was 2.88 kg and lost less than 5% of birth
>weight at discharge after 3 days.
>Baby took 3 weeks to reach her birth weight and continues to gain
>only 100 gms a week or even less and baby is at 3.08 kg at 6 weeks
>check up. Mom is not convinced that her baby is not getting less
>since baby output is more than 3 yellow seedy stools per day and 10
>to 12 wet diapers clear urine with no smell.
>She also says baby is active and seems satisfied many times a day at
>breast although her only concern is she feels baby's latch is not
>deep enough and sucking feels superficial (termed used by her) most
>of the time. She continues to breastfeed on demand and exclusively
>and wishes to continue but also fears severe malnutrition. Have
>anyone seen such slow gain in a baby with good output of stools and
>urine?
I can tell you what we would be asking about here.
What does the baby look and behave like? Does the baby *look* scrawny
and not like a 6 week old baby should look like? This is always
difficult to quantify of course, but when you have seen a lot of
healthy 6 week olds you get to know what they ought to look like.
What about behavhiour? Is this baby miserable and grumpy, in a way
that might make you think she is always a bit hungry, or does she at
least sometimes show signs of happy, deep contentment during and
after a feed?
What does the mother mean by feeding 'on demand' - really good
listening and the right, sensitive questioning sometimes reveals
some strange notions about feeding on demand. Is the mother, for
example, only ever using one breast and never switching? Is she
waiting for the baby to cry before she feeds her instead of feeding
truly responsively and unrestrictedly?
Stools and urine are not much of a helpful guide beyond the newborn
(and while they can be a useful part of the jigsaw then, they are
only a part of it) and at 6 weeks they mean very little (apart from
obvious anomalies we'd all know were red flags).
I'd also be wondering about this dramatic 'fears severe malnutrition'
- why is the mother so very fearful? The weight gain is a bit slow,
but not disastrously slow - she's gained 640g from the lowest point
which is not so terrible or scary. This baby is nowhere near 'severe
malnutrition'......this fear may be making the mother feel the sucks
are 'superficial'.
So if everything checks out ok - baby does not look scrawny, baby is
basically happy and active, mother is not withholding breastfeeding
in any way but is feeding truly actively and responsively, there is
no concern from the medical or healthcare people about the baby -
then I would observe a feed to rule out anything unusual, and then
I'd try to find her a breastfeeding support group (happily, we now
have lots in the UK) which will build up her confidence.
Heather Welford Neil
NCT bfc, tutor, UK
--
http://www.heatherwelford.co.uk
http://heatherwelford.posterous.com
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