Maureen writes:
Could it be a physiological or metabolic disorder?
Mom does not have an overactive letdown as there were no signs of baby
choking and gagging at the breast during the observed feed.
Hi Maureen,
First: This mom has a lot to do and the fact that she can't get enough milk
is not from you not knowing enough. Her breasts may have been
understimulated, she may have supply issues herself, and she's stressed and not able to
pump adequately. If she needs to use some formula temporarily, she should.
It may be controversial, but sometimes if breastfeeding is inefficient,
the time at breast is kept very short, only while baby is actively swallowing
regularly, so baby has enough energy to take the supplemental amount and
mom has time to pump adequately. This can seem counterintuitive but often
results in better outcomes longterm. Also a source of potential disagreement
but if mom cannot supplement at breast, then bottlefeeding ( "responsive",
"active" "paced style") might enable this baby to get what is needed and
start a better weight gain trajectory. If there are no pre and post weights
at a breastfeeding, I wouldn't jump to a metabolic issue. It could be that
baby is getting little at breast, then so tired that another ounce from the
syringe quiets her, but her body really would do well with 2 or more ounces
of food and she's just not able to get that much via syringe. If we knew
her intake was at least weigh appropriate, and she still wasn't gaining,
then metabolic issue would be considered. Anytime this baby stops eating after
one ounce of supplement, it could be from fatigue rather than satiation
since we don't know how much the baby might be getting at breast. A baby
stooling once a day is often not getting enough to eat, at this age. It sounds
like there are a few positive things you can help with to help this baby
gain more normally and see what works itself out, and what doesn't, at that
point.
Just my thoughts, discombobulated at they are.
Peace,
Judy
Judy LeVan Fram, PT, IBCLC, LLLL
Brooklyn, NY, USA
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