Timing will vary drastically depending on the state of the baby prior to the beginning of the problem, the severity of the problem, the presence of concurrent morbidities, and the duration of the problem. It can be extremely fast or almost chronic. It can be subtle right up until its painfully apparent.  Perhaps the RN missed something very obvious. Perhaps it was less obvious. If the RN saw the baby when she had woken on her own and cued to feed, it likely would have appeared much less alarming than what you saw. I've seen babies with FTT, acute dehydration and urosepsis demonstrate short but convincing bursts of energy and appropriate feeding behavior.  There likely were symptoms 24 hours earlier though. 

I feel strongly that collaboration and follow up are important. You could call the nurse and talk to her about what she saw and tell her about your assessment. It is very difficult to make accurate deductions about the potential near misses of another care provider without seeing what they saw and/or debriefing with them. Chances are good that a friendly conversation will improve interprofessional relations and even provision of care in your community. It's hard not to have a strong reaction when there's a baby at risk but be careful!

Good luck!
Genia Stephen, RM, IBCLC
Brockville, ON

Sent from my iPhone

On 2011-08-19, at 12:01 AM, LACTNET automatic digest system <[log in to unmask]> wrote:

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> Subject: How long from 1st sign of inadequate intake to lethargy?
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