June
Interesting case! Forgive me, I'm not quite sure what you mean by
"spilly" - but it sounds like you mean perhaps that the baby is
vomiting _after_ breastfeeding?
Looking at the weights, this baby has gained an average of 160g/week,
or 23g/day over the last 13 weeks, which is low, but not a total
train-smash. But actually, you say that he has had no gain in the
past 3 weeks, so that would mean that for the first 10 weeks of his
life he actually gained an average of 208g/week, or 30g/day which is
perfectly acceptable up to that point. Nevertheless, I would agree
that a nil gain for the last 3 weeks is definitely cause for
concern. And it's consistent with the other Sx you describe, that he
doesn't sleep, and feeds constantly.
When a baby is exclusively breastfed and vomits up a lot of his milk
I would strongly suspect a sensitivity to bovine proteins coming
through in the mother's milk. I'd go through the history carefully
to see if there is a family history anywhere of asthma, eczema, hay
fever, maternal/infant antibiotics since birth, and whether mother
hates or craves dairy products, and whether the baby has eczema,
snuffles, extreme irritability, mucousy stools. The vomiting is a
cardinal sign of sensitivity already, but there may be other signs
too. I'd suggest a total elimination of all dairy and beef products
in the mother's diet (all cow's milk, beef or any products containing
either). And I'd probably concur with the paediatrician's suspicion
of low supply (now.... but maybe not before in view of the normal
weight gain up to 10 weeks) and endorse the recommendation
(urgently!) of supplementing with her own expressed breastmilk after
breastfeeding direct. A baby with very low intake wants to
breastfeed "all day long" but actually does very little swallowing
due to lack of energy, and this will suppress lactation due to
inefficient drainage over time - so the mother may have to take
control of drainage and express very often and feed the EBM perhaps
by bottle to conserve the baby's energy, offering the breast
frequently of course, but not actually expecting the baby to "feed"
very efficiently until his weight starts to pick up again. A bovine
elimination is likely to help the vomiting, to help the baby keep
down the milk he does get....
I'm concerned that tt, lt and ptt is over-diagnosed these days, so
I'd leave that question until last and address the symptoms that jump
out at me first, ie increasing baby's intake of pure, unadulterated,
cow's-milk-free breastmilk as the first priority.
Would love to hear how this goes!
Pamela Morrison IBCLC
Rustington, England
--------------------------------------
PTP
Hello Wise Ones (Long Post)
I was contacted a few weeks ago by a mum who's baby was 10 weeks
old. He was born at term by spontaneous delivery, BW 3520 grms.
His history is quite intense, at 2 weeks he became spilly
and pyloric stenosis was ruled out, he was put on Gaviscon.
March his symptoms didn't improve, so Losec was commenced 1.oo ml
daily, and he continued to spill 5-6 times at each feed.
May he was diagnosed with a Lip and Posterior tie, which will be
released next week and his dose of Losec was increased to twice a
day. He had a weight loss at his well child check and it was
suggested to Mum had a poor supply and should express and give
supplement by bottle.
He has been seen by the Paed today, and is on the 9% percentile and
still spilling? The Paed feels mum has a supply issue
My question Wise Ones, If mum has a low supply would this baby still
spill lots after each feed? There is an issue with no weight gain for
the past 3 weeks and the Paed feels he isn't gaining weight because
of the poor supply
My other question is it the reflux or tongue tie causing the poor
weight gain He is now 13 weeks old, was weigh (5.6kg) today and
hasn't had a weight gain Mum is beside herself, she has a baby that
doesn't sleep, feeds constantly , spills constantly and has lost
faith in herself as a mum, she feels that she is battling all the
time and not enjoying being a mum:{
What am I missing? any suggestions would be gratefully received.
Sincerely
June Nicholls
IBCLC/Midwife
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