June writes:
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
~~~
It is highly possible that the tongue tie is limiting baby's ability to
transfer and keep milk down. ( Not sure if "spilling" is spitting up, or
losing milk at the corners of the mouth, or both but both are associated with
tongue function limitations.) Tongue limitations, laryngomalacia, reflux, and
poor weight can all be seen together. ( not always, of course, but often
they seem to occur together, like asterisms in the sky....) It is also
possible that this mom had plenty of milk, but that they baby couldn't transfer
it, so there was poor weight gain and also a resultant downregulation to
mom's supply.) If baby nurses, how much does baby transfer( intake) and how
much does baby keep ( not spit up.)? If baby spits up a lot even during the
feeding it sounds like very poor milk control possibly which often seems to
linked to milk returning. It may be hard to get an idea of how much baby
transfers and keeps with all the spitting up, but a weight before and after
a feeding ( baby on side to minimize spitting up) might lead some very
useful information. I tell moms it seems that if it goes down out of control,
it's more likely to return. Babies with tongue function limitations may
have very significant but subtle milk transfer and control issues. Some of
them cannot get enough to feel satiated or sleep, so they seem to be feeding
constantly. Their little bodies will not allow their bodies to rest when
they are too hungry to settle for sleep. It's like having a big bowl of peas
and no spoon, you eat one at a time and by the time you get to the bottom
it's time to start over. Exhausting.
Bottom line: if baby can't transfer and/or keep a normal amount of milk, he
won't gain. If he can't do that, moms supply may dwindle over time. It may
be that if baby is getting the release done soon, they may still need mom
to pump and supplement with her milk ( proving the issue is transfer not
supply) or building supply back up over time ( showing it was low but not
mom's issue in the first place necessarily.) Low energy babies who don't gain,
sometimes need time for catch-up growth ( and relearning/unlearning after
release, a whole other issue) until they are their happy, organized selves
again. Mom is to be commended for hanging in there. This baby has issues
she didn't cause, he's healthy and alive because of her care and
diligence...:)
Sorry, it's Friday and I hope that makes some sort of sense...:)
Peace,
Judy
Judy LeVan Fram, PT, IBCLC, LLLL
Brooklyn, NY, USA
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