Mandy
There's some pretty good info about maternal diet and breastfeeding
on this LLLI info sheet, see
https://www.llli.org/nb/nbmarapr04p44.html. In fact, a breastfeeding
mother has to be quite severely malnourished (losing not only body
fat but also muscle) for it to have any effect on either the quantity
or the quality of her breastmilk. So the fact that the baby is not
gaining adequate weight (an ounce in two weeks is _not_ enough) has
almost nothing to do with what the mother eats. As a rough guideline
the baby should have gained an ounce a day for the first 3 months of
life and 2/3 or an ounce a day for the next three months, ie roughly
7 lb over birthweight by four months of age. From your description
it sounds like this hasn't happened? And if not, it sounds as if the
the baby needs a close breastfeeding assessment, with careful
attention to positioning and attachment and noting swallowing (my
guess would be that there is little swallowing and that the baby
mainly hangs out flutter-sucking at the breast for long
periods...) Mother may need to be taught how to express her milk
after (hopefully short-ish, not more than 30 minute long)
breastfeeds, so that she can use her EBM to supplement the baby, and
drain her breasts more efficiently to re-stimulate her milk supply.
As an IBCLC living and working in the UK I confess that I'm becoming
increasingly concerned by the very casual attitude of clinic staff to
inadequate weight gain. Mothers I've worked with have been fobbed
off and reassured that their babies are fine when they're not. And
then suddenly there's a big panic when someone realizes that the baby
is badly underweight, and often Social Services are called in, and
the mother is charged with neglect of her infant. In addition, I
think this is probably not helped by local guidance for very
infrequent weight checks, eg DoH protocol available at
<http://www.rcpch.ac.uk/system/files/protected/page/DoH%20info%20for%20healthcare%20professionals.pdf>http://www.rcpch.ac.uk/system/files/protected/page/DoH%20info%20for%20healthcare%20professionals.pdf
"Babies should be weighed in the first week as part of the assessment
of feeding and thereafter as needed. ....If parents wish, or if there
is professional concern, babies can be weighed at 6-8 weeks, 12 and
16 weeks....
If there is concern, weigh more often; however, weights measured too
closely together are often misleading, so babies should be weighed no
more than:
once a month from 2 weeks to 6 months of age
once every two months from 6 to 12 months of age
once every three months over the age of 1 year.
However, most children do not need to be weighed this often; families
should be reassured that they can attend for advice without having
their baby weighed."
It's good that you're raising questions now. Best wishes to this
mother and baby.
Pamela Morrison IBCLC
Rustington, England
---------------------------------------------------------------
Date: Wed, 5 Feb 2014 11:36:53 -0500
From: Mandie Groves <[log in to unmask]>
Subject: Slow weight gain - UK nursery nurse comment
A mother and baby regularly attend a breastfeeding support group that I run.
Baby is now 4 months old and has gained a little weight every week,
sometimes one or two ounces and occassionally up to five ounces. He
has already been seen by GP and paediatrician as he was referred
through slow / low weight gain.
Today at the regular baby weigh clinic she was told baby had only put
on one ounce this fortnight and she needs to go and see her GP again.
Mum was then asked " maybe it's something you are eating ?" Mum then
replied that she can't think of anything strange that she is doing
and that she breast feeds whenever baby needs it, and that he is
passing urine and stools (yellow and soft ) frequently.
My question is "Why would the Nursery Nurse at the clinic ask about
mums diet? And what response / information can I give her to help her
understand the effect of mums diet on her milk ? "
Thanks
Mandie
Community Peer support worker.
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