To All:

I would appreciate input on this situation from all you experts out there.

Baby girl of 4 1/2 months, birthdate March 29, and birth weight of 8 lb. For
the first 2 months the baby gained nicely on exclusive bf (with a pacifier,
which the mother WILL NOT give up), weighing 10lb 3oz at 2 months.  Then, for
the next 3 weeks the baby gained nothing.  Subsequently she gained 1 oz per
week for the next 2 weeks.  She was very fussy during this time.

The pediatrician referred her to the nurse practitioner, who might be an LC,
but I'm not sure. The mother was advised to bf every 2 hours, supplement her
diet with Green Magma (one of those green products - I believe this one is
mostly barley grass juice powder), a multi vitamin, increase fat intake, and
improve overall diet. Positioning, latch and sucking reflex were not
evaluated. I should also  mention that this is G6P6, with the previous
children breastfed.

Mother advised to supplement with soy abm, didn't try cow's milk based abm
because of family history of allergies. After 1/2 oz baby vomited for next 24
hours and developed a rash. Baby swithched to Alimentum.

With 2-4oz bottles per day, baby gained 2 oz over the next week. It was
increased to 2-6 oz bottles, and she gained 3 oz. The mother then started
feeding cereal, approximately 7 tablespoons mixed with 3 oz abm, twice a day,
in addition to the other supplemental abm, and she gained 8 oz over the next
week. Now the cereal amount is being increased, and the bottle cut back to
once per day. The baby gained 5 oz over the next 10 days, which is where we're
at now.

Mother and baby did have yeast, which was treated with acidopholus, but no
other infections. I asked the mother also if there was or had been any pain
when breastfeeding, to which she said only the usual soreness in the
beginning. (As if that has to be "usual")

Now, was it right of this nurse practitioner to assume that since this was an
experienced breastfeeder, and that the baby did gain acceptably for the first
2 months, that the mother and baby did not need to be observed breastfeeding?
I also wonder why the mother wasn't advised to pump to try and increase her
milk supply?  Also, was the yeast sufficiently treated? Also, since
there's such a strong tendency for allergies in the family, which the baby
also displayed sx of, then why wasn't this further investigated? And, finally,
is it possible to salvage this situation now if the mom gets appropriate help?
(I told her she could have and should have come to me right away when the
problem was first noted. What I can't handle I always consult with and will
refer to someone who can).

TIA for any suggestions.

Devorah Shulman, BA, WIC Peer Counselor

Sorry about the signature file. It's my husband's. If I knew how to turn it
off I would, but I can't.

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