Hi All,
Got a call from a mom with 2 wk old twins born 5 wks early.  One in NICU for
3 days, bot fed a couple of times.  Both babies are now on the breast with
no supplementaion.
Both babies have had a slow weight gain - baby 1 was 5' 13" at birth, went
down to 5' 6" on day 4 and on 2-10 was at 5' 10"                baby 2 was
6' 1" at birth, went down to 5' 6" on day 4 then on 2-10 was at 5' 8.5".
Both babies have approx 6 poopy diapers mostly yellow seedy types with baby
2 having some green...varies between tsp and Tbls amounts sometimes more
than a Tbls) and 6 wets.  Baby 1 has the "vacuumm cleaner" type of suck
while baby 2 is a "gourmet" takes his time and often falls asleep at breast.
Dr is concerned with slow weight gain and had mom start BF 5 min one side
then switch, do another 5 min, then swicth...well, guess what has started in
the last day or so??  Green poopies, gas and fussiness.  Corrected that info
(tactfully).  Mom (and Dr) is concerned that baby 2 is not gaining enough,
and with a "lazy" nursing pattern is worried that baby is not getting
enough.  Babies BF every 2 hrs around the clock (mom wakes during day,
babies wake spontaneously at night) and tho they are gaining slowly, they
have gained, they have the output we would expect, and I am not convinced
that there is a "problem" here. (other than the FM/HM imbalance with baby #2
bc of switch nursing)  Mom does report tenderness of nipples when babies L-O
but it goes away quickly as they get going with the sucking. No history of
antibiotics with mom or babies, no itchy/burny stuff, so I doubt she has
yeast.  She is NOT pumping.

What I told mom was that the babies have yet to hit term, and they are still
practicing this BF thing.  They seem to have a good output, but I suggested
that she keep a record of wets and poops for the next couple of days to see
exactly how many of each each baby has.  Told her that the probable cause of
the nipple tenderness is babies still getting the hang of this thing, and to
be careful about L-O and positioning - gave details. (she has no cracks,
blisters, or abrasions - tho I have not seen her in person)  Continue to BF
as she is, watching babies cues and trying to get rest herself.  Told her to
keep an eye on the babies weight gain, also to try and BF them together to
give baby #2 (who they are nore concerned about) the benefit of letdown
stimulated by baby #1.  Also, no more switch nursing.

Anything I missed?  I also suggested that, since it is a benefit of her
medical coverage, she could go see the LC in her hosp (who I know is VERY
good) just for verification and peace of mind if she is still worried.  I
plan on calling her tomorrow to see how she is doing.  I am also wondering
if she should be doing any pumping to support her milk supply, but hesitated
to suggest this as it seems as if babies are doing OK (albeit slowly
gaining).  I would like to see them doing a bit better, but as they are not
yet at term, I wonder if this is in the range of "normal" for twins.

TIA for any education you can give!

Jay Simpson, CLE
Sacramento, California, West Coast, USA
"No Miracles performed here, just a lot of love and hard work."