I think sometimes pediatricians can find themselves between a rock and a
hard place on this "slow gain" issue. If they assume that it is just a slow
start..we will think "Ha! Why didn't he get more aggressive?" and if they
assume need for aggressive mngmt. we will say "See! Not supportive/
undermining of breastfeeding." I try to remember that they really don't
know all that we do about milk production and transfer..that is why we are
the IBCLCs.

Problem, really, is "When to refer to an IBCLC." That is what they need to
know because, to be honest, this recognizing of specific feeding
abnormalities requires a high level of clinical expertise...the sort that
one acquire by seeing hundreds of babies at the breast each year. Most peds
would do themselves a real favor by having an LC in their office....to take
the burden off of themselves for these difficult calls.

A similar problem happens in hospitals in the first 24 hours when nurses
get confused about what is a normal sleepy baby and what is a problem that
must be addressed. Sometimes I get really aggrevated with all these
referrals "He still won't latch and he's eight hours old." So, I
think...what is the problem? Call me if he is still this way tomorrow.

However, I remind myself that the policy does say that babies must eat at
least every six hours and that the nurse involved may not have my level of
experience with ferreting out the various reasons why babies eat poorly on
day one. I certainly don't want her to jump in with a bottle! I know she
will face the pediatrician in the AM if she lets baby go all night without
feeding. Better to get me in there to express some colostrum into baby's
mouth and write a note saying why I think this kid won't eat and why I
think it will get better with a little patience (by the way, about 95% of
the time it does get better without intervention.)

So, to go back to the original issue of peds who are not aggressive
enough...I try to be s/w sympathetic...remembering that this really is not
their field of expertise and they can't always see what is soooo very
obvious to me.

Susan keith-hergert RN, MS, CPN, IBCLC
Mercy Health Partners
Cincinnati

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