I appreciate Heather's balanced response to the growth issue. She is
correct; the WHO data is not all in, but the ref. Dr. Neifert refers to in
the Clinics in Perinatolog article is:
Dewey, K, Peerson, J, Brown,K, et al. Growth of breastfed infants deviates
from current reference data: A pooled analysis of US, Canadian, and
European Data Sets, Pediatrics 1995, 96:495.
Here's my own opinion. Failure to feed robustly (which ought to be reflected
by growth and health) is rapidly recognized as a symptom in animals or the
elderly. I maintain that this is the case with newborns. Luckily, in this
population, inability to feed competently is generally transient. The risk
is acquired low milk supply and in somewhat compromised growth. The growth
can typically be recovered. The body of lit. we have on failure to thrive
cautions us to suspect organic illness if slow growth persists beyone 4
weeks, by which time management, maturity, and birth med. issues are
generally resolved.
I agree with Heather. Each baby needs an individual approach. I saw a 37
weeker a few days ago who had been referred to me by an anxious pedi who was
concerned when baby dropped about 9% of birthweight. Baby was under 6 lbs
at birth and this loss was a concern. On Day 8, with exclusive bfg. baby
was back within an ounce of birthweight. She is still small, sleepy, and an
inefficient nurser who takes a lot of time to complete a feed. Yet beyond
improving mother's latch a bit, I proposed no intervention beyond a bit of
postfeed pumping (since she has a pump) to keep her supply well stim. A
bit more history on this case: Mom had a delayed onset of lactogenesis
phase II, but passed a baseball size blood clot late on Day 5, and her milk
immed. came in. Baby is going to be fine now there is milk. But what if
the clot (suspect retained placenta) had not been expelled and there was
still no milk on Day 8 and baby remained stalled at her lowest weight?
That would have considerably changed my response. When I breed my dogs, I
assist the runts by helping them to the best teat, and I brood my chicks
under a warmer or in my shirt if the weather turns cold. I look at some of
these babies and see runts. The good news is runts are usually the pick of
the litter ;)
Barbara Wilson-Clay, BSEd, IBCLC
Austin Lactation Associates, Austin, Texas
http://www.jump.net/~bwc/lactnews.html
***********************************************
The LACTNET mailing list is powered by L-Soft's renowned
LISTSERV(R) list management software together with L-Soft's LSMTP(TM)
mailer for lightning fast mail delivery. For more information, go to:
http://www.lsoft.com/LISTSERV-powered.html
|
