Elizabeth
I have worked w/ several dyads where the baby WAS NOT GETTING ENOUGH MILK
however the pedi felt the baby was "just constipated" and ordered a
suppository (as is the case w/ your client) and invariably this will result
in a stool. But...this will not be sustained and is a marker for insuff.
milk intake.
The mother's hx of breast implant surgery is significant. The surgery may
have impacted the function of the breast/nerves/ducts (not as common or
likely as w/ br. reduction surg but still possible) OR THE MOTHER MAY HAVE
UNUSUAL OR ABNORMAL BREAST DEVELOPMENT which led her to have the
augmentation.
The nipple soreness (how much pain? how much physical trauma to the nipple?)
is also a red flag to me that position/latch may be suboptimal. Anything
above a "4" on a 0-10 pain scale is a big red flag to me. The sleepiness in
baby is a sign of trouble too and I would want this baby feeding VERY often
and not w/ any longer stretches. Test wts would be helpful but I predict
very little milk transfer. Baby may have a medical problem too, but I
predict the main problem is lack of milk going into the baby.
Care plan would be:
Feed the baby generously - sns or whatever method family chooses
Support the milk supply - very freqt effective feeds, expression, herbs,
meds whatever
Preserve the bf - kangaroo care and cont. practice bf

Laurie Wheeler, RN, MN, IBCLC
Violet Louisiana, s.e. USA

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