Dear all:

First I want to make it very clear that we have some excellent pediatricians in New York City who are also lactation consultants.  We had one DONATE her office for a talk on Cleft Lip/Palate and Other Craniofacial Conditions.  

Second, I am ripping my hair out over the latest fiasco of advice to a mother of a perfectly healthy full term baby from the pediatric group that most often drives me to have to take deep breaths and make an extra trip to Marial Arts. 

The baby is a sleepy feeder and causing her severe pain. Her baby had a mild restriction of the frenulum and she of course, was told by this pediatric group that it made no difference (with no assessment).  She was also told that she didn't need to wake her 2 week old even though her 2 week old was frequently sleeping longer than 6 hours.  So, while she was pumping after feeding (which this practice discourages) the number of feedings was too few to stimulate an adequate supply.  And she was told to add powder to your breastmilk without being given a rationale.  The baby's weight gain is actually fine because she's supplementing with formula after feeds.  

So, now I suppose I'm not only going to see babies failing to thrive because of too few feedings a day, but I'm now worried that I will see some babies with hypernatremia and I'll have to start asking whether they are adding powder to their breast milk.  She was not given any instructions on how much powder to add, nor any rationale for using it. 

Fortunately, I had a family practitioner in the group who gave her an additional referral to a family practitioner who assesses ankyloglossia to add to my referral to the pediatric ENT.  I don't know if the restriction of the tongue was the root cause of the problem because she was able to reduce her pain with a more comfortable latch, which involved raising her from the 25 degree angle she said she was told to do for "biological nursing" to a more comfortable 60 degree angle.  

This particular practice is the largest source of most of the iatrogenically induced cases of failure to thrive that I see.  I have sent articles, reports, and finally I think I'm throwing up my hands in despair.  Nothing seems to derail them from more and more severe infant feeding and sleep practices and more and more bizarre compensatory suggestions. 

Sincerely, Susan Burger

Who is even more grateful for the GOOD pediatricians that really are out there.

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