Riva

What an interesting case.  I've always been interested in situations where
the baby is experiencing low weight gain.  It's something that can creep up
slowly and then suddenly there's a baby failing to thrive on exclusive
breastfeeding - or in this case - exclusive breastmilk-feeding.

The first question that springs to my mind is How Much Milk were those
low-gain babies being fed?  In the protocols of the paediatricians I've
worked with in the past, for babies who are not feeding directly at the
breast they recommend 150ml per kg per day from 5 to 10 days of age, and
then increasing that quantity to 180ml/kg/day, as a minimum (divided into
8-10 feeds).  I find that my colleagues in England are always a bit mean in
their recommendations in comparison and they stick to the lower quantity
and wonder why things go wrong.  But it's logical - if the baby is failing
to gain enough weight (an average of at least 30g/day from 0-3 months,
20g/day from 3-6 months) then the baby needs _more milk_.  For very low
gain babies we would feed up to 300ml/kg/day - and they would gain
amazingly fast as they caught up - sometimes 75g/day.  As the weight piles
on then the baby's appetite drops back down to normal.  I also find that
recommendations for feeding prem babies are too modest too.  Some of the
studies I've seen actually recommend feeding only 100ml/kg/day so that HMF
can be added, which seems counter-productive - instead of fiddling around
with skimming the fat off the milk, or feeding HMF, just feed more
as-it-comes breastmilk.

So for your client, I would doubt that the quality of her milk is at fault,
but I would question the quantity she's been advised to feed previous
babies, and I'd be suggesting ways to maximimise her production in the
first two weeks of this new baby's life and feeding _more_.   Hope this
helps and you stay well too!

Pamela Morrison IBCLC
Rustington, England (formerly Zimbabwe, where we had little technology but
breastfeeding was robustly protected).
--------------------
Date:    Wed, 20 May 2020 03:20:32 -0400
From:    Riva WeissfishIBCLC <[log in to unmask]>
Subject: "low quality" milk

PTP. A women I was trying to help retain breastfeeding, told me that she
bottle fed three of her children EBM and even with adequate volume they did
not have appropriate weight gain. When they were fed the equal amount of
formula they did gain weight. She was told by her physician that her milk
was "low quality".  We are not speaking about which charts were used. They
fell off their own rate of growth curve.
In the past, she starts with breastfeeding, switches to pumping and then
continues with supplements until she finally switches entirely to ABM.
This time she wants to change to ABM already "before he starts to lose
weight".
Is it possible for milk to be so low in fat that infants will not gain
weight? According to her report she has an average diet and reasonable
calorie intake. She does not have oversupply issues (thinking: too much
milk -not finishing sides). If this would be the case, is there a solution
to the problem? Would pumping out beginning of the meal to access fattier
milk be effective?
Thanks for your insights!
Stay Well!!!
Riva

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