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Subject:
From:
Lynn Shea <[log in to unmask]>
Reply To:
Lactation Information and Discussion <[log in to unmask]>
Date:
Fri, 11 Jan 2002 09:09:40 EST
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Hi Trish,
Thanks for sharing your very interesting case!
Poor baby!
The oral aversion is certainly explainable by the events but I might pay
close attention to a few details. How food friendly is this household? It
sounds like a silly question but I did home care for a 2 yo a while back that
was receiving TPN (d/t supposed GI issues) and trying to advance on solid
foods. The family was very nice and you never would have known there was an
issue if you didn't spend time in the home but the mother was not supportive
of his attempts with feeding. That is she was extremely anal about
cleanliness, would offer food only at designated snack and meal times, would
coerce him to take it and provided him with little oppurtunity to feed
himself, as it would make a mess. Food was not fun! It is sooo tempting to
fight with a child to eat, I see it with family members whose children are
healthy and the coercion may be subtle.
Loss of hair CAN mean a zinc deficiency, I saw it often with babies on long
term TPN. Does he receive an MVT. As far as the size of the NG tube not
allowing more cals, why can't they use a larger if they feel he needs more
cals. The situation is unclear because you state that his weight gain is ok.
I would be skeptical about those numbers as most likely he needs to do alot
of catchup growth! If so, it is tough to reconcile this with the idea that if
given more cals, he might be too full to want to po feed.
Is she still attempting to feed at the breast? If not, why? If she thought it
were possible would she try? If she is willing to attempt, I would try him
when he is half ASLEEP and with a full breast. I am sure he will look at her
as if she is crazy if he is awake!  If he is comfortable at all with a bottle
nipple, I might try a shield as well.

Lynn Shea Rn,Bsn,Ibclc- spending way too much time with Lactnet this week!
Franklin,Massachusetts

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