Hello everyone,
    I am an inexperienced/or less experienced IBCLC and request your
guidance.  The following is a history per mom with her permission to post.
I am REALLY feeling the pressure as the mom told her infant.....I knew that
Paula would help and we will get some answers now.

    Initially I saw this infant three times for HHC visits. Normal first
time breastfeeding problems.  Mom does have very large breasts.  Mom and
Infant dismissed from my care at about 3 weeks of age.  No problems.  Weeks
later I get the following history and plea from mom.

Mom's statement........"I have just returned from Wal Mart with formula. I
must admit I am having a hard time with this, because I tried so hard to
just give breastmilk and now he has lost weight and the doctor is concerned
about his weight. I am to bring Tyler back in 2 weeks to see if he has
gained and if he has not gained enough they will do blood work. What did I
do wrong and are there a lot of mothers who have to supplement with
formula?"

SO concerned with no weight gain for 10 days Oct 29 - Nov 9.  Insists that
she take infant to a pediatrician.  MOM did start giving infant cereal on
Nov 8 twice a day.  (per  Family Physician's orders)

Nov 10- go to pediatrician.  (NOT BF Friendly)    Infant weighs 11 lb.. 13
oz.  Physician says he is below weight and needs to eat more  during the
day, he suggests mom get formula with iron.  infant eats 2 oz. of EBM and
cereal at 1000 and nurses at noon and then gets 2 oz. EBM and cereal at
1400.

November 14th- Mom called me.  Reassured mom that  she did nothing wrong &
listened as she cried.  (so sad) I assured her  that we still had time to
preserve the BF relationship.  Infant stooling >3 QD.  Laughs, gurgles and
wets.  I instructed on the basic BF info for low/slow weight gain/loss
infant and directed her to a very breastfeeding friendly pediatrician (his
wife is/was an IBCLC).  Labwork done/normal.  He  went with tried and true
rule....FEED THE BABY  and then referred her to me for follow
ups/suggestions.

The pediatrician wanted the infant supplemented with EBM,  but needed to
increase supply.  Mom started Reglan 10 mg TID on Nov. 19th.  She is also
pumping after feeds.  Mom is away from infant from 0800-1700.  She pumps BID
with double pump and feeds infant at noon.  Feels that this began when she
started back to work. This mom is very educated, attended my childbirth  &
breastfeeding classes, read recommended books about breastfeeding.  She
knows "a lot of mothers" don't have to supplement.

Infant has gained 6 3/4 oz since we started working with her.  I observed
this infant at breast..........I have never seen anything like it....checked
the archives nothing specific.  It is actually "slurping" at the breast.
Which would explain the wt. loss and decreased supply.  This infant is very
"nosy".   He has a loose shallow latch and pops off with any distractions.
He clicks and dimples.  It  seems to me that he has a very uncoordinated
suck.  Would an infant this old obtain these types of problems with 2
bottles per day?  (A**** bottle with slow flow and no pacifiers)  I tried to
do a suck assessment and he wasn't going for it. (My bad?)  As per the
archives, I don't want to ride in on my white horse, saving the day with
500+ solutions.

 8 lb. 2 oz    June 29 (born)
12 lb. 4 oz   Aug 26  (physician's office)
12 lb. 14 oz Sept 28  (physician's office)
12 lb. 2 oz   Oct 29  (physician's office--he is not concerned with his
weight for his age)
12 lb. 2 oz   Nov 9  (Pediatrician office)

12 lb. 2 oz   Nov 16  (BFF Ped.)
12 lb. 8 3/4 oz  Nov 22  (in my office)

Feel free to respond privately.

Thank you,
  Paula Hancock RN, IBCLC
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