Hi Yasmeen,

From your post I gather that baby gained about 7 grams per day average between hospital discharge on day 3 and 3 wks of age. Then baby averaged 9 grams per day between 3 wks and 6 wks of age. So this wt gain is very low.

You say, "Mom is not convinced that her baby is not getting less since baby output is more than 3 yellow seedy stools per day and 10 to 12 wet diapers clear urine with no  smell." and  "Have anyone seen such slow gain with good output of stools, urine.?"



 Yes I have seen that. The baby is making enough pees and poops showing she is not dehydrated but is barely eeking by. Diaper count is but one estimation of how baby is doing, but wt checks remain important too. You also say that baby is active, seems satisfied, but mom concerned about latch not deep enough and "sucking seems superficial most of the time." This tells me that there could very well be low milk transfer, or low flow due to low supply and possibly non-nutritive sucking most of the feeding. You say mom "fears severe malnutrition."



Here are some suggestions: 1. observe a feeding or two; check milk transfer, swallowing. 2. check mom's supply; how full are breasts before a feeding, can she express streams of milk easily? 3. consider a pre/post feeding wt or two; this can tell if baby is transferring several ounces or just a few mls or anywhere in between. A baby with that birthwt should take in *about* 48 mls x 10 feeds, and at current wt, at least 52 mls x 10 feeds (just to give you a vague idea, this is not a prescriptive amount). Hopefully you have been on lactnet when we have had much discussion abuot the pros/cons of pre/post wts and the situations where they are useful or not, and how to interpret them. 4. If baby is taking in plenty but not gaining wt, then there is a medical problem e.g. metabolic, infection, heart, or other. It is more likely, though, that milk production is low or has gotten low and milk transfer is low, and so mom can pump after bf to increase supply, she can alternate feed to baby, she can take herbs to increase supply, and get help with deep latch, breast compression, switch nursing, things to help baby take in more.



Hope this helps,



Laurie Wheeler RN MN IBCLC, Mississippi USA

























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