----- Original Message -----
From: "Cindi Swisher" <[log in to unmask]>
To: <[log in to unmask]>
Sent: Sunday, February 22, 2004 4:24 PM
Subject: sleepy baby and excessive wt. loss


> Dear Lactnetters,
> I saw a mother yesterday and I'm still worried about it.
> DOB:  2/12/04
> BW:  8lbs 3 oz
> Wt on day 4 was 7lbs 8 oz.
> 3rd child, mother breastfed first 2 with mastitis being worst problem
> Mother states has thyroid problems( not sure if hypo or hyper), but is not
> taking any medications because levels were WNL during pregnancy.
>
> Mother calls very worried because baby isn't peeing or pooping and won't
> wake up to eat.  States that she hasn't been nursing well since she saw
> doctor on day 4 and mom's milk came in and she became very engorged.
States
> baby wasn't able to latch to full breast and became frustrated and would
> arch her back.  States she kept at it, but by day 9 there were no more wet
> diapers and mother was concerned because baby wouldn't stay awake to eat.
> No rooting.  Difficult to even give her a bottle.  Mother had no pump and
> had not been pumping because baby had been "breastfeeding".  Mother stated
> she called Ped (on call) who told her that she could supplement if she
> wanted but it didn't sound like baby was dehydrated.  Just to keep
nursing.
> So....
> Examination of mother's breasts:
> Mother's nipples are about the size of a quarter and erect.  She states
that
> her nipples were sore with her other babies for the first couple of weeks.
> Breasts are soft, symmetrical, no lumps.  Nipples are intact.
>
> I take a pump over to mom's house and see baby who is very lethargic and
> whose wt is now 6lbs 12oz.  Baby will cry only if naked and touched with
wet
> washcloth, but cry lasts only 2-3 seconds and baby falls asleep.  I was
only
> able to get baby to wake up briefly myself.  Baby had taken a total of 4
oz
> of formula in the last 9 hours.  I tried to feed baby myself and baby
would
> suck once or twice and then let the milk dribble out of her mouth.  No
overt
> signs of dehydration.  Baby looked "skinny" and had a very worried and
weary
> look in her eyes.  Gave me shivers.  Needless to say, after I saw the baby
I
> suggested we get the wt which I stated above.Then we called the Ped again
> and the mother was firm that she wanted the baby to be seen.  So the Ped
> agreed and they took the baby to the ER last night.
>
> Mother called me last night to say that the ER had given baby a clean bill
> of health and told her to just keep nursing and relax.  They did give the
> baby IV fluids at the hospital and the baby seemed alert and was rooting
> while at the hospital.    This morning mother calls me again and states
that
> baby is still lethargic and since I saw her last night, she has taken 7 oz
> of formula. (That would be 15 hours)  They can get her to take no more
than
> 1 oz at a time.
> Mother states that she is unable to get much while pumping.  Lactina
Select
> with 30mm flanges.  She states that her nipple do rub a bit on the sides
of
> the tunnel.  States that she was able to get 1 oz the first time she
pumped
> but after that is unable to get much at all.  I encouraged her to keep at
> it.
>
> My questions to you.
> 1)  How can we get this baby to eat?????
> 2)  Basically this mom hasn't been emptying breasts since they became
> engorged and now supply is down to very little.  Will pumping get the
supply
> up?  Will she need to take herbs or Domperidone?  Will the pumping be
> effective if the nipple touch the flange tunnels?  If not, I don't have
any
> larger flanges and neither does anyone in town.  Any ideas?
> 3)  I'm furious (and the mother is furious) that the on-call ped and the
ER
> wouldn't take her seriously and gave her no suggestions on how to get the
> baby to eat, just keep nursing and supplement if you want.  Not how to get
a
> baby to eat who won't wake up.  Or when she does wake up, just lays there
> and looks limp.  Maybe I should offer to talk to the pediatrician myself?
> The mother talked to the ped yesterday.  The mother states she is certain
> her regular ped will listen to her and she is planning on taking the baby
to
> him tomorrow.  I guess I can't see any point in going to the ER again.
But
> I'm still worried...
>
> Thanks in advance for any help or advice.
>
> Regards,
> Cindi Swisher, RN, IBCLC
>
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