Jessica,
In regards to your FTT baby, I'd like to share a recent case with you. Mom
and baby referred to Lactation Center by pediatrician at one month with poor
wt. gain--in fact baby was below birth wt.  Baby had been bfdg 7-8 times per
day since birth, had adequate output--in fact I observed a moderate sized
brown yellow/ stool in the office.  On test wt. he took 45 ml over about 45
minutes with switch nursing and breast compression. After this baby refused
to take any more milk by bottle and would not nurse any further. Mother was
still able to pump out about 1.5 oz. milk.  So, my question was whether the
baby's poor wt. gain was due to low milk supply (did not seem like it),
decreased intake, or something else.  Baby had been seen by one of my
colleagues a week before and with improved latch and management had still
only gained 2 oz. over the week.  Suck on my finger was strong and
coordinated.  Baby, however, did not look good--very pale with low tone and
low energy.

In consultation with the peds, I sent mom home with a scale and asked her to
do test wt.s with each feeding and to pump and supplement so that baby would
get at least 2.5 oz. every 3 hr.s.  This is what we found out:  Baby never
took more than 30-45 ml every three hours. by bottle or breast--12 oz. per 24
hr.  Mother's milk supply, miraculously, was not low.  I think she was,
perhaps, an overabundant producer to begin with and had settled into a normal
supply with the baby's poor feeding.

Baby was admitted to the hospital the next morning and after an extensive
workup which icluded sending blood work to Mayo Clinic, baby was dxed with a
rare metablolic disorder--homocystine urea.

This was a puzzling case--output was good, but intake *was* poor.  Despite
poor intake, supply was fine--24 oz. in 24 hr.--plenty for this baby to grow
on if he would take it.  I think the moral of this story is that we can't
ever take a piece of data in isolation.  This was a sick baby--that was the
explanation for the poor intake and the failure to thrive.  I think we always
have to determine if intake is adequate in a FTT kid.   Even in the hospital
it was hard to get him to gain, but bless his heart he would only tolerate
mom's milk and he went home on expressed breast milk finally gaining well.
The good output was also puzzling.  There was no malabsorption--only poor
intake.

Kathy Boggs, RN, IBCLC
Mountain View, CA

             ***********************************************

To temporarily stop your subscription: set lactnet nomail
To start it again: set lactnet mail (or digest)
To unsubscribe: unsubscribe lactnet
All commands go to [log in to unmask]

The LACTNET mailing list is powered by L-Soft's renowned
LISTSERV(R) list management software together with L-Soft's LSMTP(TM)
mailer for lightning fast mail delivery. For more information, go to:
http://www.lsoft.com/LISTSERV-powered.html