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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