I have a situation with a nurse practitioner here at the hospital where I
work that could use some input. This NP has an 11 mo old daughter who has
never had formula despite the fact that mom works (yeah, mom!). The baby
was born IUGR and is still below the 5th percentile on all the growth
charts. Birth weight was 5-7 (at 40+ weeks), and she now weighs 15'8 at 11
mos. She has steadily gained though always below the charts. Ped has now
decided that along with the tests she is ordering, mom has to stop the
breastmilk and give formula. She originally told mom that her milk was fine
and she wasn't going to have her do anything, then called this am after
having talked to her non-bf supporter colleague, and put the fear of God
into this mom about her baby's brain development and neural growth, saying
they wouldn't be adequate because she was not gaining enough weight. This
despite the fact that this 11 mo old is already walking and talking. Mom
says she is the picture of health, but understandably, doesn't want to harm
baby (which Doc is strongly suggesting she is doing). Still, she doesn't
want to give formula unless it really is necessary. In fact, she's been
crying ever since talking with the ped. I gave her info from K Auerbach's
book about slow gaining babies and the growth charts. I suggested she
dialogue with her ped about other options which she is willing to do,
provided she really would not be "harming her baby". I also suggested a
creamatocrit and we're working with lab now to try to get them to do that.
(BTW, I'm taking info from Lawrence's book about how to do this and in
reading through it, one of the authors of the article she cites is the neo
who, along with his wife, are causing me and nursing moms all kinds of
problems at the children's hospital here!)
Baby does take solids and Mom says she always seems satisfied after
feeding, whether by bottle at the sitter's or breastfeeding at home. Baby
usually sleeps through the night, but occasionally wakes up to nurse. I
talked to mom about stepping up night feedings, but if an 11 month old
doesn't wake on her own at night (Mom is willing), is it really necessary to
wake her? This mom also recently took a round of Reglan to step up milk
production, which helped, because she felt her supply was dwindling. Mom
believes the ped thinks something really is wrong with the baby. What else
should I tell her to help her find her way through this situation? Is the
weight that bad? I know it's below the charts, but this baby doesn't sound
like she's suffering. She's ahead of the averages developmentally.
Wouldn't she be showing signs, if she wasn't getting adequate nutrition?
I'd love to see an answer from some of the docs on this list for this mom to
take to her ped. How would you manage this situation? Suggestions from
fellow lactnuts also appreciated. TIA!
Warmly
Marsha in Indiana, where I better get busy on my resident's talk which is in
90 minutes. Along will a sick teenager at home, this situation has consumed
my morning!
~~~~~~~~~~~~~~~~~~~~~~~
Marsha Glass RN, BSN, IBCLC
Mothers have as powerful an influence over the welfare of future generations
as all other earthly causes combined.
John S. C. Abbot
~~~~~~~~~~~~~~~~~~~~~~~
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