Date:    Mon, 24 Nov 1997 18:04:00 -0500
From:    Ann Perry <[log in to unmask]>
Subject: poor wt gain

I have a case that is very troublesome to me and the poor mother and I would
love any feedback anyone could give me.

Mom is a 39 y/o primip with vaginal birth at term. Birth wt 6-14, D/C wt 6-7,
day 7 wt 6-0 ( 12% loss), by 3 weeks wt 6-9, 4 weeks wt 7-1, then 2 days
later 7-0.
Mom has had a good milk supply, uses an electric pump between some feedings,
getting 2 oz. At one visit baby consumed an oz. with a pre and post wt check.
----------------------------

Ann, you say the mom has a "good milk supply," but I don't think that a one
ounce milk feed is adequate for this child...In my mind, there is either
something wrong with:

1.  the baby (infection?), Have they checked all possibilities for infection?

2. something wrong with the supply (mom should be pumping after as many
feedings a day as possible, minimum of 6 postfeed pumpings with a double
pump/hospital grade pump), and finger feeding the milk pumped, or
supplementing with this milk at breast with an SNS or a periodontal syringe,
to ensure plentiful feedings and intake, or

3. there is something wrong with the transfer of milk, and this sounds like
it might also be the case. Sounds like her supply may be diminished, or else
the baby's bf technique is down too. 40-60 minutes per feed is *too long.*.
Baby is not efficiently breastfeeding, or else the supply just isn't there.

I would make sure the pumping and supplemental feedings (at breast
preferably) are happening, and see what the kid is doing with his tongue to
make that crease. Have you checked for tongue tie? What is the palate like?

ALso, yeast can make a mother have a reduced supply,/poor weight gain..acc
to Ruth Lawrence's book.  Is baby being treated for yeast, and has everyone
been treated for a lengthy period...ie two weeks after symptoms have
disappeared (for topical treatments)? Have they tried Gentian Violet in
water, a la Jack Newman?

Kathleen
Kathleen B. Bruce, BSN, IBCLC co-owner Lactnet,TLC, Indep. Consultant
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