I need help with a difficult case I am dealing with.  Quite frankly I'm
not sure what to do, figures one of my first exposures to the medical
community as an IBCLC and I get this really difficult situation.
Mom is a WIC participant and I am dealing with her as an LC at WIC.  Baby
was born 9-15-97 at 8lbs 1oz.  Weight dropped to 7lbs 5oz first week.
Mom is a vegetarian and has one son 8yr old.  Used formula with first
born and supplimented with cereal by 3mos as baby  "needed more".  Mom is
adamantly against use of formula this time and only wants to breastfeed.
I was told about this mom on 11-24, just before Thanksgiving!  I called
her MD and he was clear that he was concerned about this mom and baby.
He seemed willing to let me try to work with her.  I suggested that I
would weigh the baby as the mom was comfortable coming to WIC ( he stated
that the mom was not very cooperative, that she had made appts. and not
shown up) and report to him. She reports that it's her baby and he has no
right to insist that she give the baby formula.
Anyway, baby was here on 11/25 after a visit to MD and had gained 4oz.,
everyone was hopeful.  I instructed mom on use of electric double pump
and SNS to build supply and deliver a suppliment of hindmilk after
nursing to help put weight on baby.
Baby looks ok from neck up.  No sunken fontanel and cheeks ok.  Baby
appears clean and well cared for.  Legs and arms are scrawny, torso is
boney.  Mom was asked to keep a daily log of nursings, suppliment given
and wet/dirty diapers.  I was to see her again on 12-2 (long time due to
holiday :( ).
She came in on 12/2.  She did not keep much of the log.  She said due to
holiday frenzy.  She was cooking and was a guest at mom's house but she
did nurse him frequently.  Baby was up 1oz only in 5 days.  I told her
she must keep the log so we can see where the problem might be.
She came in today (12/4).  We had a very long meeting.  Baby lost the
ounce he had gained, now weighs 8# 12oz.  It is very disheartening.  She
did keep the log.  Baby nurses about 8 times per day for around an hour
each time!  She gave the baby a total of only 4oz of pumped BM over the
course of a day which she says he guzzles down.  Has frequent wet diapers
but infrequent bowel movements. He appears to have a good suck but tires
quickly at the breast and falls asleep(low energy?).  She spends some of
the hour of nursing rousing him to suck more.  My WRITTEN instructions to
her today were to: pump after every feed, give him at least 1oz in SNS or
bottle, 8 times/day or 2oz four times/day in addition to regular
breastfeeding sessions.
Use switch nursing.  Try to get Reglan from midwives to see if the
increase in supply solves weight gain problem of baby.  TAKE BABY TO MD!

WHAT ELSE DO I DO?  Am I missing the boat here?  How do I keep pedi from
threatening to take baby?  Is he right to insist on formula?  Are there
acceptable alternatives if not BM, such as cereal/banana to increase
calories?  HELP!

Please email to [log in to unmask] not my WIC address.   Much thanks for
any suggestions.