Dear Lactnetters - I could use some ideas. Last thursday I saw a family with
a 5 week old baby who had just been released from hosp. She had been
hospitalized because of poor weight gain and constant crying and nothing
untoward was found. The baby was born at 3300 grams and left the hospital at
2770 grams. The mother received pethidine and phenergan  but the baby
apparently latched on well on the delivery table. The first week after birth
the baby gained 200grams and then she faltered, and during the next month
gained only 300grams. The parents reported that she feeds all day and spits
up a lot. Plenty of wet and stooled diapers. The doctors also considered
reflux and the baby was givin prepulsid.
--- On examination I found a skinny, alert and very awake baby - just
beginning to socially smile. Skin tone good, wide palate and good cupping of
the tongue on my finger- no unusual mouth anatomy. She could not tolerate
being offf the breast for more than a few minutes. On the breast she latched
on well and after inital pursing she flanged her lips well. Suck and audible
swallow was heard many times during the feed. The baby had many yellow,
loose stools while she was here, not frothy and with a good, clean smell,
and her urine was clear. The mother has a history of allergies. The parents
are exhausted, worried but highly motivated. We decided to try a milk
elimination diet, and to feed on one side for at least 21/2 to 3 hours. I
don't know how to say this but this isn't your usual miserable baby....she
doesn't have that pained look although she appears to be in discomfort. The
mother brought a pump with her and eaily pumped milk.  Last night on the
phone the mother said that even in her sleep the baby is in constant motion
and 3 days into this program things are a bit worse. Her father sent me her
schedule of the previous day which he says looks better on paper.

>June 28:
>
>1. 02:30-04:00 (several short breaks in between)
>2. 06:00-08:30 (longer breaks in between)
>3. 09:30-10:00 (large quantity)
>4. 11:40-12:45 (shortly after 11:40 two large throwups)
>5. 17:00-19:15 (two medium throwup + 2 smaller ones)
>    20:15 throwup.
>6. 21:15-10:30
>
>
>June 29th
>
>1. 01:30-02:30
>2. 05:30-07:00
>3. 08:30-13:15 (prepulsid medication)
>4. 16:30-17:00 (prepulsid medication)
>    17:15 small throwup.
>5. 18:15-19:30
>6. 20:15-21:15
>
>June 30th
>1. 00:40-02:30 (prepulsid)
>2. 03:45-4:10
>3. 05:45-06:00 (prepulsid)
>4. 07:45-
>
    Today the parents are going to weigh her. Any ideas before the parents
are pressured to supplement. By the way the doctors did not sugest
supplementing at this point - the pressure is from nurses and family....and
by now the parents are considering it. All ideas would be greatly
appreciated. Toby



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Name: Toby Gish R.N.LLLL.IBCLC
e-mail<[log in to unmask]>
"What is essential is invisible to the eye..."
    Antoine De Saint-Exupery
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