I finally saw mom & baby today. They spent three hours with me.
(For those of you just back from Boca - short summary ; baby two months
old, very slow weight gain, disorganized suck, no real treatment so far.
Was seen by LC, but only phone consultation with me. Mom didn't pump so
far. Two older children bf OK.)
Mom started giving more supplements by bottle, after nursing, and baby
gained 300 gr last week. Gained nothing the week before.
Assesment of baby: very thin, alert, good head support, smiles. Suck
assesment - would hardly allow my finger into her mouth, as gently as I
tried - makes disgusted face. When she finally sucks my finger for a short
time she has a gag reflex whenever I get near the S point. Her toungue is
pulled back and I feel the lower gum most of the time. No good seal, and
only 4-5 sucks before she opens her mouth and tries to push me out.
Couldn't get her to finger feed with a tube - she wouldn't suck long enough
to feel the milk comming.
At the breast - at first latches quite well, bottom lip a bit sucked in -
showed the mother how to pull it out gently. Baby sucks and swallows for a
short time, and then starts to arch back. She does seem to get some milk. I
tried to insert a feeding tube, but when the milk reached the baby she
pulled back - maybe the container was to high and the flow to fast. She got
irritated when I tried again. I couldn't get her to nurse with the tube in
place. After a while baby starts to get frustrated, and mom gives a bottle
(Avent). Baby drinks only from the tip of the nipple, and any trial to get
her to open her mouth more and the nipple farther to the back results in
gagging. Drinks about 80 cc. Falls asleep, wakes after a short while, put
to the breast again, nurses fairly well for a few minutes and falls asleep.
This goes on all the time.
Mom able to express sprays of milk after nursing, after I explained hand
expression. With the mini electric (the only available pump) on minimum
setting and with water for moisture - no pain, only slight discomfort, but
also no milk spraying. Probably hand expression is better for her.
The plan I gave them:
1. Feed the baby - keep nursing frequently and trying feeding tube device
with breast or finger, but if this doesn't work - bottle after nursings.
2.Suck training - try to get baby used to finger, and to learn to pull it
deep into her mouth. (After trying here for a while there was improvement.)
3.Express or pump milk after feedings, at least 6-8 times a day. Feed this
to baby at next feed, after breast, before formula.
4. Mom will consider fenugreek or Domperidone - she isn't sure she wants to
take drugs.
I will be in touch with her next week, and keep you all informed.
Thanks again for all your wonderfull help.
Bye,
Mira
mailto:[log in to unmask]
|
