The last baby I saw who acted as Cindy describes turned out to have
hypernatremic dehydration.  I sent the parents right to the doctor, and
I called him as soon as I was in my car and told him the baby was too
lethargic and that I was sending them to his office immediately.  He
called me back with the lab results after he saw and admitted the baby.

When a baby (or a mom) is really in trouble, I think we should talk to
the physician asap and make sure that their concerns are taken
seriously.  There does seem to be a big difference in the care of
evaluation when the mom calls and when another health care professional
calls on her behalf.  One mom I saw with a newly emergent pulmonary
embolism was getting the brush off from her ob until I got on the phone,
described her condition, and asked him if it could be an embolism.  He
had her come right to the ER then, and sure enough, it was.

As for getting a very lethargic baby to eat, I find fingerfeeding with a
syringe and tube very effective.  One can safely feed a sleepy baby this
way, if one is careful to pace the feeding properly.  It's best not to
feed too much volume at once, smaller feedings very often is better,
both to not overwhelm the baby's system which is in energy conservation
mode, and to avoid potential brain swelling if the baby is hypernatremic
and no one picked it up.  Babies who are failing to breastfeed don't
look *bad* until it is almost too late...

--
Catherine Watson Genna, IBCLC  New York City  mailto:[log in to unmask]

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