Ghislaine's first case

[Guest guest]

I said I would keep you posted on my first case, remember the slow weight gain baby. The mother reports that the baby is steadily taking 23 g per day. It's not a gigantic gain but It's steady. The pediatrician is happy. However, mom is supplementing, about 4 ounces per day with polychose added (a sugar concentrate to add calories to the EBM). I'm keeping in touch. Parents will see doctor again in 2 weeks. Baby is growing also in lenght and head circumference.

Now to my second case : I saw a 4 day old baby this weekend. Second born, first baby breastfed 7 months without any problem. This baby was born by C-section (as the first one) under spinal. First feed was 3 hours after delivery. Baby is still under the effect of the meds the mother received (in my opinion) as this baby is very hard to wake up. She'll go 7 to 10 hours without nursing. She has fewer than 2 bm every day.

Mother has very large and very soft breast. When I visited, baby would not latch and after 2 to 3 tries, baby would shut off and fall back asleep. I instructed on the asymetrical latch and mother was able to achieve a wider latch with sustained active bf for at least 10 minutes (as opposed to 2 minutes with a very small latch). I instructed the mother to supplement if baby does not succeed in actively bf with a deep latch and if bowel movements are not sufficient. Mother is also instructed to pump to maintain supply.

Yesterday, baby slept from 7 a.m. to 3:30 p.m. and mother could not wake her up. Parents were worried and took baby to Montreal Children's Hospital. They saw 2 doctors and a nurse LC(not IBCLC). Nurse LC said I had given the right advice and to continue. However, doctor said not to worry if baby goes long without feeding but to keep baby close to mom.

I mentioned kangoroo care for stimulation and explained sleep states in babies. I disagree with doctor about the number of feeds and lenght between them and instructed mother to supplement. Community nurse will come and weigh baby every 2 days (as per doctor's instruction). I'll be in touch with mother after nurse's visit to follow up on weight gain.

This baby's lack of interest in bf and very deep sleep worries me.

Any other tips ?

Ghislaine Reid