Looking for insight

[Guest guest]

I saw a 9 day old baby this evening who has lost almost 10% of her birth weight

and is not regaining yet. Oral exam felt totally normal and she has a strong

sucking reflex. Mom has very large fibrous nipples, but baby seems to latch well

if mom gets baby in closely and aims nipple to nose. Once baby is latched, she

just sits there without sucking at all until mom's milk lets down and then

drinks usually for less than 5 minutes and then falls asleep (when flow slows),

wakes up less than 10 minutes later and then wants to nurse again. I saw A LOT

of nonnutritive sucks tonight and few swallows overall. She is having over 8 wet

dipes a day, but just 2 darker yellow poops. She did not poop for 2 days after

she was born. She has not had any problems with jaundice and appears normal -

not hypotonic, etc.

Mom is tandem nursing and says that she often feels engorged enough that she

encourages her older child to nurse a little more to get relief (only after she

has tried to get her newborn to nurse as much as possible). She pumped during

our visit tonight and got milk out immediately and was able to easily express

out an ounce in just a few minutes. Tried giving the expressed milk by tube at

breast, baby drank for maybe a minute of constant deep drinks and then fell DEEP

asleep.

I suggested staying in bed skin to skin for the next couple of days to nurse

baby more often, pump after feeding and give expressed milk by tube at breast

and/or finger feed to get baby fed more, maybe bring her supply up a bit and see

if that changes baby's behavior at breast. Mom wants to try this for a couple of

days and then reweigh. I also suggested CST.

Something just feels odd about this and I don't know if I'm completely missing

something. Usually in moms I've seen with low milk supply, babies are more

vigorous at breast, get upset and don't just sit there and moms aren't easily

expressing milk. Obviously, it seems baby is not getting enough, but I can't put

my finger on an obvious reason why as latch seems good and supply seems good and

baby can organize drinking when flow is quick. My thoughts were that maybe if

baby got in a couple of days of really good feedings and mom's supply came up a

tad that there might be a difference.

Thoughts?