Guest guest Posted December 3, 2008 Report Share Posted December 3, 2008 Today I saw a dyad at WIC that still has me puzzling, hours later. Pardon my lack of details. I rushed off without my notes, and it is only now, later in the evening, that I recognize that this case is really bothering me. Baby is now 4 weeks old, still under birth weight. She was referred to me by one of the WIC staff after mom had what seemed to be general breastfeeding questions, and concerns about a sleepy baby. Well, not only was baby sleepy, baby *was not* gaining. A week ago, she was given the instruction to wake the baby more often during the day (baby was feeding more frequently at night, sleeping more during the day), pump after as many feeds as she could, and offer back that milk to the baby. When I saw her today, she hadn't followed the instructions. She was waking the baby more frequently, wasn't pumping, wasn't feeding milk back. Baby had managed to gain, but only 3.5 ounces in a week. Mom is using a nipple shield. BTW, we do have a bit of a language barrier (mom's primary language is Spanish, mine English; her English is much better than my Spanish). I had an interpreter come in at one point to be sure we were communicating clearly Quote Link to comment Share on other sites More sharing options...
Guest guest Posted December 9, 2008 Report Share Posted December 9, 2008 Hello , Here are a few questions that came to mind when reading your post : Could this baby have laryngomalacia or tracheomalacia ? They make a lot of noise but don't gain much. Also, could this baby have a UTI ? Mom's production is probably low by now as a consequence to weak suck or not enough suckling at the breast. Did you check for tonge-tie ? Have you tried supplementing before the feed ? Refer to article on "finish at the breast" : http://www.lowmilksupply.org/finishatthebreast.shtml Good luck ! Keep us posted. Ghislaine Reid, IBCLCConsultante en allaitement « Donner l’exemple n’est pas le principal moyen d’influencer les autres; c’est le seul et unique moyen. » Albert Einstein (traduction libre) Am I hearing things? Today I saw a dyad at WIC that still has me puzzling, hours later. Pardon my lack of details. I rushed off without my notes, and it is only now, later in the evening, that I recognize that this case is really bothering me. Baby is now 4 weeks old, still under birth weight. She was referred to me by one of the WIC staff after mom had what seemed to be general breastfeeding questions, and concerns about a sleepy baby. Well, not only was baby sleepy, baby *was not* gaining. A week ago, she was given the instruction to wake the baby more often during the day (baby was feeding more frequently at night, sleeping more during the day), pump after as many feeds as she could, and offer back that milk to the baby. When I saw her today, she hadn't followed the instructions. She was waking the baby more frequently, wasn't pumping, wasn't feeding milk back. Baby had managed to gain, but only 3.5 ounces in a week. Mom is using a nipple shield. BTW, we do have a bit of a language barrier (mom's primary language is Spanish, mine English; her English is much better than my Spanish). I had an interpreter come in at one point to be sure we were communicating clearly. Now to what has me puzzled. Baby readily goes to breast. I *hear* gulp, gulp, gulp, for quite awhile, then consistent swallowing for another 10 or 15 minutes. I hear them, no stethoscope. Weigh the baby--1oz difference. Huh?! I swear, I heard the gulping. I was thinking, "Well, now I know why she needs a shield--OAMER!" Then only 1oz?! Mom put her to second breast, little intake; back to first breast and took another .8oz. Still, why all that noise and not the associated intake? Certainly you can't swallow *that* much spit! Wagner-, MS, MFT, IBCLC, LLLL Roseville, CA Quote Link to comment Share on other sites More sharing options...
Guest guest Posted December 10, 2008 Report Share Posted December 10, 2008 Thanks everyone for your suggestions. One of the more frustrating things about working for WIC is the frequency of follow-up, or lack thereof. Add to that the fact that I might not be the person doing the follow-up and I can get even more frustrated. Anyway, I'm going to browse files tomorrow and see what I can find. Mom was supposed to call in with weights from doctor. I did not see signs of tongue-tie; will check again. Ghislaine, are you thinking UTI has an impact on weight gain? Or does UTI not stand for urinary tract infection and is bf related? WD who probably shouldn't answer email late at night after 14 hour work days. =) Quote Link to comment Share on other sites More sharing options...
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