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Breast Feeding

Poor weight gain in an I.U.G.R BABY

05/11/2000

Question:

my sister had a baby at 36 weeks that weighed 3lb 13oz he is now 4 weeks old and has not regained his birth weight,in fact he has lost weight.She is feeding every 1.5 hrs and is exhausted.She does not want him to have a bottle of any sort.I would value your opinion.

Answer:

It sounds as if your nephew may be "in the restaurant" when at breast, but he is not actually suckling effectively, so he is unable to transfer enough milk from the breast into him. This generally is related to a temporary problem with a baby. Rarely is it a mother-related problem, but it will cause her milk production to drop. It is not unusual for a baby born at 36 weeks, who was also small for gestational age, to experience difficulty with coordinating sucking and swallowing. However, Rule # 1 is FEED THE BABY.

This little guy needs food NOW to live and grow. He should have been gaining more than ½ ounce (15 gm) each day since the end of his first week after birth. If he cannot yet breastfeed effectively, he needs to get food some other way for a while, and he needs to get it NOW. To wait any longer could result in serious consequences for both baby and mother. Incidentally, your sister`s own milk still is the ideal food, which she can express by using a hospital-grade pump and then give to him via an alternative feeding method. Please let your sister know that using another feeding method for the time being does not have to interfere with long-term, full breastfeeding. Your sister may also need to know you support her in her long-term breastfeeding goal, but her son`s sucking difficulty must alter current breastfeeding.

There are several ways to get food into a baby that do not involve bottle-feeding. If the baby has some ability to coordinate sucking and swallowing, a feeding tube device, such as the Medela Supplemental Nursing System® (SNS) taped to the breast will allow your sister to get more food into the baby during breastfeedings. Some babies do better initially if such a device is taped to a parent`s (clean) finger for what is called "finger-feeding": baby gets food through the tube as he sucks on the parent`s finger. In some situations, wearing a thin, silicone nipple shield during breastfeeding helps an infant organize their sucking and transfer milk from the breast more effectively. I`ve often used a 10-20 cc needleless syringe to get food into a baby without introducing a bottle. (A local IBCLC should be able to explain alternatives.)

Still, getting calories into this baby NOW is the bottom line, and there are times when that takes a bottle. If a bottle is necessary, your sister might try a brand of bottle teat/nipple that is marked "slow flow" on the package. She then can encourage the baby to continue to use breastfeeding behaviors by tapping his lip to encourage rooting and waiting for him to open wide and stick his tongue over his bottom gum before he latches on to the bottle. With a true "slow flow" teat, he should have a few seconds between drips of milk to take a breath as needed, so he can keep his tongue out over his bottom lip as with breastfeeding. (However, the primary objective now is getting fluid and calories into him; reinforcing breastfeeding behavior is secondary until he is gaining weight well.)

Rule # 2, MOVE THE MILK, also is important in this situation. Not only will your sister want to express/pump her milk so it will be available for alternative feedings, but she also should express her milk because milk production decreases when a baby isn`t breastfeeding/removing milk from the breasts effectively. Hospital-grade electric pumps can be rented. If milk production is already dropping, the baby may have to be given some infant formula after he takes the available breast milk.

I urge your sister to take her baby to see his pediatric care provider TODAY. The "newborn feeding team" at a large children`s hospital may be able to help if a sucking difficulty is interfering with his ability to breastfeed. I`d also recommend that your sister contact an International Board Certified Lactation Consultant (IBCLC) in her area. The IBCLC can help her develop plans that will ensure that the baby receives the calories and fluid he needs and that will help your sister maintain/increase milk production. She also should be able to assess whether a particular breastfeeding device might be helpful and can instruct your sister how to use it properly. As your nephew improves, the IBCLC can work with your sister on a plan to help them resume full-time breastfeeding. For the names and numbers of IBCLC in her area, contact the International Lactation Consultant Association (919-787-4916) or the International Board of Lactation Consultant Examiners, Inc. (703-560-7330).

This situation cannot continue. Your nephew is lucky to have a concerned aunt. If your sister is not willing to get help from the pediatric care provider and a lactation consultant, you will have to consider contacting the children`s protective service in your area. It may be that exhaustion is making it hard for your sister to think through this problem. You might help by offering to contact the health care providers mentioned and drive her and the baby to appointments as needed.

Please let me know what happens. I am very concerned after reading your description of the problem. If you or your sister has additional questions, don`t hesitate to write again. All the best to you, your sister and your new nephew!

.

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Response by:

Karen Kerkhoff Gromada, MSN, RN, IBCLC
Adjunct Clinical Instructor
College of Nursing
University of Cincinnati