Re: [ozmidwifery] weight loss

[Susan Cudlipp]

Thanks for all the replies to my question. To answer: Baby did have bag urine and full paed check on readmission, as far as I know nothing abnormal was found. No tongue tie and no projectile vomitting.  He was reviewed by paeds daily while back in hospital.  He was breast fed and supplemented with formula for 3 days whereupon he started to regain weight and have bowel movements, also woke up and started behaving more normally. Was discharged again with EDP follow-up, fully b/f.  Lost weight again over 5 days and again no bowel movements.  On Tuesday I recommended mum re-start formula top-ups again post feeds if he wasn't settling - she had been feeding for long periods and he was still not settling so was keen to do this.  Her diet appears to be adequate, she has good family support and is a calm, confident mum - I observed feeding on a number of occasions and saw good latching and swallowing happening, appears quite content at the breast. Yesterday bub had put on 120gms and was polishing off 60ml formula top-ups post feeds (3 hourly) Had an enormous bowel action - first for 4-5 days. Today weight was static - maybe due to huge BM.  I advised her to offer more a/f and let him decide how much he needed if he was not satisfied post b/f. I have discharged her to the CHN who visited yesterday but we can visit in the interim if she has any worries.  He appeared well, has never been jaundiced, and is well hydrated but looks 'skinny', not much body fat yet.  I do wonder about this bub though because I just felt that something was not 'right' with him and perhaps down the track he may be found to have some other issues as yet un diagnosed. I also agree with Andrea that the tegretol may be part of the answer - she is also on carbimazine for ulcerative colitis (that was the med that I couldn't remember) Many times I have heard women say 'I had to stop feeding because my milk was 'no good'' and I have never thought this could be true but this one did have me stumped and I wonder if there is any possibility that sometimes mum's milk is not high enough in calories for a particluar baby (diet issues aside) Thanks again for all your input Sue "The only thing necessary for the triumph of evil is for good men to do nothing" Edmund Burke ----- Original Message ----- From: Andrea Quanchi To: ozmidwifery@acegraphics.com.au Sent: Thursday, May 25, 2006 2:40 PM Subject: Re: [ozmidwifery] weight loss I have personal experience of another Mum who was on tegratol and lamictal and had similar scenario. Bub really struggled for some months as Mum perservered but eventually bub needed to be comped and has never looked back. Give it a bit longer if bub is happy as weight is not everything but if bub is showing signs that he is hungry then offering a comp will allow him to tell you whether this is what he needs or not. If it isnt he wont take it.  He might only need a small amount once or twice a day to tope up what he is getting from mum and this will allow them all to relax and get on with it.  Worrying about him being unhappy will not do anything for her supply Andrea On 25/05/2006, at 6:29 AM, Nicole Carver wrote: Hi Susan, This is indeed puzzling. The babe needs a visit to the doctor to have medical reasons excluded, if it hasn't already been done, including bag urine for culture etc. However, the fact that the baby regained wt in hospital and then lost it again at home does seem to point to a feeding management issue. Is Mum feeding the baby often enough, or leaving the baby on the breast long enough? Does the baby have a tongue tie (these babies feed well from the bottle, but find it hard to strip a breast)? Is Mum hearing baby at night or is she slightly sedated by the Tegretol, or the baby sedated by it? I assume someone has checked if Tegretol is ok with BF? Warm regards, Nicole Carver. -----Original Message----- From: [EMAIL PROTECTED] [mailto:[EMAIL PROTECTED]]On Behalf Of Susan Cudlipp Sent: Wednesday, May 24, 2006 11:44 PM To: midwifery list Subject: [ozmidwifery] weight loss Dear wise women I have been following a client on early discharge whose baby is losing weight. Now about 2 weeks old, I readmitted her on day 5 as bub was lethargic, had not had a bowel movement and had lost weight. She expressed, fed and topped up, bub 'woke up' and put on weight, started opening bowels and generally improved all round, went home again fully breast feeding, seems to have plenty of milk, plenty of wet nappies but again - no poo's, and on last 2 visits had lost weight, 50g then another 40g. Has not regained birth weight yet and does not seem satisfied despite frequent b/f.  I will be seeing her again tomorrow and am frankly puzzled by this scenario. She is on medication herself for epilepsy (low dose Tegretol and another that I can't remember) and has been taking Motilium to boost supply. Any suggestions/comments? TIA Sue "The only thing necessary for the triumph of evil is for good men to do nothing" Edmund Burke No virus found in this incoming message. Checked by AVG Free Edition. Version: 7.1.394 / Virus Database: 268.7.1/347 - Release Date: 24/05/2006