----- Original Message -----
Sent: Thursday, May 25, 2006 6:30
PM
Subject: Re: [ozmidwifery] weight
loss
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 -----
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.
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
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