why would a breastfed baby loose weight?? kittie frantz, rn, cpnp-pc clinical instructor in...

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WHY WOULD A BREASTFED BABY LOOSE WEIGHT??Kittie Frantz, RN, CPNP-PC

Clinical Instructor in Pediatrics

Keck School of Medicine at

The University of Southern California

frantz@usc.edu

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DISCLOSURE

I own Geddes Productions, LLC – producer of breastfeeding DVDs and a distance learning course called “The Baby’s Perspective”

I was breastfed for 9 months

I breastfed my three children

All of my 7 grandchildren have been breastfed

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I have received copyright permission to show these photos, films, and drawings only to the live conference audience.

Handouts, photos and recordings may not duplicate these images.

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BREASTFEEDING IS NATURALIT HAS BEEN GOING ON FOR TENS OF THOUSANDS OF YEARS……RIGHT?

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SO, IS THE CAUSE OF POOR WEIGHT GAIN…

The Mother? The making

The Baby? The taking

The Opportunity?

The Absorption?

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WHY IS IT ALWAYS “BLAME THE MOTHER”?

“She doesn’t “Have enough milk”

“This is her first baby so she is inexperienced”

If this were true most of the time, all first borns would never survive

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UNDERMINING THE MOTHER’S CONFIDENCE

My bottle baby weighs more than your baby

Maybe she just thinks she is not making enough milk

AP news

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IF SHE BREASTFED HER OTHER BABY WITH GOOD WEIGHT GAIN, THEN….

She has a proven breast

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I AM NOT SAYING THAT IT COULDN’T BE THE MOTHER

Likely possibility is low She does the making

but the other 3 categories involves the baby

The lethal gene theory

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MATERNAL DIAGNOSIS THAT COULD EFFECT A MILK SUPPLY Hyper or Hypothyroid

Pituitary gland problems

Polycystic Ovarian Syndrome

Retained Placenta

Sheehan’s Syndrome

She has lost her pregnancy weight too fast

Gastric bypass that inhibits absorption

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COULD BE MEDICATIONS SHE TAKES

Estrogen containing birth control pill

Progesterone birth control shot, patch or pills before 6 weeks postpartum

Antihistamines

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ANATOMICAL DEFICIENCYLACK OF GLANDULAR TISSUE

Gift from patient

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SURGERYREDUCTION MAMMOPLASTY

Gift from T Fuller

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SUGGESTIONS CAN ALSO: “BLAME THE MOTHER”

Let’s build up your milk supply with

an electric breast pump

© Kittie Frantz

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SUGGESTIONS THAT ALSO CAN… “BLAME THE MOTHER”

Take some herbal tea or capsules to

build up the milk supply

Buy special cookies or oatmeal

Use gut motility drugs

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THIS FEEDS INTO HER FEELINGS OF INADEQUACY

LAC+USC Midwives

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BUT…WHAT IF IT IS NOT HER BODY THAT HAS BETRAYED HER?

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WHAT IF IT IS THE BABY? IT TAKES TWO TO TANGO !

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THE BABY NEEDS TO SUCKLE WELL

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HOW CAN WE DETERMINE THAT?

© Kittie Frantz

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THERE ARE THREE PHASES TO THE SUCKLE YOU CAN CHECK

© Kittie Frantz

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THE ANTISIPATORY PHASE

© Kittie Frantz

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THE INNER LIP STIMULUS

© Kittie Frantz

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THE DIGITAL FEEL

© Kittie Frantz

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MAKE SURE BABY IS NOT TONGUE TIED

© Kay HooverGift from patient

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WHEN BABY CRIES, IS HIS TONGUE SLEEK AND CURLED?

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YOU CAN OBSERVE THE BREASTFEED

© Kittie Frantz

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MORE AREOLA ON THE TOP THAN THE BOTTOM?

© Kittie Frantz

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LIPS FLANGED?

© Kittie Frantz

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CHEEKS ROUND?

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DRAWS IN BREAST SKIN?

© Debi Bocar

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FEEL TONGUE UNDER CHIN?

Gift from patient

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WIDE JAW EXCURSIONS?

© 2007 Smillie, Makelin, Frantz licensed from Geddes Productions, LLC Baby-ked Breastfeeding: The Mother-baby Dance www.geddesproduction.com

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SUCKLE/SWALLOWING RATE?

© 2007 Smillie, Makelin, Frantz licensed from Geddes Productions, LLC Baby-ked Breastfeeding: The Mother-baby Dance www.geddesproduction.com

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ALL THROUGH EVERY FEEDING?

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ANY SORE NIPPLES?

Gift from patient

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ANY ENGORGEMENT?

© Kittie Frantz

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THE ELEPHANT IN THE ROOM…..WHY IS HE NOT SUCKLING WELL?

Normal for newborns to take time to organize their suckle in the first five days Gryboski

Does baby have high or low muscle tone?

Is Baby’s central nervous system immature?

Is he sick? Sepsis

Is he a 36 - 37 week late pre-term infant?

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IF IT IS THE SUCKLEHOW CAN WE FIX THAT?

Hand express while baby feeds to increase the flow

Listen for swallows

Can’t get baby to continue to swallow? Switch breasts

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IF THAT DOESN’T WORKSOMEONE WILL SUGGEST SUPPLEMENTING

© Kittie Frantz

© Kalman and Frantz

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BEST TO SUPPLEMENT AT THE BREAST

Medela AG

© Geddes Productions from Supplemental Nursing System DVD

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OK….SO MOM IS OK AND BABY IS OK……SO WHAT NEXT?

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THE OPPORTUNITY?

UNICEF

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HOW OFTEN DOES HE FEED?

Is she just repeating what she was told to do?

I would if I was dead tired

How many of you could recall how often your baby fed in the first week?????

Do a 24 hour recall with her

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HOW OFTEN SHOULD SHE FEED??

THE AAP SAYS….

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IF SHE KEPT A LOG, REVIEW IT

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HOW LONG SHOULD BABY BE AT THE BREAST?

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WHAT SHOULD THAT NUMBER BE AT EACH BREAST?

THE AAP SAYS…

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WHAT HE GOT DEPENDS ON HOW WELL HE SUCKLES

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SO…THERE ARE 3 THINGS NEEDED FOR A GREAT MILK SUPPLY

Frequency of the feedings

Length of the feedings

Quality of the baby’s suckle

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WHAT CAN INTERFERE WITH BABY’S OPPORTUNITY AT THE BREAST?

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SWADDLING

Gift from patient

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PACIFIER

© Kay Hoover

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SWINGS AND “PUT THE BABY DOWN” THINGS

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SCHEDULED FEEDINGS

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UNDERMINING MOM’S CONFIDENCE CAN SLOW THE MILK SUPPLY

You mean he isn’t sleeping through the night yet???

So she tries to make that happen

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SLEEP TRAINING

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LOS DOS COSAS

© Kay Hoover

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BAD ADVICE

© 2009 Geddes Productions, LLC licensed from The Baby’s Perspective www.babysperspective.com

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DA TAH DA DAH…..HERE COMES LLLI AND WIC!!

© H Quimby

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THIS IS WHAT YOU DO BEST !!!

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AHH ….. BUT THERE IS ONE MORE THING TO CONSIDER

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IT COULD BE THE ABSORPTION

Infants with undetected cystic fibrosis

Infants with myotonic dystrophy

Infants with metabolic disorders

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ANY QUESTIONS??