21 day old with rash

Valerie,

I can't speak to the rash - although I'd agree that it seems too late for E.
toxicum. I can speak to the breastfeeding and weight gain, however. A baby
that is 15 oz. below birthweight at 21 days is undernourished and needs
additional formula supplementation until you get the breastfeeding fixed.
I would have mom pump with a hospital grade pump - see how much she gets,
use this as supplement as well as the formula. Did mom have a rough time
with engorgement initially? Did she have noticeable changes in her breasts
during pregnancy? Is there a history of thyroid problems in mom or in her
family? Is this baby a 35- 36 or 37 weeker? [these babies can have a tough
time stimulating a full milk supply in mom and mom will often need to pump.]
Breastfeeding 6 or 7 times a day is not enough for a baby who is
underweight - I would aim for 10 times a day - q 2 or 2 and 1/2 hours with
no longer than 4 hours at night. If mom tells you it takes an hour for him
to feed, think milk transfer problem, ask if baby is falling asleep at the
breast, try to observe a breastfeed or part of one. Does the hospital have
a lactation consultant? If so, use her.

Regarding pees and poops, I'm been misled by these before. When you ask
about poops ask what color - yellow? brown? black? and ask how much.. I've
had moms tell me their child is pooping 8 times a day only to find out later
that what they're calling a poop is a little smear [skid mark, racing
stripe, etc.]. I use "bigger than a 50 cent piece" "can get it all with one
wipe" or "need at least two wipes" as 3 size markers that have proven
useful. The golden rule of fours is "four days to four weeks, four
substantial yellow seedy stools per day." I'll bet you mom is counting skid
marks as real poops.

Does the baby look sick? My inclination would be to change his formula
supplementation to nutramigen to eliminate the milk. When I've seen milk
allergy in the past it's presented as a facial rash - bumpy and red -
sometimes looks like bad cradle cap on the face, I havent seen a whole body
rash. I think I'd see what the labs say first - not sure I'd give benadryl
but it's an option. I'd definitely get the baby reliably gaining weight
[fix breastfeeding if possible] before I would release the baby back to
home.

I'd like to see a picture of the rash if possible [and know the lab results,
too]
Just my thoughts.
Gail
Gail S. Hertz, MD, IBCLC
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