Refer to breastfeeding counselor

When you bring Davina and her parents into the clinic room, she looks visibly bigger, with more fat on her cheeks and a healthier skin colour. Her parents are also delighted to have had the session with the breastfeeding counselor.

Divina’s mother explains that she fed her baby while the counselor watched and it was immediately evident that Davina was in the wrong position and not latching on properly. Once this was sorted, she began to feed for longer, was more satisfied by the feed and had longer breaks between feeds. They feel it was a feeding problem.

On the downside, she now brings up a little milk after each feed, and you explain to the parents that this is called ‘possetting’ and quite normal.

You re-examine her and there are no new findings. She has more subcutaneous tissue, especially on her abdomen.

Her weight is now 1.68 Kg and length 47.5 cm, head circumference 32.0 cm.

You plan to see her again in three months and then potentially discharge her from the neonatal follow up clinic.

In three months time you again welcome Davina and her parents back into the clinic room. Davina is now wearing a baby dress and looks very interested in the new surroundings.

Her parents are very happy with her progress. She is smiling, recognizes her parents and beginning to try to use her hands.

As far as feeding goes, she is still fully breast fed. Her mother continues to enjoy the process and now feeding has become very natural and easy. Her posseting has stopped.

She is again measured - Weight 5.25 Kg, length 57 cm, head circumference 39.5 cm.

You are very pleased with her growth and her progress. You discharge her from the clinic, but leave the neonatal secretary’s contact details so that they can make another appointment if new problems develop.