Bad clinical day!

  1. Please give me your opinion on this situation. My first clinical day at a L&D floor. My babe is a 9"11 oz. healthy boy. He was last fed at 10:30 a.m. At about 12:45 or so, he starts fussing, rooting around, chewing on his shirt. Tried rocking him, walking with him, pacifier-which he continued to spit out--changed diaper, etc. etc. This kid was p(*^&&ed. Sooooo.......STUPID ME!! I think-Gee, maybe he's hungry? Was not told of any specific feeding policy, times, etc. and proceed to feed this kid 90 cc. which he basically inhaled. Changed him, rewrapped him snug as a bug, happy as a clam, snoozing away. So I proceed to tell my charge nurse that I fed him and she looks at me with daggers and says, "WHY???" "HE JUST ATE AT 10:30!!" I don't think she could have sounded any nastier if she tried. What was I supposed to do, let the kid freak out and stop him at 45 cc? Please, all you baby nurses, tell me if I did something wrong." I guess when I fed my kids, I was never aware of any cc. limit. I realize you shoulden't be feeding them every hour or two, but geez.
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  2. 17 Comments

  3. by   cactus wren
    That`s a big boy!..And how much DID he take earlier?? Maybe he WAS hungry....One reason breast feeding is best...no durn oz. marked, just feed til babe stops... Now, I`m no OB, but am a mom of 5 and g-mom of 11...so I do know a bit about babes....And sounds like you gave him just what he needed...hate scheduled feedings
  4. by   Cali
    When I worked L&D we would only feed the babies about 30cc's of formula. Formula fed babies were fed about every 3-4 hours. In my oppinion I think it was okay to feed the baby again although it had only been 2 hours since the last feed, but 90cc's was a bit much. No one told you the policy so how were you supposed to know? All I can say is learn from your mistakes............
  5. by   lynn1967
    Well, he had taken 45 cc. earlier. My instructor told me not to worry about it but I really felt stupid, I mean I have three kids, always fed em on demand. Well, I guess the good news is that was the only day I am at that particular site!!
  6. by   cactus wren
    30 ccs every3-4 hours???wow poor starving babies...!! might be good for 6#er,but this kid is almost 10.....i do think he needed a bit more than that...after all, he did settle,and go to sleep....no colic or anything...
  7. by   Sally_ICURN
    I'm no baby nurse but I am a mom. From my experience with kids, especially babies, don't eat if they're not hungry--period. From the evaluation of your intervention, it seems the kid was obviously hungry. Pi$$-poor feeding policy if you ask me (remember, I'm no baby nurse). Don't they take into account the child's size? If the baby was with mom and fussing like that, would they prohibit her from giving the babe a bottle? I don't get it?

    ~Sally
    Last edit by Sally_ICURN on Jan 6, '03
  8. by   SmilingBluEyes
    I don't know about anyone else here, (I am a OB/Newborn nurse), but I have fed 60cc to a "normal" size baby (about 7-8lb ) w/o incident. I usually burp them every 15-20 cc. This kid is LGA (large for gestational age) and needs to eat MORE OFTEN-- altho not necessarily 90cc at one feeding. That much, he may wind up spitting up 1/2 or more. Remember, their tummies are ONLY as big as their fists (as are ours, for that matter). So to overfeed at one sitting may result in a lot of distress. I personally would feed a kid this big about 30-60cc every 2 hours--- or on demand (which may be as often as every hour or 90 minutes). They NEED a lot of kcal when they are this big, but I say MORE often.

    That charge nurse who yelled at you for feeding *too soon* was off-base as far as I am concerned. But the 90cc may have been a bit much. Dont' take it to heart.....let it roll off your back. No harm was really done. Check your pediatrics text if in doubt; it should tell you what the appropriate amount of formula for a baby nearly 10 lbs is (but it will give figures for how many GRAMS a newborn weighs, so you will need to know this number)....usually this is figured per 24 hours in cc's. That way, you have backup when you do things in nursing. Always check if in doubt. There should also be a policy at that hospital regarding feeding and monitoring of LGA babies and they are usually quite specific. You can check that. I wish you luck! Don't beat yourself up!
    Last edit by SmilingBluEyes on Jan 6, '03
  9. by   fab4fan
    Yeah, this is exactly how we want to treat students...Geez Louise, it was not a fatal mistake...the kid was hungry and screaming (and if you hadn't taken care of the screaming she'd have been on your back for that, instead).

    At least your instructor sounds like she has some common sense. Take her advice, try to let it roll, and chalk it up to a tactless person being in charge.
  10. by   RN2B2005
    The funny thing is, babies don't read textbooks, and they definitely don't read hospital policies. If the baby sucked down 90 cc, then 90 cc was what he needed to feel full. The hospital needs to catch up on modern thinking; babies eat when they're hungry, not when it's 10:00 or 12:00 or whatever.

    My son's great-grandmother, Ruth, a farm wife, tells a story about her first child, my father-in-law. At the time (1942) scheduled feedings were in vogue. The doctor had said to feed the baby every four hours and no more; feeding more would 'spoil' the baby and he had to be 'taught' to adjust to an adult schedule. Well, Ruth's father-in-law came over one day when the wheat was in and the baby was crying. Ruth was crying too, having listened to the baby cry for two hours. Clem asked, "What does he want?", and Ruth told him about the doctor's orders. Clem--a man who could go a week without saying more than a dozen words--said, "The doctor's not here, but I am, and I want my grandson to be quiet. Go feed the baby." And that was that...Ruth put the baby on an on-demand schedule, never told the doctor, and everybody was happy.
  11. by   TracyB,RN
    Not a baby nurse here either, but when they are hungry, they eat. I'm sorry that "nurse" snapped at you :P on her.
  12. by   Aussienurse2
    As the mother of four boys...my kids fed for about twenty minutes either side every couple of hours. The one I bottle fed got what he wanted, usually about 150mls every two to three hours. They still feed every two to three hours, I am beginning to see her point, she's saving the mother money in years to come! LOL!!

    Don't stress, you did the right thing at the time.:kiss
  13. by   NICU_Nurse
    I'm sorry that you got treated so disrespectfully- let's pray that the charge nurse was just having a bad day! I agree to not worry about her rudeness- there could have been a thousand reasons for her being cranky, and though there is no excuse for it, we are all women enough to admit that we do it to at times. ;>) Well, not me, but you know. The rest of you. *lol* I work in an NICU, and the first thing I wanted to say was that feeding the baby 90cc at once won't kill him, and that's your priority. No killing of babies, at least not until you have your license and can be held legally responsible. There are three basic rules that I have learned that really helped me prioritize when working with infants, and perhaps you'll be able to make use of them...

    1) No killing of any kind. Moms don't like it when you kill their precious wittle pootieheads.

    2) Don't call a baby a "porker" out loud at any time. This is just bad all around.

    3) When changing a diaper, make sure that the anal orifice is directly facing anyone in the room but yourself. Babies have magnificent distance-pooping capabilities, and can be a marvel to watch, and while being pooped on sucks royally, watching others be pooped on can be quite a treat.

    So, as you see, your particular sin does not fall within any of those parameters. You're safe in my book. ;>)

    We look at the total number of cc's in 24 hours; sometimes babies are hungrier than other times, and contrary to popular belief, they don't understand you when you tell them it's not time to eat yet. I do agree with one of the posters above who mentioned the spitting up- feeding a large amount, especially if it is gobbled down, is not a good idea because you will overfill the stomach and it's just going to come right back up again. Remember, babies will eat when they're hungry, and will stop when they're full, but it takes the brain time to register the fact that the stomach is full- this is true for adults as well as infants. Perhaps the baby WAS hungry, but if the feed had been slower, it would have provided an opportunity for that stomach to FEEL fuller, and maybe then the baby wouldn't have been so eager to drink the whole bottle. I agree that perhaps that baby would be better fed if you were allowed (or if the order was written) to feed smaller feeds (30-60cc) more often (q 1-3 hours instead of q3-4). Ultimately, you did little wrong here (and I wouldn't even call it 'wrong', honestly, but I would have asked the nurse in charge of the baby what she thought I should do before doing anything else). Don't let the man get you down. ;>) You actually showed excellent critical thinking skills by running through all of the possibilities and attempting to solve the problem (the baby crying).
  14. by   dawngloves
    *sniff sniff* Do I smell a Big Fat Baby thread here? LOL!!!
    You did fine! You feed 'em until they are done! What, was the kid on Jennie Craig or something? Jeez! Poop on that ole' nurse!

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