karen
it is quite common for babies with cardiac anomalies to gain wt slowly. 
perhaps supplementing with some hindmilk at some feeds. it is possible that 
this baby is dealing with oversupply/overactive letdown issues - at least 
for him. {"very unsettled baby and can only breastfeed for short spells 
before coming off and fussing."} Since this is a multipara mom and 
experienced breastfeeder, perhaps she has a good supply even with a less 
than vigourous feeder. So you might help her manage bf with oversupply/oamer 
strategies.
also the baby may need to pace his feedings. mom can be taught to watch for 
stress cues and allow baby to pace for better oxygenation. it *might* even 
be that the baby can be paced on a slow flow bottle of ebm, if other 
measures don't work. This might be considered a somewhat extreme measure, 
but I mention it because TET is a very extreme health challenge for the 
baby.


Laurie Wheeler, IBCLC, MN, RN
New Albany Ms, s.e. USA

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