There are a lot of red flags here. It's rare that a baby fails to gain 
well when mom "has a lot of milk". Recent research shows it's more the 
volume of milk that babies get than the fat content that leads to good 
weight gain. Aksit, S et al. Effect of Sucking Characteristics on Breast 
Milk Creamatocrit. Paediatr Perinat Epidemiol 16, no. 4 (October 2002): 
355-360.

So, we have a baby who has gained less than 1 lb per month, who started 
out SGA, and who has difficulty handling milk flow (which we cannot just 
assume is due to rapid MER). Swallowing issues are one major cause of 
failure to thrive, because feeding is so stressful for the infant that 
they can only do it in small spurts.

Things to assess:
Baby's actual intake (pre post weights on one feeding, mom to keep a 
feeding log of how many times baby bf and how many oz she takes from the 
bottle).
Baby's coordination of suck:swallow:breathe at both breast and bottle. 
Some babies seem like they are gulping a ton of milk, but they are just 
coordinating very poorly and getting very little.
Baby's overall health - dysphagia (difficulty swallowing) can be caused 
by respiratory malformations, neurological conditions, and genetic 
disorders, and even by tongue tie.

Just nursing longer is unlikely to solve the problem, unless mom's 
management has been restrictive. More often would be a start, if the 
baby accepts more frequent feedings...

Refer this one out if you don't have experience with all the above, and 
go along and learn.

Catherine Watson Genna, IBCLC  NYC (who just finished reviewing the 
video of one of my clients' visits with a feeding specialist (therapist) 
I referred her to).

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