June writes:

May he  was diagnosed with a Lip and Posterior tie, which will be released 
next week  and his dose of Losec was increased to twice a day. He had a 
weight loss at  his well child check and it was suggested   to Mum had a poor 
supply  and should express and give supplement by bottle.

He has been seen by  the Paed today, and is on the 9% percentile and still 
spilling? The Paed feels  mum has a supply issue

My question Wise Ones, If mum has a low supply  would this baby still spill 
lots after each feed? There is an issue with no  weight gain for the past 3 
weeks  and the Paed feels he isn't gaining  weight because of the poor 
supply 
My other question is it the reflux or  tongue tie causing the poor weight 
gain 
~~~
It is highly possible that the tongue tie is limiting baby's ability to  
transfer and keep milk down. ( Not sure if "spilling" is spitting up, or 
losing  milk at the corners of the mouth, or both but both are associated with 
tongue  function limitations.) Tongue limitations, laryngomalacia, reflux, and 
poor  weight can all be seen together. ( not always, of course, but often 
they seem to  occur together, like asterisms in the sky....) It is also 
possible that this mom  had plenty of milk, but that they baby couldn't transfer 
it, so there was poor  weight gain and also a resultant downregulation to 
mom's supply.) If baby  nurses, how much does baby transfer( intake) and how 
much does baby keep ( not  spit up.)? If baby spits up a lot even during the 
feeding it sounds like very  poor milk control possibly which often seems to 
linked to milk returning.   It may be hard to get an idea of how much baby 
transfers and keeps with all  the spitting up, but a weight before and after 
a feeding ( baby on side to  minimize spitting up) might lead some very 
useful information. I tell moms it  seems that if it goes down out of control, 
it's more likely to return. Babies  with tongue function limitations may 
have very significant but subtle milk  transfer and control issues. Some of 
them cannot get enough to feel satiated or  sleep, so they seem to be feeding 
constantly. Their little bodies will not allow  their bodies to rest when 
they are too hungry to settle for sleep. It's like  having a big bowl of peas 
and no spoon, you eat one at a time and by the time  you get to the bottom 
it's time to start over. Exhausting. 
Bottom line: if baby can't transfer and/or keep a normal amount of milk, he 
 won't gain. If he can't do that, moms supply may dwindle over time. It may 
be  that if baby is getting the release done soon, they may still need mom 
to pump  and supplement with her milk ( proving the issue is transfer not 
supply) or  building supply back up over time ( showing it was low but not 
mom's issue in  the first place necessarily.) Low energy babies who don't gain, 
sometimes need  time for catch-up growth ( and relearning/unlearning after 
release, a whole  other issue) until they are their happy, organized selves 
again. Mom is to be  commended for hanging in there. This baby has issues 
she didn't  cause, he's healthy and alive because of her care and 
diligence...:)

Sorry, it's Friday and I hope that makes some sort of  sense...:)
 
Peace,
Judy  

Judy LeVan  Fram, PT, IBCLC, LLLL
Brooklyn, NY,  USA
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