Dear Fio,

Although there is always the outside chance that this baby is suffering from some disease state which prevents him from gaining weight in spite of adequate intake, the most likely situation is that the baby is not transferring enough milk - wet diapers do not equal milk transfer.  Scant poops, which you mentioned in the previous post, are a strong indicator of inadequate intake.  How do you know that the baby is "nursing well?"  All indications are that nursing is not going well at all.  You mentioned a history of slow weight gain babies. It could be that the mom never had an adequate supply.  It may be that the baby appears to be sucking properly, but actually is not, perhaps due to a tongue tie or some other oral anatomy issues (which can run in families).  It may be a combination of both.  The baby may not have ever developed the strength to nurse properly due to calorie deprivation.  Until the baby gets up to speed on calorie intake/weight gain, it will be difficult to ascertain what is actually going on.  If baby is not nursing properly, then the use of a pump may be crucial to reestablishing a supply.  And the SNS is not always the best way to supplement - there are many factors to consider. Please do not take offense at these replies - I am simply trying to point out that this is a very complex situation and simply painting the doctor as the bad guy solves nothing - in fact, this doctor may be doing his best to try to work with a mom, who although she is worried, refuses to see that she has a very serious problem which may require intensive supplementation, at least temporarily, in order to protect the health of the baby.  The ideal situation is an experienced IBCLC working with a supportive physician and a motivated mom who really wants to understand her situation and develop a realistic plan to address the challenges she is facing.  I hope that is what happens in this case.  But I have worked with more than one mom who simply refused to accept that there was a serious problem and would not give the baby the amount of supplementation necessary to maintain adequate weight gain.  These moms are often producing almost no milk, so should be giving the baby large amounts of supplements, not just the couple of ounces a day that they think is all the baby needs.  You have no way of knowing what is really going on here.  So I do hope that she is able to hook up with someone who can visit her in person and get a handle on the situation.  Good luck.
Warmly,
Sharon Knorr, BSMT, ASCP, IBCLC
Newark, NY (near Rochester on Lake Ontario)
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