The cases this week on LN about babies who are not gaining as expected  
seem to me to be true cases of babies not getting enough food.  I  
don't pretend to know the cause, in any of the cases.  But the baby  
who lost fifteen per cent of his birthweight and then didn't make it  
back to birthweight until he was two weeks old, whereupon he proceeded  
to take off ten percent again over the ensuing two weeks, that is not  
a baby I would be in any doubt about feeding.  I would give him  
unpasteurized hamster milk if that's all I had available.  It sounds  
like he just plain needs food.  Caveat: my response is colored by the  
memory of the one really starving baby I have ever seen, and the only  
reason for it was that his mother didn't realize it was important to  
feed him every time he showed hunger cues.  She was even pumping to  
treat her engorgement and freezing her milk because she didn't realize  
it would be better put into the baby, and he was getting a pacifier  
because he was inordinately fussy.  I never want to see a baby like  
that again.
The other baby, the tenth one in the family, also sounds like he  
mostly needs food.  I would be far less concerned about elimination of  
things in the maternal diet, and more concerned about including more  
FOOD in the infant diet.  It was Barbara Wilson-Clay who always  
reminded us that a baby who is already depleted, will not be giving  
his or her best performance at the breast.  They can't suck their way  
out of a paper bag, is what she used to say.  So putting a baby to the  
breast who is *trying to breastfeed* is not a good strategy to remedy  
the situation unless it is done as recreation and cuddle time, in  
addition to actively feeding the baby, and taking steps to protect  
mother's supply from the downregulation that inevitably results when  
stimulation is inadequate.
An aside, about being realistic with mothers... if a woman with PCOS  
who had needed help to get pregnant asked me what her chances of  
bringing in a full milk supply were, I would tell her what I know - I  
can't predict the future, and these are the things most likely to lead  
to success (Ten Steps etc).  I might well mention some things likely  
to undermine her, such as supplementing out of fear, expecting the  
baby to feed for 20 minutes 6 to 8 times a day from day one and every  
day after that for the first six months, sending the baby elsewhere at  
night in order to sleep, putting up with bad positioning, getting a  
late start, all those things we know aren't good.  Kathy's example of  
mothers who are dismayed at how hard it is to bring in a supply for a  
premature baby after doing absolutely nothing to get started in the  
first week of the baby's life, only underscores what I said.  One of  
the Ten Steps to Successful Breastfeeding is to begin expressing milk  
early and often if a mother and baby must be separated or the baby is  
unable to come to breast.  There are reasons for all the things in the  
Ten Steps, as these mothers so painfully experience.
Again, unless my plans for following up the mother and baby would be  
changed substantially in light of the risk factors present, I would  
not mention them per se, because the standard care will catch them in  
plenty of time to deal with things.
Rachel Myr
Kristiansand, Norway

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