I, too, would be very concerned about this baby, whether I was the MD, 
the LC, a volunteer counsellor or the mother. It is so sad when this 
happens, and there is often a tendency to simply stop breastfeeding or 
doing both. As the mother of several slow gainers who could have become 
no gainers if I had followed my heart and continued putting them to 
breast only despite the situation, and as a volunteer who has worked 
with mothers whose babies alarmed me or their HCP, I would suggest that 
everyone try to work together in the best interests of the baby *and* of 
breastfeeding. It was a relief to me to learn that babies can become 
*better* breastfeeders when they are supplemented enough to grow, 
thrive, and get strong. The mother can be reassured that the baby is 
deriving comfort, nurturing, immunological and lots of other very 
important benefits from the breast, even if many of the calories come 
from somewhere else. And the new expectations can include working 
towards solely breastfeeding (e.g. eventually eliminating EBM or ABM) or 
making up in duration what was lost in exclusivity. Even if formula is 
used until after solids are going well, there can still be years of bf 
and solids compared to a few months of bf and bottles. I would suggest 
cup-feeding or spoon-feeding rather than bottles or even SNS, since the 
baby will eventually drink from a cup and eat with a spoon anyway. This 
helps make a better distinction between breastfeeding for all the good 
stuff and feeding for calories, IMHO.
Jo-Anne

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