I would refer her to an SLP or OT who works with babies for feeding 
assessment. If baby can't even bottle feed, this assessment and 
subsequent treatment is very very necessary. Something is wrong. I agree 
that a too fast MER can make baby pop off and on. My concern for this 
mom is that if baby is riding the MER and not really working the breast 
properly, her milk supply will most likely drop after 6 weeks and then 
baby begins to stop gaining weight. Usually I see these babies at 3 
months and at that point, they can not remove enough milk to sustain 
growth and mom's MER has down regulated to normal and her supply often 
is now low. You could try a nipple shield for a temporary fix and see if 
baby can grip that better. Also, I have gotten fairly good at looking at 
the lips to see how much muscle tone there seems to be. Some babies are 
very tight, and have fish lips with white ridges around them. Other 
babies have relaxed lips from the beginning that look like when baby is 
finished with the second side (you know those soft, relaxed lips -- 
still on the breast but not gripping it). You often don't see much 
mouth/lip muscle tone or flanging with these babies. Best, Kathy Eng, 
BSW, IBCLC

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