I've recently started working with a 10.5 week old baby who was just released from the hospital, having been admitted for FTT. The mother had Child protective services called on her because of venomous accusations made about her by her ped. At week three the baby was not gaining well and was doing some spitting, but not projectile by any means, was put on rice cereal mixed with breastmilk for thickened feeds. Diagnosis was Gastroesophageal reflux. (No test was done). No breastfeeding assessment was ever done. Mother has very small areolae with lactiferous ducts located outside the areolar margins. She saw a "lactation specialist" in hospital right after delivery who supposedly said as long as the aroela is in baby's mouth, baby will do fine. Some weeks later, mother called her doc and said her baby didn't look good to her whereupon, the doc had a homehealth nurse come and check on baby every few days. Again no breastfeeding assessment was done and no mention of supplementation even though baby was still not gaining! 4 weeks later, baby is admitted to hospital for FTT and mother is accused of starving her baby! Mother has a history of pituitary and hypothroid problems and has every symptom of hypothryroidism now. When I assessed the baby, baby was not attached deeply enough to strip milk from the sinuses and mother's milk supply was in the garbage. Baby was being fed 12 oz. of overly concentrated formula (3 scoops to 5 oz.):. to up the kcal count to 24 per oz. I just about fell off my chair! Mother said that doc said that overconcentrating the formula is a typical treatment used at this hospital. In my office, once on deeply, the baby did great sucking, great milk transfer, and did extremely well with a supplementer at breast. I suspect the original lack of gain was related to poor attachment, however, we are investigating the thyroid and the pituitary thing. No one until me has attempted to determine mother's ability to produce a full milk supply. I am so appalled by the way this situation was handled, I can't stand it! Anybody have any references regarding the dangers of overconcentrating the formula so I can give them to the baby's ped? (You would think the warning on the formula can label would be enough.) or perhaps I'm all wet and the overconcentration is a good idea. Anybody want to comment? TIA Alison