Karen,
With mom tandem nursing, the baby might be getting too much flow. I 
wonder if she can try letting the toddler bf for the first MER, then put 
the baby on. She can do this on both breasts. The extra calories can 
only help.
Observing good jaw movements (suck pause suck pattern) is only accurate 
for healthy babies. Babies with any kind of reduced cardiorespiratory 
capacity or tongue tied or neurologically impaired babies who have 
difficulty with bolus control are going to look like they are taking in 
much more than they are.
Is there an IBCLC this mom can see who has a scale that can weigh the 
baby's intake? I resisted getting a scale for a long time, but once I 
got one I realized that some babies were "fooling" me.
Catherine Watson Genna, IBCLC  NYC

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