By my calculations, baby had lost about 15% on day 5 and then made very
very small gains with some interventions, which seemed well-intentioned,
but ineffective. In addition, the time between weight checks is WAY too
long. Pamela Morrison has shared a very EXCELLENT and thorough protocol for
dealing with such infants, and I highly recommend you try to access it via
the archives or contact [log in to unmask] for it. I am going to
cc her this post, but I know she would not mind sharing, as she has shared
it before, and would want to help you help this baby.

If the mother herself is reluctant to use suggested interventions, this is
a delicate problem, however she may not have been properly educated as to
what is going on, or perhaps she is having some mental health issues
including postpartum depression. Sometimes child protective services must
get involved, but rarely.

If I were working with such a case, of course I would be in touch very
closely with the primary healthcare provider, and I would be having the
baby weighed ideally every day or two until a turnaround occurs, which I
would expect immediately. I would be very clear but not mean to the mother,
in telling her very directly that her baby needs much more food for his
brain and all his organs to grow and function properly, and that we must
assess whether these sufficient calories do put the weight on, and if not,
the hcp must urgently look for serious diseases. This generally gets the
mother's attention and she will come along with the plan. Your counseling
skills will come into play to explore her thought processes, possible
misconceptions, etc.

General protocol:
1. Feed baby by easiest method, probably bottle. I don't think I would have
the baby even breastfeeding at this critical juncture, just get sufficient
calories in.
2. Use all mother's ebm and next best alternate (this could be donor milk
or formula) to make up the difference in baby's needs.
3. This means mother is spending her energy ensuring baby is taking in
calories by easiest route and she is expressing to produce a full supply
and/or preserve it
4. IF SUFFICIENT CALORIES/VOLUME ARE BEING CONSUMED (this can be calculated
easily) and the baby STILL DOES NOT GAIN WEIGHT then the hcp should be
looking elsewhere for reasons, often cardiac, sepsis, metabolic disease.
This is usually not the case, but that instead the infant has just not been
taking in sufficient volume=calories, but one does find disease sometimes.
The baby is a preterm, after a difficult pregnancy, and then C-section
birth, so there are some risk factors here.

Do keep us posted if you can,
Laurie Wheeler RN MN IBCLC
Louisiana and Mississippi, USA

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