Laura, need some more information on this case.
The second baby, after mom changed to formula how did this baby do?   Really 
would like to hear her description of the feedings with a bottle and  later 
introduction of solids.  Many times if babies have breastfeeding  issues as you 
described, they also have problems with bottles and solids but  moms then feel 
they have to push forward with that plan.
With this current baby, you stated the baby would nurse for about 5 minutes  
and than pulls nipple repeating this several times than releasing and  
fussing.  Did you observe swallowing in that scenario?  Does the  mother ever 
describe choking or coughing at any of these nursings?  Before  introducing a SNS 
would really want to know if it is a flow or supply issue or  something else.
If this mother is not receptive to the SNS, I would not push it  either.
If this is an issue of normal weight gain and milk production for the first  
2 months and than the drop off; I would take a further history of what was 
going  on in both mom's life and the baby's when the problem arose.  Did she 
start  on any birth control at that time?  Did she start on any medications?   Did 
she return to work or school?  Was the baby sleeping long  periods?  Was the 
baby being put off on feedings?
Having her come for a visit would be helpful and doing a pre and post  weight 
may give you some more data.  See if she would be open to power  pumping for 
a week.  To pump 8-10 x for 5-15 minutes/day and see if she can  push her 
supply up again.  Than there is also galactogouges.
Good luck,
Ann Perry, RN IBCLC
Boston, MA



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