Thank you all for your suggestions. I will pass them onto the mother. She already has an appointment for CST, so I hope that will make a difference. I mainly work in a hospital and felt like I didn't have time to devote to her outpatient so I referred her to an IBCLC in private practice that I know is very good. I think its always better to have two sets of eyes anyway. I'm hoping she seems something that I missed. 

I'm also nervous about this infants poor feeding behaviors. I'm hoping it's not a sign of some underlying medical condition. It's strange that the infant was such a slow start feeder, without any risk factors. Except that mom did have a long labor, but not unusual for a primip. Over 24 hours, with about 2 hours of pushing. 

I will also pass on all of the good suggestions to her and the other IBCLC, nipple shield, hands on pumping, paced bottle feeding, feed the infant to calm him and then try breastfeeding when he's relaxed. 

Tricia Shamblin, RN, IBCLC

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