Besides the other suggestions made, here are a few different ideas I have, for Down's baby and others who are not gaining well. Make sure that baby is getting lots of physical contact. Some babies need an extreme amount of this, and will not gain optimally without it, even with extreme caloric intake. Suggest that Mom increase the time she spends with the baby, with as much skin-to-skin contact as possible. Slings are great. So are front packs, especially those which have a zipper portion that allows for skin-to-skin, and breastfeeding in the pack, as well as the opportunity for baby to hear Mom's heartbeat. Along those same lines, I would try avoiding having Mom spend time just pumping. Instead, nurse more often, every hour to hour and a half during the day, with several nursings at night, even if waking the baby is required to do this. The daytime feeds don't need to all be full-length ones. Encourage mom to find a way to do this with the least amount of effort, so that she can get back to sleep as soon as possible. To further increase calorie intake, have mom pump while nursing, after baby has finished first side and switched to the other. This hind-milk can then be used in a nursing supplementer at the next feed, or fed by spoon or cup. I would avoid bottles, unless no other method of feeding the EBM will work. If a nursing supplementer is used, a slow flow is preferable, so that baby keeps sucking well. With frequent feeding, one ounce of expressed hindmilk every other feed, or a half ounce every feed, becomes significant. And, of course, keep reminding Mom that SHE is what her baby needs, and that there is no replacement for her! Darillyn _________________________________________________________________ Add photos to your messages with MSN 8. Get 2 months FREE*. http://join.msn.com/?page=features/featuredemail *********************************************** To temporarily stop your subscription: set lactnet nomail To start it again: set lactnet mail (or digest) To unsubscribe: unsubscribe lactnet All commands go to [log in to unmask] The LACTNET mailing list is powered by L-Soft's renowned LISTSERV(R) list management software together with L-Soft's LSMTP(TM) mailer for lightning fast mail delivery. For more information, go to: http://www.lsoft.com/LISTSERV-powered.html