Hi! I'll introduce myself another time but suffice it to say that I am a student lactation consultant in the BSC course and a pediatric dietitian at Children's Hospital of Phila. I've been lurking for awhile, but now I have a problem with a mom who I'm counseling and I need input from those with more experience. This mother has a three week old baby who is not gaining any weight. Birth wt: 7 lb 13 oz. He has been at 7 lb 3 oz since discharge. There were many problems with latch-on initially and a very lethargic baby which I attributed to her difficult labor and medications (demerol and epidural). However, the baby is now sucking well for many hours a day but is still irritable and sleepy. There are plenty of wet diapers. At last week's check-up there was still no weight gain and PMD says to give 1-2 oz. formula per day and return in one week for weight check. Mom called me early this morning to say that the baby slept 6 hours last night and when she woke up her breasts were not the least bit full. She tried to pump from the right breast and nothing came out! She did get some runny, clear fluid (foremilk?) out of the left breast, but after twenty minutes pumping she only got one ounce. This mom had a very hard time getting pregnant and was treated with pergonal and HCG. She had no difficulty carrying the pregnancy to term (no medication needed), but her labor did not progress and she did not dilate until a pitocin drip was started. She experienced only minimal breast changes during pregnancy and immediately after delivery. She never had any engorgement, leaking or signs of let-down. Mom wants to know if all this is related to some hormonal deficiency. I suspect lack of developement of alveolar tissue and a true inability to successfully lactate. She is going to discuss this with her fertility MD tomorrow. Has anyone ever seen this before? Is there any hope for her to be able to produce enough milk for this baby? TIA. Rachelle Lessen, R.D. (soon to be IBCLC, hopefully)