I see babies like these very frequently in my private practice. The common thread, I believe, is the baby's suboptimum suck which leaves the milk in mom instead of getting it into the baby. These kids are "in the restaurant" but not actually eating. This causes engorgement and milk stasis then suppressed supply in the mother and insufficient calories to the baby, which leads to many problems including jaundice, etc. etc. My Rule # 1 is FEED THE BABY. If the baby can't effectively remove milk from the breast for any reason, even after correcting latch-on, I believe it is prudent to remove milk another way (hand express or pump) and feed the baby another way (cup, spoon) that does not further compromise the tongue peristalsis pattern needed for breastfeeding. This philosophy accomplishes an increase in milk supply and gets sufficient calories into the baby while we figure out what caused the suboptimum suck pattern and set about getting it fixed. If the poor suck is from birth medications or birth insults, we continue as above and wait till the medications wear off or the injury heals, all the while attempting to get the baby to breast many times a day. If the problem is structural such as a short frenulum, it should be clipped by a dentist or another qualified provider. If the baby's head is still very molded or the cranial bones are overlapping or misaligned, a referral is made to a qualified practitioner who can address this issue (some Doctors of Osteopathy are very skilled in this therapy). Sometimes the misalignment resolves on its own in a week or so; other times treatment is needed. Misaligned cranial bones can compress any of the 6 cranial nerves that are involved in suck-swallow-breathe. IMHO, this is the most promising area of inquiry, and there is considerable interest in this concept by the National Institutes of Health Office of Alternative Medicine. Collaborating with the primary provider(s) is ESSENTIAL in any situation where the baby is not eating effectively. Sometimes there is an underlying illness in the baby - heart disease, etc. My role as an LC is to help support mom's milk supply, help the baby get calories in a way that does not further compromise the suck, and help her find a combination of providers who can address her baby's inability to suck effectively in collaboration with her primary provider(s). And support mom's efforts all along the way - this kind of situation is very difficult for mothers to handle, and the LC's counseling skills and patience is every bit as important as her other clinical skills. Linda Smith, hoping that more research will be done regarding why so many babies can't suck well at birth. I see far too many babies in this category! If we did to athletes what we do to babies during birth, we'd never get anyone to the Olympics! LC in private practice, Dayton, Ohio