I have recently been working with 4 older babies with slow or poor weight gain, so I feel up to the challange of giving you new ideas. I am noticing that "normal" breastfeeding weight gain expectations have gone up, both from a talk Dr. Marianne Neifert recently gave and from the new Breastfeeding Answer Book. 

Baby needs a full consult to assess his/her sucking at breast, latch-on, as well as test weighing. Baby needs to have a 24 hour test weight regiment going. Do a test weight on a Baby Weigh Scale at every nursing for 24 hours, and have mom write down the amounts. Then check and see how much per day baby is really taking in. One of the baby's I am working with dropped down to only taking in 24-30 ml per nursing session, or 12 ounces a day, at 5 months! 

If her intake is adequate, I would suspect genetics or disease. The pedi is most likely going to want to supplement anyway to see if extra calories bring up the weight. 

Dr. Newman has some excellant ideas in his new book about older babies who are gaining poorly. He says something like the latch on was probably never that great, and baby got by in the early weeks due to an excellant milk supply. Eventually nature catches up and the supply drops and baby begins a very slow or even no weight gain pattern. 

Some older babies are just not willing to work at getting the milk out. They stop nursing as soon as the flow slows. Some are very passive and go to sucking on their hands, or thumb, instead of demanding food. Other babies have poor or disorganized sucks that was never corrected in the early days (they are living off the MER).

I am currently having these moms use the SNS at every feeding for at least a week to get baby back to adequate breastfeeding. One baby we took a more relaxed approach and he has not improved as much as we hoped for in 6 weeks (has a normal suck but is not willing to work at the breast without a good flow). Another baby started doing better after 24 hours with the SNS and mom feels her milk supply came back at 48 hours. And we have tried a variety of drugs or herbs to increase the supply.

Kathy Eng, BSW, IBCLC

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