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

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