Can you use an ng tube with donor milk for this baby?    Is mom able and 
willing to take medications and pump to increase her own milk supply to 
provide tube feedings? Poor muscle tone and low energy are exacerbated 
by undernutrition. Sometimes increasing the baby's intake will help her 
be a better feeder. I have one baby I've been working with who has 
definately improved since she has been being tube fed additional ebm.

Solids and formula can be problematic if there truly is a metabolic 
problem, so I'd like to see the testing complete before throwing more 
solids at this baby. And CF is definately worth testing for. Breastfed 
babies don't get the zillions of infections that are the hallmark of CF 
in an artificially fed baby, they generally just grow slowly, and 
finally start showing protein deficiency.

Once baby is better nourished, you'll get a better idea of her oral 
motor skills and perhaps be able to help her with sucking.
Catherine Watson Genna, IBCLC  NYC

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