I would do some test weights with supplementation at the breast (SNS or 
periodontal syringe type device) and see if this increases baby's 
intake. I have worked with a few moms that just by supplementing at the 
breast we improve baby's ability to remove milk. After a few days, no 
longer than a week, baby is cured. I have also worked with way too many 
babies that could not remove enough milk by themselves at the breast. 
They self limited and tired too quickly. We have a couple of excellent 
OTs, and SLPs here in Houston that worked with these babies and got 
their oral motor skills back to normal in about 8 weeks. With poor 
weight gain, when mom can pump out more than baby can remove (verified 
through test weights), then I look to poor oral motor skills. I also 
watch the baby suck on a slow flow wide based bottle nipple to see where 
they put their lips and how well they remove milk. If baby can't grip 
with his lips on a wide based nipple, this makes me suspect weak lips. 
And I sit baby upright on the bottle and see what they can or can not 
do. Paced feeding can help a baby improve sucking ability. I would 
encourage mom to do 2-3 days of pumping after every nursing to really 
bump up her supply. And I would encourage her to use 3-5 capsules of 
fenugreek taken 3 times a day (information from The Breastfeeding Answer 
Book). Many IBCLCs recommend Blessed Thistle capsules to be taken with 
the fenugreek in the same amounts. Because the test weights were so low, 
I would suspect this was a baby issue initially. Poor sucking leading to 
poor growth and poor milk supply.

Kathy Eng, BSW, IBCLC

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