Karen posts on a baby with diagnosed tetralogy of Fallot, who is fully
breastfed, five weeks old, and 300 grams above birthweight.
I wonder, Karen, what makes you say that milk transfer is OK?  Do you have
an objective measurement of how much the baby is taking in?  Because with
this alarmingly slow weight gain in a baby who is not content, I would
suspect inefficient milk transfer at best.  At worst I would be concerned
that inefficient milk transfer over several weeks may have resulted in a
decline in production which will take a concerted effort on the mother's
part to rectify.  I doubt the baby will accomplish it, nor does it sound as
though he should be required to.

I am puzzled that anyone would think there is no obvious reason for the
fussing.  The baby might simply be trying to tell everyone 'I can't DO this
on my own, HELP ME GET FED!'

This baby should be a lot heavier by now.  If the cardiac condition is
making him expend an inordinate amount of energy just to stay alive, he
needs even more food.  If the heart condition is affecting his ability to
nurse effectively, then expressing milk by some other means is the only way
to maintain supply.  In any case, a baby who is this far behind expected
growth is unlikely to be a prime performer at the breast.  Everything in
your post is shouting 'needs more food'.  If the mother can express milk and
feed it to the baby by finger feeding or a tube at the breast, he will
probably start acting happier about being there, if hunger is the main
problem.  If he is unable to cope with an increased flow, she'll need to
figure out a way to get him nourished, in collaboration with whoever is
following him for the cardiac condition.

Good luck, and do keep us posted on what happens.
Rachel Myr
Kristiansand, Norway

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