My question would be: Why is baby so inefficient?
Look for:
-tongue tie (normal baby should be able to lift tongue tip all the way 
to the palate with the mouth open, when crying tongue should lift all 
the way like this)
-respiratory issues (short sucking bursts, harsh or unusually rapid 
breathing during pauses, stridor (squeaky breathing sounds)
-cardiac issues (panting after short sucking bursts)
-swallowing issues (noisy (gulpy) swallows, increasing nasal congestion 
as the feeding proceeds, wet sounding breathing)
-low muscle tone (floppiness)
-any dysmorphic (funny looking) features that might suggest a submucous 
palate or a genetic syndrome - widespaced eyes, oddly shaped or flat 
philtrum (ridge between nose and mouth), bony ridges on the sides of the 
nose, oddly shaped nose, eyebrows, eye fissures, fingers, toes.

Mom might be better off breastfeeding for practice (short feedings using 
compressions when baby is actively swallowing only), and pumping to 
remove extra milk (which can be fed to the baby another way) until baby 
can do a better job at breast. Baby's weight gain is still not optimal, 
and he's not managing any "catch-up" growth. I know this sounds a little 
heretical, but protecting moms milk supply and keeping the baby well 
nourished are our first goal, and direct breastfeeding doesn't seem to 
be doing that yet.

Catherine Watson Genna, IBCLC  NYC

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