Maureen writes:

Could it  be a physiological or metabolic disorder? 

Mom does not have an  overactive letdown as there were no signs of baby 
choking and gagging at the  breast during the observed feed.




Hi Maureen,
 
First: This mom has a lot to do and the fact that she can't get enough milk 
 is not from you not knowing enough. Her breasts may have been 
understimulated,  she may have supply issues herself, and she's stressed and not able to 
pump  adequately. If she needs to use some formula temporarily, she should. 
It may be  controversial, but sometimes if breastfeeding is inefficient, 
the time at breast  is kept very short, only while baby is actively swallowing 
regularly, so  baby has enough energy to take the supplemental amount and 
mom has time to  pump adequately. This can seem counterintuitive but often 
results in better  outcomes longterm. Also a source of potential disagreement 
but if mom cannot  supplement at breast, then bottlefeeding ( "responsive", 
"active" "paced style")  might enable this baby to get what is needed and 
start a better weight gain  trajectory. If there are no pre and post weights 
at a breastfeeding, I wouldn't  jump to a metabolic issue. It could be that 
baby is getting little at breast,  then so tired that another ounce from the 
syringe quiets her, but her body  really would do well with 2 or more ounces 
of food and she's just not able to  get that much via syringe. If we knew 
her intake was at least weigh appropriate,  and she still wasn't gaining, 
then metabolic issue would be considered. Anytime  this baby stops eating after 
one ounce of supplement, it could be from fatigue  rather than satiation 
since we don't know how much the baby might be getting at  breast. A baby 
stooling once a day is often not getting enough to eat, at this  age. It sounds 
like there are a few positive things you can help with to help  this baby 
gain more normally and see what works itself out, and what doesn't, at  that 
point.
Just my thoughts, discombobulated at they are.
 
Peace,
Judy  

Judy LeVan  Fram, PT, IBCLC, LLLL
Brooklyn, NY,  USA
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