I agree--the most likely explanation is he is fooling everyone and NOT actually transferring enough milk. He really needs to be weighed before and after feeding, and start gaining at least an ounce a day.

In addition to what you have recommended, I would suggest she pump at least 8 times in 24 hours and offer him everything she pumps.

IF he is eating appropriate volumes, then as stated before, he needs a visit with his primary care provider and perhaps another bilirubin to be sure it is all indirect.  I do not want to alarm you, and it would be MUCH more rare, but a cause of not gaining despite eating adequate amounts would be biliary atresia. We saw a baby who was not diagnosed until 6 weeks...she was not gaining despite good intake and one day she came in for a weight check looking green instead of yellow.

Kathy Leeper, MD, IBCLC, FABM
Breastfeeding Medicine Specialist
MilkWorks-nonprofit breastfeeding support center
5930 South 58th, Suite W, Lincoln, NE 68516
CELL(402)432-6867, FAX(402) 423-6422, www.milkworks.org

Creating a healthier community by helping mothers breastfeed their babies....

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