Thriving babies can gain close to 1 lb every 2 weeks after a small weight
loss, usually, in the first couple of days. (I even had one exclusive
breastfeeder last week who gained weight (maybe 1 ounce) between birth and
hospital discharge in 2 days). Your client's baby gained about 1 lb in 7
weeks.

It would be helpful to know what amount of milk the baby is transferring at
some feeds, so that is where pre/post weights can be helpful. Mother could
rent a scale, or see you at measure 2 feeds. I would guess the intake is
very low. Coming on and off the breast is a red flag, because babies who
are breastfeeding well, and at that age (as you know), will latch, gulp
readily, and come off the breast full and sated.

My guess is that baby may have a swallowing issue or a reflux issue, or
something. You also said that she spit up some alternate method feeds. I
think she takes the breast because she can control the flow or release the
breast often. I think an urgent and thorough investigation needs to be done
to find the cause of her food refusal. These babies often do just suck a
pacifier and sleep, they are calorically deprived and almost resigned to
not be able to eat.

Mother should be expressing after feeds and if possible 8-10x a day to
protect her milk supply, which I imagine is dwindling.
If she has private health insurance or WIC supplemental food plan/Medicaid,
she should be able to get a hospital grade pump and kit with a doctor's
order. I think she could try to get as much milk into the baby as she can,
via frequent breastfeeding, safely co-sleeping, discontinue the pacifier,
and maybe even little extra spoons of hindmilk if she is expressing. But my
priority would be a medical work-up.

Laurie Wheeler RN MN IBCLC
MISSISSIPPPI USA

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