Hi all!  I need help.  Saw a baby last week, who will be 4 months old on the
29th of August, referred by the doc.  This couple is from Taiwan (mo)  and
China(fa);   they live in university housing at MSU--just moved one month ago
from Louisiana.

One week ago prior to my visit , the Mom started hand expressing and putting
 EBM in bottle because she did not think her baby  was getting enough
directly from her.  SHe also supplements with sim.... From what I could tell
without watching a feeding, this infant had been nursing a couple of minutes
and then  asleep.  She had been monitoring the weight at the Peds and they(
including the doctor)  were very concerned because infant only gained 8 oz.
in two weeks, whereas the gain had been greater.  This couple had a growth
grid at home and the growth gird actually looked good, even height for
weight, except that there was a leveling off at the last plot instead of the
increment on the curve.  I know that just one measurement isn't indicative
but this couple is very watchful and they also said that baby was not happy
and had dark circles under eyes.

The problem is:  Baby will not take bottle unless she is asleep.  She sucks
from bottle fine although she must  very gently stimulate her to suck more
without waking her.  * Listen to this:**  WHen baby was 2-3 mos. the parents
tried to force feed her cereal by dropper for 2 weeks, 2x/day.  There was no
other history of gavage feeding or problems at birth, according to the
parents.   I tended to think that this force feeding  was reason for bottle
refusal.  Actually my gut feeling is that we could have long term feeding
problems with her if this is not resolved.  Do you think that an OT is the
next person to get involved or will this cause the parents to be even more
anxious?.

Mom would not breastfeed for me because "I'm afraid she will not take bottle
anymore ."  She herself had tried the SNS and said that infant would not take
that once she realized there was a tube there.
.  On day of my visit infant had taken 27 oz. on day previous and weight was
up 11 oz. in one week.  I tried to give them a few things to try to get her
to take bottle awake, advised them to never force her to take anything, and
advised on how to keep up milk supply.  Also suggested that they allow her to
be more active.  Also referred them to a PHN that I know for frequent visits
so They have someone on regular basis  for infant care teaching, and to vent
with.

Today Mom is ready to work on breastfeeding at breast again because infant's
intake is down again (took 15 oz. only yesterday) and it is she still refuses
to bottle feed awake.  This fluctuation has been typical.   I am going to
observe a feeding and  will try SNS with her becasue the baby nurses only 2-3
min. and falls asleep and because her supply is decreasing.  I don't have a
lot of hope for the SNS  if baby is this aware but must try it and must
observe a feeding, and give all the standard, how to deal with sleepy
 breastfed baby instructions.

Anymore suggestion?  I need them.   Cindy, IBCLC, PHN on leave