Hi friends :)
I'd like your feedback on this one...
I have a client with a 4 1/2 week old girl who was referred to me by the ped.
for poor BFand wt. loss.  I saw her first at 2 weeks of age, with fair latch
(only mild nipple tenderness), good suck strength, a somewhat posterior
tongue, but not severely so, but a placid, sleepy baby.  She would nurse only
5-10" at a time.  Mom has nursed two others successfully, and is very
diligent-was pumping additionally to increase supply.  We initially worked on
mouth exercises (that helped suck coordination), nursing one breast/feeding,
and supplemented over one weekend (peds orders also due to weight loss).  The
supplementation was then cut back to just once or twice/day-she was having no
stools and just barely held her weight that week. We increased
supplementation and she gained weight that week, was having good urine
output-and a few stools.  I started mom with a supplementer at breast, as she
was getting discouraged and worried. Ped agreed.  She is putting an ounce in
the supp. each feed.  We have had to use the large tubing to get her to take
3/4 to 1 ounce/feed.  Mom seems to have good supply-can pump several ounces
at a time easily, has good MER.  At breast, WHEN she sucks well, there is
audible swallowing.  Baby has had more than a pound gain in last two weeks-I
keep expecting a turnaround in energy/suck-she is still a very sleepy baby
requiring marathon efforts by mom/dad to wake her to feed.   She has more
awake/alert periods, but even with the supp. sucks effectively for at the
most 20 minutes.  Mouth anatomy feels normal, suck coordination much better
now.  This mom is tiring out.  She is well educated, very compliant.  She is
also 41 years old. We will do a weight check again tomorrow or Tuesday.
Any suggestions fellow LCs???  Thanks in advance!

Denise Mollenkopf
Florida