You're welcome, Laura - I certainly hope that the pedi will be receptive :-)

3-4 oz gain per week is very low, I agree.  I wonder why baby is not 
taking as much supplemented breastmilk as she is offered - that's a 
bit odd, and I wonder also if you've actually _seen_ what is 
happening.  I've found in the past that mothers of low-gain babies 
want so much for the baby to take all nutrition at breast, and at the 
same time are so wary that the baby will get hooked on bottle-fed 
supplements that they look for cues to show that baby doesn't really 
want them, and just don't offer enough.  I try and really push the 
recommendation for Feed The Baby, suggesting:
1.  Breastfeed with compression and switching max 30 mins
2. Top up with EBM for a baby with this kind of gain I'd probably 
suggest about 90ml/kg/day in the bottles until baby had caught up
3.  Asap after feeding pump both breasts and reserve EBM for next top-up.
4.  (This takes about an hour...) Rest two hours and start again, 
more or less round the clock..

I also find that most paediatricians are happy as soon as they see 
the baby gaining appropriately and are less worried about whether the 
top-up is EBM or ABM as long as the baby starts to "thrive".

And - interesting that the TT and LT release 3 weeks ago has not done 
the trick???  Was this really the problem??

Keep us posted!  Sending best wishes, she's lucky to have your support.

Pamela

At 17:01 24/10/2014, you wrote:
>Date:    Fri, 24 Oct 2014 11:00:55 -0400
>From:    Laura Spitzfaden <[log in to unmask]>
>Subject: Re: Mixing powdered formula with breastmilk
>
>Thank-you, Pamela!
>
>I have been asked for more information about this case. The baby had 
>a TT and LT release 3 weeks ago. She has always been a slow gainer, 
>3-4 ounces a week. Mom is working on the right balance of 
>supplementing extra breastmilk, of which she has plenty (not 
>oversupply, just plenty) and listening to Baby's cues. She has been 
>able to get Baby to take more feeds and a few bottles but she is 
>refusing to drink as much as is offered.
>
>The pediatrician wants the baby to gain faster. We actually think 
>she may have finally started to but the mom wants references to give 
>to the pediatrician of why it isn't best practice to add PIF to 
>breastmilk to increase calories in case the weight gain is still 
>low. The mom really likes the pedi and wants to keep a good 
>relationship but is listening to me about solute load and the other 
>dangers of PIF. The pedi has shown herself to be open to information.
>
>I think the information provided by Pamela may be helpful.
>
>Laura Spitzfaden, LLLL, IBCLC


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