In the past few months I've been called in to evaluate three different
infants who look like perfect little breastfeeders--but there's no (or
minimal) milk transfer. I saw two of these babies after they'd seen other
lactation specialists.   One baby was at MINUS 2 grams after what appeared to
be an excellent 20 minute feed.

These moms have been able to pump milk.  All anatomy WNL.

The babies all appear to go readily and hungrily to the breast.  The gape is
wide, tongue down.  No clicking.  No tongue-tie.   A normal
suck/swallow/breathe pattern. It definitely looks like a textbook nutritive
suck.   Mom's nipples are fine.  One baby did have a "soft" suck and a bit of
a flutter, but when the milk started to flow, she looked perfect.  The other
two looked great from the beginning.

We're stumped.  Is it in the water?  One was a completely unmedicated birth.
 The baby with the flutter suck had APGARs of 9/9.  We've been helping
mothers breastfeed for a combined total of nearly 45 years.  We're ready to
turn in our credentials!!!

We've reviewed Marmet's Suck Training, significant portions of Riordan and
Auerbach, and the Neonatal Motor Assessment Scale.  Any words of wisdom?  Any
one of you learn something in New Mexico you feel might help us?

Bewildered in San Jose, but with great company...

Elizabeth Puzar, IBCLC and friends