Hello all!
I'm and IBCLC new to private practice, and an RN (not working as a nurse at all now, just my PP). I'm in a rural area, and there are no PP IBCLCs in my area. I've just started seeing clients formally in the past month or so. 

I have a client that has a FTT baby, with a rather spotty history reported by her. I can't tell if she's truthful with me. She's 20 years old, and this is her third baby. Reported birthweight in mid-October was 8lb, weight today 11lb 1 oz. This baby is SO tiny, and SO classically FTT-looking, though alert and interactive. Long story short, she reports having been seeing baby's doctor for scheduled well-baby visits, and reports he was not concerned about weight until the 4.5 month mark because baby was "happy and meeting milestones."  She consulted with me 3 weeks ago, and at our first meeting I instructed her to begin supplementing 10-12 ounces daily to start (she had given zero supplementation until that day, test weight revealed 95cc intake at that meeting). They have multiple factors impacting their breastfeeding, including possible IGT, and a restrictive labial and lingual frenulum. Baby gained 8 ounces the week following our first consult, and only 3 ounces in the last 10 days since that second meeting. Today was my last weight check and I am concerned; mom reports she's only been able to supplement 5-6 ounces daily "because she's just not seeming hungry".  I don't know if mom "gets it," or if she's trying to save $ on formula (she's WIC-eligible but chooses not to access it), or she's hoping that the baby will be more hungry to BF...I dunno and she just kept repeating that baby didn't want more when she offered. Baby breastfeed hungrily, pulling off as I've seen her do at our first meeting, then mom offered 2 oz formula before nursing again with a couple minute's worth of swallows. Baby pulled off and mom offered a pacifier and swaddled the baby. I counseled her to give more formula (the baby was still wide awake and a bit fussy), and she put me off, wanting to finish the visit to get supper started for her older kids. 

Anyhow, our consultation time is now concluded and I won't be visiting again (unless she wishes to book more time) and I have communicated all three of our meetings to the baby's doctor, including my strong recommendations for close and ongoing follow up, recommendation to her that she utilize her WIC peer counselor and access the maternal/infant support services through our county health department, including formula, supplies and home visits by a nurse.  I'm bamboozled that the doc hasn't been more aggressive with her, which makes me wonder if she's been going as she reports.  I've had no return communication from the doctor, and will follow my letter of today with a phone call on Monday.  I'm considering a CPS report to get her into "the system" for closer follow up and engagement with services. But I've never filed a report...and I'm not sure it's indicated here. While their home is messy and smells of dogs and cats, there were no obvious dangers or hygeine issues that cause immediate harm (in the areas I saw, anyway). They have utilities and food, and mom had a can of formula and bottle/nipple at the ready. Selfishly, I'm also concerned that she'll know I called, since she's had no other contacts in the system, and I don't want to injure the trust she placed in me, or have people think that I'm the busybody nosing around people's homes/families. 

Anyone care to weigh in? How might you approach this? 

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