Cindy - I think we all hear the desperation in your voice!  Baby lost so
much, readmitted, discharged and lost *again* and wont nurse!  Just over a
year ago I was asked by the family's employers to see a 6 week old African
baby who had been born at 34 weeks weighing 2100g, discharged at 4 days
apparently "breastfed", had had a recorded weight of 1600g at 16 days (loss
23.8%!) and now weighed 1800g (still 14.2% below his birthweight).  As you
may imagine, he was very emaciated and lethargic, and had been receiving 10
- 15 ml EBM by "dinky-feeder" (small bottle with teat) every 2 hours in the
previous 24 on the advice of the employer.  Because he wasn't breastfeeding,
the mother (aged 19) had been expressing her milk and *discarding* it!! (I
never did find out why).  They had been in the public health-care system and
it was a weekend with no hope of receiving prompt medical attention.  I
contacted my friendly paed for his thoughts and he said the baby was
probably better off where he was and to go ahead and treat as a "feeding
problem" until Monday.  Anyway, to cut a long story short we gave EBM by
bottle every 3 hours at first (baby totally unrouseable, but would swallow
while asleep once his palate was stimulated by the teat).  Within 3 days he
was taking 220 ml/kg/day (by bottle!) and had gained 180g (6 oz), 4 days
after that he'd gained another 280g (10 oz).  He started a little
breastfeeding about two weeks after I first saw him, but couldn't really
manage more than a few sucks, and mother was eager to keep topping up by
bottle.  A week later I saw him breastfeed "properly" for the first time and
a week after that he was exclusively fed at the breast and had just about
doubled his weight.  I'd plotted all sorts of things on his weight chart and
it seems that he was able to breastfeed again once his actual weight came up
to the point that it should have been if he'd gained well from the beginning.

This baby taught me so much.  The Clinic Sister was horrified that he was
being fed with a bottle instead of by cup and frankly I was terrified that
he would be hooked on the bottle too, but didn't want to disturb something
that was working well, so we just waited for him to be able to breastfeed
again.  And, sure enough, as soon as he could, he did!  And then he took
off, became fat and dimpled and bright as a little button, breastfeeding any
old time.

The point of this story Cindy is that it seems that as soon as a baby is
strong enough (and well nourished enough) he *will* be able to breastfeed.
I think we have to concentrate on getting the food in first and worry about
the method of delivery once the weight is fairly good for age.  And yes, I
always check percentage weight losses.  The same friendly paed thinks I'm
neurotic, and has actually said he doesn't worry unless the loss is 16%
below birthweight, but as a general rule of thumb I think we need to watch
carefully anything more than 7% and start doing something about fast it if
it exceeds 10%.  There's always a reason (although finding it isn't always
easy!)  Best of luck.  Keep us posted.

Pamela, Zimbabwe