I would be very concerned too, Tina.

GI surgery and healing can make feeding painful, and/or can disrupt gut 
peristalsis or absorption of nutrients. So the first question: is the 
baby self limiting? You could answer that by trying another method of 
feeding where you provide a bolus (in time with her sucking efforts) so 
she doesn't have to work as hard. One way to do this: Fingerfeed with a 
tube and syringe, and gently push the plunger to deliver about .5 ml per 
suck and stop to give her a respiratory pause when she stops sucking. If 
she eagerly takes food, then we suspect that she mostly ran out of 
energy to eat well.  You can use the syringe and tube (or Hazelbaker 
fingerfeeder) at the breast) and squeeze some extra milk to the baby 
while she sucks if this is the case. When babies are very underfed, it 
takes them several days to be able to take in as much food as they 
really should. We are looking for eager feeding, without swallowing 
problems, and gradually increasing volumes of intake over the next week 
until baby starts rapidly gaining = catch up growth.

If there are swallowing problems, then that needs to be addressed. 
Speech therapists are good at that if the suggestions in Supporting 
Sucking Skills don't help ( don't have time to write it all here). 
Spilling/dribbling, gulpy sounds, coughing, color changes while feeding 
are all signs that coordinating swallowing is difficult.

If the baby is self limiting, she will take an oz or so and then 
steadfastly refuse to eat any more. That can be due to pain, GERD (which 
gi surgery increases the risk of), allergy (which also increases GERD 
risk). That can take some detective work to solve. Short, frequent feeds 
with supplementation as above may at least get her growing while you do 
that detective work.

Good luck!

Catherine Watson Genna, BS, IBCLC   NYC  www.cwgenna.com

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