Let's not get too hung up about numbers.  Remember that the rules are
there for a reason, and most health professionals forget what those
reasons are:  good weight gain is a sign of good health in a baby.  If a
baby is gaining well, it should mean this, and only this: one more sign
(along with good colour--slightly yellow in the case of exclusively
breastfeeding well gaining babies--, bright eyes, active, alert etc)
that the baby is healthy.  If a baby is not gaining according to certain
norms, then we have to ask ourselves why.  We have to say to ourselves,
this baby needs some extra attention.  If it turns out the baby is
healthy, content, and developing normally, we can accept weight gain
which is slower than the norm.  The baby needs to be watched, in case
something becomes evident later, but there is no need to put a tube down
the baby's nose and fill him up with olive oil to get him back to the
norm.

I would reassure this mother.  I would fix the latch.  I would ask her
to use breast compression.  I would ask her to switch back and forth
once the baby does not drink.  I would ask the mother to latch the baby
on at night and sleep with the baby attached to the breast during the
night.  I would consider using fenugreek and blessed thistle.  I would
try not put her under pressure, and I would try to get the pressure off
from others.

Jack Newman, MD, FRCPC