Hi there, I was wondering if I could get some help with a situation that I
have at my clinic with a mom with twins.

I forgot her chart so I don't have exact numbers for you.  This mom came in
the day before for her WIC appt.  Our Breastfeeding Coordinator was
concerned about the babies slow weight gain.  She wanted the mom to come in
the next day to see me.  The mom came in with her babies the next day to see
me.

Her babies are 2 months old and have gained gained approx. 2 lbs and some
oz. since birth.  One of the twins is much bigger than the other one.  She
weighs aprox. 2 lbs. more than her sister.  The mom was supplementing 1
bottle a day for each of them.  Other than that, they are being totally
breastfed.  There are plenty of wet diapers everyday.  The bigger twin has 1
bowel movement every 3 days, and the smaller twin has 1 every 4 days.  I
watched the babies nurse and there is good latch on and postioning.  They
seem to both have good, strong sucks as well.  The smaller twin does not
nurse on both sides at each feeding and seems to only nurse approx. 5-10
min.  She seems full though.  The bigger twin nurses both sides at each
feeding and nurses longer.  The mom tries to get the smaller one to nurse
longer, but the baby is not interested.

Aside from the babies being small, they look really good.  They are both
very alert, active babies.  The mom did say that there could be a problem
with down's syndrom with one of them.  She tested positive for it when
pregnant, but did not have an amnio test done.

I told her to keep a log of times breastfed during the day and # of diapers.
I gave her an SNS system so that she could get rid of the bottles.  Also, to
try to get weight up.  She is supposed to come back in a week to have the
babies weighed.

My question, how serious is it for these babies to have a slow weight gain?
If they are gaining each week on a steady basis, but not as much as they
should.  It concerns me about the lack of bowel movements--but these babies
seem very alert and active.

Please, any feedback on this situation would be greatly appreciated.  The
mom very much wants to breastfeed.  She has breastfed all of her children
and she has 8!.  She does seem overwelmed with all of this.  Her kids range
from 14, 12, 9, 8, 7, 3, 2 at 2 months.

Carrie
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