I haven't written in a while so I will reintroduce.  I am an IBCLC and CCE in
practice in western North Carolina.  I have been working since 1982 as CCE
with some breastfeeding counselling during that time, and since 1990 doing
primarily lactation consultation first at the health department, and this
year, setting up an LC service at our local hospital.  I am the only LC in
our county (population 50,000), though we do have an active LLL as well.  Now
for my question/problem. I have just seen my 3rd case in as many weeks of
babies referred to me by pediatrician for FTT or slow weight gain.  The first
mother I saw on day 6 of baby's life with hx of "drops of colostrum"
according to the mother, and the floor nurse, but no milk on the day I saw
her. Baby was latched on well, sucking away but no swallows (well, maybe 1 ot
2 in 17 minutes, but I chalked that up to saliva).  Pumped side two and got
NO milk. Tried hand expression on both sides, and also no milk.  Normal
looking breasts, and some breast changes with pregnancy-larger, darker
areolas, etc.  She used the SNS for a few days, pumped to stimulate more milk
production, never saw a drop of milk.  Has hx of radioactive iodine to
thyroid and is on synthroid.  At my request, Ob checked her synthroid level,
also T4, TSH, and prolactin.  All within normal range!  Now, she also has a
hx of leukemia in late childhood, does not remember name of chemotherapeutic
agent, doesn't know if she had radiation.  Anyone ever hear of a mother with
such a history never having lactogenesis?? Case #2 has been with mother of
older baby referred to me at 3 weeks for slow weight gain. This baby lost
over 1 lb, and at 3 weeks was not even back up to birth weight.  This baby
sucked and did some swallowing, but long episodes of just sucking between
suck/swallow bursts (i.e. widely spaced MERs), had small weight gain after
the feeding (intake about 1 ounce), and came on and off the breast alot.
 Mother says this is such a "goood" baby (you know the syndrome-q4hrs between
feedings, willing to sleep alot).  Now, here is interesting part.  She has
previous hisory of nursing first baby 9 years ago quite successfully--great
weight gain in first 3 months.  Since that time she has had some thyroid
problems "hemorrhage on thyroid" (?), required synthroid for some time
(though not now and she got pregnant and carried the baby no problem), and
there is family hx of this problem in her twin, her father. She has used now
the SNS, pumped frequently which did seem to increase her milk supply some,
and went on Reglen for a while which also seemed to help, but never brought
her milk up to full supply. Again, nl breasts and breast changes during
pregnancy. The baby now takes about 14 oz of ABM a day, rest is BM and is
gaining nicely.  I wonder about:  her thyroid levels, etc. but her OB is not
backing me up on checking this, or a possible hypothryoid baby.  Interesting
thing is clinically, I would say this mom presents as hyperthyroid, not hypo.
 Very energetic, busy, moving fast. Has lost her weight pretty quickly, etc.
 Any comments on this one? Lastly, Mom I saw yesterday.  Baby lost 1lb2oz by
day 5, on day 6 weight stabilized there.  I reported concern to pedi cuz this
kid had not stooled in 4 days!! Started her on SNS with pediatrician
counseling only 2 oz/4xday. Baby gained 1 oz in 4 days, finally stooled 2
days ago.  Observed feeding with before and after weights.  Baby latched well
both sides, suckles and swallows some again with big pauses between MERs.
Weight following 25 minutes of nursing on both sides--.6 oz! Then attached
SNS and kid downed 60 ml in 15 minutes. Weight then: 2.6oz (natch!) Mom has
breast asymmetry of about a cup size smaller on one side,though breast did
not look hypoplastic, nor tubular and baby did swallow more on larger side.
 Pumping after the feeding produced a few sprays of milk.  Again, a hx of of
Synthroid use which was increased during pregnancy.  Obviously effective in
maintaining the pregnancy, but why not better milk production?  Requested
thryoid panel from a different OB on this one and he is complying, so we will
see.  But again this is a mom who seems hyperthryoid to me if anything!! Any
comments on this, or other endocrine problems.  All these babies had good
latch-on, sucking etc.  Baby 2 was too good, but others appear entirely
normal, asking to BF at good intervals for a hungry baby (i.e. all the time),
crying well, etc.
Please advise! Thanks!   Betsy Wall, IBCLC