Hi Ilene,
Firstly Mazal Tov!!!!!
Now to the issue at hand. If after a week the baby is not gaining, then I would suggest that your dil pump. I am nervous when there is no weight gain in the first weeks. Moms are too often feeling like the failure if something goes wrong with breastfeeding so when we can it is helpful to explain to the mom that it is not necessarily HER. A baby who is tongue tied is limited. The baby might be able to transfer milk, but I believe that the frequency of feeds and duration will usually be affected. So, I have had all different levels of tongue tied babies who were definitely able to transfer milk, but there is no doubt that clipping might very well enhance any breastfeeding experiences, on both the baby's part and the moms. I had a mom in just this morning who was actually depressed. 3rd baby, slow weight gain - just under the minimum on average - (125 per week)
The baby is already 7 weeks, so there is a feeding pattern which is probably not yet well established in your little one. I did detect a "slight" lack of mobility of the tongue, and suggested to this mom that she get that checked out. When I explained to her that it is NOT her supply or mismanagement that is causing the problems, she left me like she was dancing on a cloud. She was so relieved. Because this baby IS gaining, I recommended changing her feeding patterns (both sides, which she was not doing, less use of dummy, and just feeding more) to see if there will be an improvement without clipping. And if not, after doing everything to increase his intake, then to get the tongue clipped.  This might be what is hampering getting your baby gaining. I would suggest she protect her supply by pumping and then you could get to see if she succeeds - in upping her supply. I agree with heather that the formation of the breasts while MAY indicate a limited capacity - does not always predict failure and it would probably be better to keep mom optimistic by blaming the slow start to the baby's limited tongue flexibility. Then take it step by step as he increases his intake and becomes less sleepy and stronger, then you can advise her how to proceed. Doesn't promise that she does not have supply issues, but better to be sure than to guess. Which obviously can knock a new mom right out of the (breastfeeding) game.
Good luck.
Ellen Shein, IBCLC
Tel aviv
 

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