Actually, this is a question, and some comments from me after reading
your first post, Lea, and then the follow ups from three other IBCLCs,
all of them in NYC - what a resource you have there with such great
colleagues!

I didn't see that the baby's birth weight or current weight were
mentioned anywhere. so I ask, what were they?  How much did baby lose
after birth before starting to gain and on what day did it happen
(assuming it has happened now by five weeks?)  Unless baby has been
gaining very convincingly all along I would really want some
definitive sign that milk transfer is taking place.  Diapers
consistently wet and poopy is too vague for me.

I found myself reacting to the word 'snacking' in what I assume was
the mother's description of how the baby was feeding.  Is it effective
suckling or just what Jack Newman called 'pretending to breastfeed'?
And how can any mother distinguish between 'snacking' and whatever
other kind of feeding a newborn baby does (and perhaps more to the
point, why should she)?  Is it a snack if it happens at a different
time of day from when our regular adult meals do, and a meal if it
coincides with breakfast, lunch or dinner?  What does the mother think
is the 'correct' number of 'meals' for a five week old baby?  Why is
the mother using the term 'snacking' at all, especially when it seems
to carry a negative connotation?

I have to say, too, I would prefer to avoid the mother perceiving the
baby as 'ticked off at having to work so hard'. Like the other three
who have offered suggestions, this sounds to me like a stressed baby,
stressed because she is not getting enough milk to live on.
'Desperately trying to get someone to notice that I am starving and
I'm a BABY who can't fix this on my own so PLEASE HELP ME' is more
like what it sounds like to me.  When there is a known factor like
tongue tie, that can have a strong negative impact on baby's ability
to stay adequately nourished at the breast, I would want to know that
the baby is not in imminent danger of starvation and I would
definitely want a Plan B to cover my own backside in case the mother
doesn't keep the ENT appointment.  I hope you can reassure us on this,
Lea :-)

This whole case sounds pretty typical for how babies behave when they
are incapable of transferring milk effectively.  Things may go OK
(just OK, hardly ever 'really well') in the beginning when the baby is
so new she isn't expecting buckets of milk and the milk supply is
still largely hormonally determined rather than driven and maintained
by effective drainage of the breasts at frequent, regular intervals,
the way it happens if breastfeeding is working.  When the milk supply
finally ends up where the baby's efforts put it, the baby is
increasingly distressed and will try to tell the world about it. If
the mother doesn't understand it, sometimes it falls on us to tell
her.  If I hear a mother describe her baby as angry I prick up my ears
and look to see whether she perhaps needs my expertise to help her see
what a brilliant baby she has, who is sounding the alarm in plenty of
time so she can get help to fix the feeding problem (and they can go
on to enjoy a long happy breastfeeding relationship afterwards).  The
sadder scenario is if the baby gets so frustrated by repeatedly being
expected to satiate herself at the breast when it was difficult at the
outset and impossible later on because supply has suffered and she is
weakened by not getting enough food for so long, because in that case
the baby may simply not dare to come back to breast even after the
anatomic obstacles are removed.

If it turns out that baby started out at normal weight and has been
growing and gaining weight at an astounding rate from day three or so,
I would say, evaluate for oversupply instead, but my money is on too
little milk rather than too much.

Regarding the other case, the post-frenulectomy jaw-pistoning baby, I
would say some of the best expertise in the world is right in NYC.
Why not start with the person in Queens who edited and wrote the book
on supporting sucking skills in the breastfed infant?

Hope we will get to hear how things turn out with the TT baby,
Rachel Myr
Kristiansand, Norway

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