>I'm looking for help for an online friend.  Her newborn is
>about six weeks old and fluctuates between gaining and losing weight
>-- she's still not much over her birthweight.  She has green stools
>and the mother is unsure whether this is due to too much foremilk, or
>a tummy bug.  The mother has been taking fenugreek and eating lots,
>and feels her supply is adequate.  Among the things she's tried are
>skin to skin contact, baby-wearing and massage.  She feeds from one
>breast per feed and often repeat feeds on the same breast to get more
>hindmilk.

I wish people would forget the terms foremilk and hindmilk sometimes!
This technique is for *oversupply*, not poor weight gain. Aside from
absorption-type problems, a baby not gaining well just needs *more
milk*. This is achieved by feeding both breasts per feed, maybe even
returning to each again, ie switch-feeding. I would not recommend
feeding only one breast a feed 'for the hindmilk'. There is also no
mention of how many feeds she has in a 24-hour period.

What leads the mother to believe her supply is 'adequate'? Baby's
output? If it is on the low side, then I think she just needs to get
more breastmilk into the baby and stop worrying about foremilk and
hindmilk.

If on the other hand, the output is good to copious, I would start to
think about something reducing the efficiency of absorption, like
food sensitivity. Is baby happy or generally unsettled? If the stools
are copious and green, then this is more a possibility.

Mother is not a vegan, is she? Another long shot if everything else
checks out OK is to test baby for cystic fibrosis.

> She has tried syringe feeding, but the baby doesn't like
>it much.
>
>Does anyone have any other tips on encouraging weight gain?  Does the
>fat content of the mother's diet affect the fat content of the milk

No. It may reflect *types* of fats from mother's diet, but not
quantity. The fat concentration of milk is directly proportional to
the emptiness of the breast. So both breasts should be 'emptied'
frequently and efficiently.

>(I always recommend lots of protein for milk production, but her
>paediatrician has suggested she eat more fat to increase the fat
>content of her milk)?
>
>BTW, this baby had a twin who died during labour, and the parents are
>terrified they'll lose this one too.

Ooooh - psychological factors here could be having quite an impact.
Is mum having any let-down problems? Maybe Rescue Remedy could help
if this is the case.

Perhaps the parents need some (more?) counselling to help them relax
a bit and enjoy the baby they still have. There is no way they are
not going to grieve for the lost twin, but they need to stay sane
enough to care for the living one. What an awful thing to have to
endure. My heart goes out to them coping with this.

Hope some of this helps.

******************************************************************
Joy Anderson B.Sc. Dip.Ed. Grad.Dip.Med.Tech. IBCLC
Nursing Mothers' Association of Australia Breastfeeding Counsellor
Perth, Western Australia.   mailto:[log in to unmask]
******************************************************************

             ***********************************************
The LACTNET mailing list is powered by L-Soft's renowned
LISTSERV(R) list management software together with L-Soft's LSMTP(TM)
mailer for lightning fast mail delivery. For more information, go to:
http://www.lsoft.com/LISTSERV-powered.html