I have a difficult case and need your assistance. Mother is first time mother. Nursing was going well for the first 6 weeks. The baby boy gained from 7# 12 oz to 12 lb, and 2 oz. The mother nurses on demand and is at home with the baby. Infrequent pacifier use. Occasional bottles of breast milk started after 4 weeks. No formula. Then in the next 2 weeks (at 2 month checkup) the baby lost weight, 5 ounces. The mother started the progesterone mini-pill at 6 weeks. Infant seems to fight at the breast during feeds now. Pre and post feed weight showed 2 oz milk transfer and then baby would not go back to breast, this seems low to me. This baby seems calm and alert. Father is also very tall and thin. This baby is 80th percentile for height, started at 40th percentile for weight and 5th percentile now for weight. I recommended feeding the baby more, but the mother says the baby rarely cues to feed. She needs to encourage the baby to the breast. She thinks the most she can get him to eat is maybe 10 times per day, he usually nurses 7 to 8 times. The baby is doing well developmentally, he is already rolling over now at 3 months. From 2 to 3 months weight increased 5 ounces. Still really not good. I suggested she consider trying to switch to non-hormonal birth control to see if there is any improvement. Also some increased feeding and pumping. She has tried some bottles of formula since the diagnosis of slow weight gain and he does not seem any more enthusiastic about the bottles than the breast. He seems like a baby that is happy to starve. Any thoughts? Could it be the progesterone-only pill? It's odd that there is such a dramatic difference starting at 6 weeks. The grandmother reports that the same thing happened with the father as an infant and he was put on rice cereal (the cure for everything back then). Thanks for your help.

Tricia Shamblin, RN, IBCLC

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