To response to Nikki Lee and Heather Welford Neil, and their posts just
before I went NO MAIL on or about 22 December:
   These contented babies who are *not* doing well, not creating good
milk transfer, I refer to as "happy starvers".  I'm not sure who first
coined the term, but I've seen it very occasionally since 1965.  It's
one of the v. few situations in which I'd use a supplemental tube
device; I encourage the Mum to express (manually or by pump) after at
least some feeds (we discuss which ones, to be specific), to increase
the stimulation.  Yes, and it makes sense to use "alternate massage" or
Jack Newman's breast compression.
   The thing is to get the baby *fed*, each case being individually
assessed.  Usually once a baby is fed adequately, s/he will start
feeding with more vigour and everything will come up roses. However,
occasionally some of these Mums are *already* complementing, either with
pumped EBM or with some ABM. If the baby is getting loads of milk this
way, but is still very sluggish and not doing well, that's when to
assess very carefully and send the Mum and baby to the relevant medical
specialist. (Here, that means getting a referral from the GP.) It may be
a case that the baby *wasn't* getting enough nourishment *before* the
complementary feeding, and that it has only and not had the chance to
take effect. It may (as with a recent client) be that the baby was
vaccinated the day before and doesn't usually act so sluggishly. It may
be the case that there is something physical or neurological underlying
the situation - and needs the relevant professional assessment.
   Personally, I don't like the term "good" baby, whether this is
applied to a thriving, contented baby or to a happy starver.  Many years
ago I read in the LLL News (as it was then called)a wonderful comment
from one of the League's Founding Mothers, to the effect that:
        "*All* babies are *good*; some of them are
          just easier to live with."
   The weather is showery here in Brisbane. So much for the tourist
slogan "Come to sunny Queensland".
    Happy New Year to all of you.
         Regards,
         Virginia
         Virginia Thorley, OAM, IBCLC
         Brisbane, Queensland, Australia

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