I see babies like these very frequently in my private practice.  The common
thread, I believe, is the baby's suboptimum suck which leaves the milk in mom
instead of getting it into the baby. These kids are "in the restaurant" but
not actually eating. This causes engorgement and milk stasis then suppressed
supply in the mother and insufficient calories to the baby, which leads to
many problems including jaundice, etc. etc.

My Rule # 1 is FEED THE BABY. If the baby can't effectively remove milk from
the breast for any reason, even after correcting latch-on, I believe it is
prudent to remove milk another way (hand express or pump) and feed the baby
another way (cup, spoon) that does not further compromise the tongue
peristalsis pattern needed for breastfeeding. This philosophy accomplishes an
increase in milk supply and gets sufficient calories into the baby while we
figure out what caused the suboptimum suck pattern and set about getting it
fixed.

If the poor suck is from birth medications or birth insults, we continue as
above and wait till the medications wear off or the injury heals, all the
while attempting to get the baby to breast many times a day. If the problem
is structural such as a short frenulum, it should be clipped by a dentist or
another qualified provider.  If the baby's head is still very molded or the
cranial bones are overlapping or misaligned, a referral is made to a
qualified practitioner who can address this issue (some Doctors of Osteopathy
are very skilled in this therapy). Sometimes the misalignment resolves on its
own in a week or so; other times treatment is needed. Misaligned cranial
bones can compress any of the 6 cranial nerves that are involved in
suck-swallow-breathe. IMHO, this is the most promising area of inquiry, and
there is considerable interest in this concept by the National Institutes of
Health Office of Alternative Medicine.

Collaborating with the primary provider(s) is ESSENTIAL in any situation
where the baby is not eating effectively. Sometimes there is an underlying
illness in the baby - heart disease, etc. My role as an LC is to help support
mom's milk supply, help the baby get calories in a way that does not further
compromise the suck, and help her find a combination of providers who can
address her baby's inability to suck effectively in collaboration with her
primary provider(s). And support mom's efforts all along the way - this kind
of situation is very difficult for mothers to handle, and the LC's counseling
skills and patience is every bit as important as her other clinical skills.

Linda Smith, hoping that more research will be done regarding why so many
babies can't suck well at birth. I see far too many babies in this category!
 If we did to athletes what we do to babies during birth, we'd never get
anyone to the Olympics!
LC in private practice, Dayton, Ohio