Carol,
I am not sure about the fat analysis, IMO I wouldn't start there. Your case
is one where I feel the pre and post feed weights are very useful. This
tells you about what baby is getting at breast, and usually it is not much.
Soemtimes even swallowing CAN be deceiving. I realize that one test wt. does
not represent all fdgs (this has been discussed before), but it helps to
extrapolate the ounces needed for supplementing.

I would hazard a guess that the bf was ineffective in early days/weeks and
mom's supply plummetted and maybe much more supplement than the 6 oz/day was
needed. Did she begin expressing right away to restore supply? and how is
supply now? So I am guessing that the ebm is not deficient but just that
more was needed. There is nothing magical about the formula (unless it is a
high calorie variety) but much more is being given (16-20 oz) than the ebm
was.

I realize that babies can get adeq. cals but still not gain due to high
metabolic needs, illness etc. So this could be explored as well. But from
the description, I would look at the EFFECTIVENESS of the bf, the milk
supply, etc ala the rules of the road that serve me well - feed the baby,
protect the supply, fix the bf.

Laurie Wheeler, RN, MN, IBCLC
Violet Louisiana, s.e. USA

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