I guess this note is to vent more than any thing, I feel very burnt out and
at this moment very sad, frustrated, etc. I just finished talking with one
pediatrician that asked for help 4 weeks ago.
Baby at that time was 2 weeks old rejecting breast, mother was not brf or
pumping, according to mother baby did fine the first day but baby stayed one
more day in hospital, was introduce to bottle and good bye breast.  Baby was
admitted to E.R due to diarrea and the emergency MD put baby on pedialite for
3 days.
Dr. and mother wanted to return to Brf. my first intervention was to help
with latch on, it was successful, 2nd, worked on establishing milk supply.
 When I assessed suck this was very weak, so I began useing Lactina double
pump. plus nursing on demand.
One of the Pediatricians concerns was that baby was not gaining wt
appropiatly, he found a heart murmur but cardiologist told him that this
condition was not a factor for the slow wt gain.
Baby was born with 7.5 pounds on 11/28/96 and by 12/10/ was 8.2.
Mother started to nurse on demand but almost nursing round clock, after one
week mother is not suplementing but when pumping she's unable to express much
milk but baby had 5 to 6 diapers very wet, only one stool, suck is not
improving wt after feeding is .3 or .5 of ounze  sometimes .2.
Wt gain per week is aproximately 4 oz; pediatrician evaluates every week and
I do wt check + support and suck progress that it is none.  also this baby
when I provide breast milk with spoon or cup she can't coordinate to swallow,
or does it with difficulty.
Wt on monday 9.00 pounds, for the first time mom is leaking from the other
breast, when baby is nursing.  Baby starts a very bed cough similar to mother
and father.  Wt on Th. 8.14  mother reports that baby sleeps more and
sometimes baby threw up milk due to coughing I recommended to nurse having
baby like in sitting position, all this time a lot of praise, emotional
support, listening skills.
Due to my observation and recomendation Ped. send baby for suck evaluation,
that was done yesterday.
Guess what, Speech theraphist recommended bottle feeding because baby suck
better in a bottle than in a breast, the Ped. called to explained he support
breastfeeding but in this case he's agree that bottles are needed.
we had a long discussion with same result,  he recommeded express breast milk
given into bottles, put baby at breast first but if he gets tired give bottle
with breast milk or the artificial breast milk.
Ped. explained also that baby's lung are affected, and he's concerned that
baby will get worse, I reported this condition yesterday,  I though it was
only broncuitis
I guess I should feel reliefed, this is not my problem, right, well I don't
feel that way, specially that mother was unable to express milk with the
lactina.
Well if you have any opinion or ideas what can I do, please let me know, I
will really apreciate it.

Rosa Kuschel who thinks that this situation has been mismanaged. Spanish is
my first language and I wrote this quickly, forgive the errors.