Katherine,
Respiratory problems are a common cause of failure to thrive.  If this
baby needs to stop after a short sucking burst and pant or breathe
heavily, this is probably the issue.  Babies with respiratory problems
tire before they are full, so they fail to remove enough milk to grow
well, or to support mom's milk supply.  It is pretty difficult to come
in after several months and rebuild a supply, but it sounds like this
mom is doing the right things in terms of her milk supply: supplementing
at breast, pumping (though I would rather see her using a hospital grade
pump) and taking galactogogues.  For the baby's sake, an ENT consult
would be the way to go.  Airway malformations such as laryngomalacia and
tracheomalacia are common, as are cardiac problems that affect pulmonary
blood pressure and aerobic capacity.  Also, beware of increasing the
flow too much for a baby with a respiratory problem- too fast a flow on
the sns or bottle can overwhelm the baby's ability to coordinate sucking
swallowing and breathing.

Some strategies that can be helpful for infants with respiratory
problems:  breastfeed with head extension, breastfeed in a prone
position, give short, frequent feeds so baby has time to recover his
oxygen balance before the next one.

This baby is just another example of why we need to carefully assess
feeding skills in infants who gain slowly initially, IMHO.
--
Catherine Watson Genna, IBCLC  New York City  mailto:[log in to unmask]

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