Hello all, This is my first time posting having only recently upgraded my PC to allow me these facilities (and now I am lactnutter too!). I work with Jean Ridler in Cape Town, South Africa and have just re-written *the exam* after 10 years. I have been working with a mom for the past week and would welcome any help from the collective brainpower. I first saw this baby at age 3 weeks. The mom was desperate to breastfeed but had been advised by a baby clinc to supplement the baby with ABM (in a bottle) as the baby was not gaining weight. The mom arrived at hospital about ½ hr before the birth - no time for drugs or interventions. Breastfeeding was initiated but the baby did not do well and a stomach washout was done. Bf did not improve. Birth weight was 3,650 kg and lowest weight 3,180 kg (a loss of 12.9%). Weight at my first visit was 3,536 kg (after a feed) and baby had been receiving 50-75ml ABM ± 3 hourly after attempting to first breastfeed. A nipple shield had been used on one breast and baby refused the other breast completely. During my visit we managed to latch the baby fairly easily to the one breast without using the nipple shield, with a minor episode of suck/swallow and the occasional swallow. The mom's milk was dripping from both breasts during this time. For most of the time spent at the breast the baby "munched" (jaw action and nothing else). I introduced feeding ABM at the breast with a no.5 Naso Gastric tube and the baby sucked and swallowed regularly until the end of the feed. ± 10ml of breastmilk was "caught" from the other breast. The baby will now feed from both breasts but continues to "munch" unless the NG tube is there. Mother is now pumping 50 - 60 ml EBM after every feed and has tried co-bathing and skin-to-skin contact. Baby has gained 147g in the week. Are there any other buttons we can push or do we just need a "tincture of time"? Thank you for your help. Rose Gauld, RN, RM, IBCLC [log in to unmask] *********************************************** The LACTNET mailing list is powered by L-Soft's renowned LISTSERV(R) list management software together with L-Soft's LSMTP(TM) mailer for lightning fast mail delivery. For more information, go to: http://www.lsoft.com/LISTSERV-powered.html