Thank you all for your input. I hope I can answer all the questions. Karen, the mother is calling me, with me returning missed calls at this point. I did try to call her, and left messages when she was staying at the relatives house, then since then she has called me. (As a rule I will call a mother twice, if I don't get a response I figure she probably isn't interested in what I have to offer.) Her nipples seem a litte irritated, but she is not in pain. I am chalking it up to letting him nipple feed and that tongue. I think fixing the nipple feeding will remedy this. Wow, I didn't know the word "compliant" was such a hot button, I have certainly seen it on Lactnet before. It is commonly used in charting. It seemed more expedient than saying "we agreed on a plan of action, she said it would work for her, and then she didn't do much of it, and is still in disress, and asking for more help." I am sorry if anyone was offended. I saw her this afternoon. We undressed the baby for the weigh, and he was as chubby as could be. He is still gaining 10 oz a week! I gently suggested that she could really afford to start weaning him off of the formula, and he might continue with supps just from the milk she was pumping (I saw her chart on the table, she is getting, on average, between 3.5 and 1.5 oz per. Not as bad as she had related.) He aslo had a really wet diaper. I had to stress that "feeling empty" isn't a problem at 6 weeks post partum. She seemed to be comforted by engorement. "I know there is something there." We talked about the fact that there IS "something there" even without the discomfort of engorement. I asked the mom what SHE wanted to do, what she wanted from me, and that she needed to let me know when I was maybe being too, um, assertive, and she needed to call the shots and let me know what she really wanted from the breastfeeding. I stressed that this was her baby and her breast. (I really have no problem being direct. LOL) After an OK feeding, (about 15 min on one side and about 5 on the other, with baby self detaching, sleepy) the baby had transfered 2 oz. We had to reattach the baby at least 5 times on the second side, as he kept sliding towards the end of the nipple. THIS could be a big part of the problem. I stressed they would both be better off if he was taken off and reattached EVERY time he did this, rather than just letting him nurse while not compressing sinuses. The swallowing seemed better, and MER occured faster than the last time I saw her, but he had been nursed shortly before I arrived, so I can't go on ONE test weigh. She decided (I am so glad she made the decision!) that she did NOT want the shield, as she understood there was a possibility that it could compromise her supply. We got her set up with an SNS, and she and the baby did wonderfully. (He saw the SNS and thought it was a bottle and started vocalizing at it, like he does towards *her* when she is opening her shirt.) He took a little less than 1.5 in the SNS and still gained an *addition* ounce from her breast. For a 4.5 ounce feed in all. He was in arms more, and she seemed to be responding to earlier hunger cues than 2.5 weeks ago. We talked about "sucky" babies who need to snack all the time. She related the idea to her dh, who shrugged and said "So what, I eat about 10 times a day, too!" I said, "See, it's genetic." and we all had a good laugh. I am hoping this time the idea that *some* babies need to nurse quite a bit, even if they aren't ravenously hungry, and it does NOT mean they are starving to death, sunk in. This baby LOVES to suck. (I am SO glad she is totally against pacifier use, I can't even imagine the trouble we would have if that were the situation.) She seemed more relaxed. I hope she continues to work at this. Thank you all again. It is much appreciated. It is really helpful to air the entire thing out to others in the field, especially with a "high need" client. Only you Wise Ones understand. Mary Jozwiak IBCLC, RLC, LLLL, AAPL Private Practice *********************************************** To temporarily stop your subscription: set lactnet nomail To start it again: set lactnet mail (or digest) To unsubscribe: unsubscribe lactnet All commands go to [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