These are the mystery babies, and I see quite a few of them. They present with marginal weight gain, and have what I call a "worried look." Sometimes mom's milk production is fabulous -- esp. if I get involved early on when supply is still essentially hormonally driven. Poor draining of accessible milk generally results in supply problems later, so that if I get involved at 6 weeks pp or so, I may wonder if I am looking at a slow-gainer due to primary milk production problems. These are not FTT babies, but children who put on weight painfully slowly, barely making 2-3 oz gain a week (although they may occasionally have a rather good week for no apparant reason.) They may suck fairly well for a few min. but often close their eyes and fade out, and seem to have stamina problems. If I try to supplement them, I find they do the same thing even with an augmented flow: fingerfed, or cup or bottle or sns, they close their eyes and tune out. They spit up a lot, seeming to do much better with very small amounts. If the doctor intervenes and says: " You must give x amount per 24 hrs" the mother spends the whole day trying to get this amount in the baby, and often says the baby won't accept it. Hence my perception that the baby is self-limiting intake. Now, why would a baby do that, programmed as they are to grow rapidly and with gusto in those early weeks? I have frequently seen it with reflux and with babies with respiratory distress. I had a pediatric nurse client with the most bountiful supply of milk and a baby who was almost starving. Neither weaning down, nor special positioning, nor alternative feeding methods helped. The only time baby was happy was when NOT feeding. I had suggested swallowing evals. sev. times, but it wasn't until ulcers in the throat were dx at 6 mo pp from acid reflux that baby got treated. She cont. to have feeding prob. and needed thickened fluids for 3-4 yrs. I have seen babies with heart defects self-limit. They can only handle small vol. feeds for physiologic and stamina related reasons. Cleft palate babies often do it. I suspect they find nasal aspiration very disquieting. I saw a baby recovering from botulism self-limit. He was so floppy that he just lost control and began sputtering after a few min. of feeding. I am working with a very interesting baby right now, who self-limited intake.. 35 week Preemie -- NICU a short time -- now 9 lbs. I saw this baby about 6 wks ago about 2 weeks post-discharge. Baby had so much nasal congestion that to fill his mouth caused him to panic ( he had to mouth breath due to blocked nares.) When mom forced him to breast, he went crazy. He wasn't much happier with a bottle of pumped milk. He literally held his breath, gulped as fast as he could to get some food, then went nuts flailing his arms, stiffening, so mom would take bottle away. Then he panted until he caught his breath, vomited from the gulping and the stress, and aspirated some more. This was typical at each feed. It was painful to watch. He could do this for only so long, and then just shut down on eating. His growth and certainly his feeding enjoyment was horribly compromised. Plan to remediate included: teaching mom how to pace his bottle feeds, pulling the nipple out every 2-3 swallows, teaching him to trust the feeding process wouldn't drown him. Her milk supply was very depressed, so we instituted pumping with good pump and fenugreek so she could dc all formula. I showed her how to bottle feed him in a sort of flexed, seated, upright position. I communicated with the pedi about the stress cues, feeding behavior and labored breathing. MD prescribed saline nasal spray to clear the accumulated milk debris from the nasal passages. Reducing the stress of bottle feeds produced reduction of reflux, better organization of respirations, improved growth. Mom cont. to report baby being very stressed when bfg was attempted, so I went back today. We worked with an upright, seated stradle position with baby's head very unfettered (support only at shoulders so he could pull away as needed.) We calmed him with a sip of bottle delivered pumped milk, and then he did very well at breast in this more up-right position. He has more maturation, better organization, altho he still doesn't have a good suck-swallow-breathe rhythm. But it is better. He has learned that if he is calm, he can get more breath.. The saline solution and reflux meds have helped a lot. He took in .6 oz from one an .7 oz from the other breast. Not a full feed, but a good start. Both mom and I were so encouraged and happy. Baby has had so much stress, he really deserves a normalized feeding situation. I have seen babies with very sore mouths, from viral infections esp. self-limit. Also injured babies -- esp. broken collarbones. These babies all find feeding painful, so they begin to have an aversive reaction to the process, and just take in enough to stay even -- rarely achieving that robust appearance we generally associate with normal feeding. Hope this gives a sense of what I meant when I referred to the baby who deliberately self-limits intake. Sorry it's so long. Barbara Barbara Wilson-Clay, BS, IBCLC Private Practice, Austin, Texas Owner, Lactnews On-Line Conference Page http://moontower.com/bwc/lactnews.html