Agree this wt gain is not optimal esp in light of early weeks gaining. How often does baby feed? You say <mom reported pain and some scabbing early on that resolved has had one bout of mastitis (rt breast) & 3 plugs, various locations smallish nipples protruded, very slightly compressed after nursing> This indicates to me less than ideal latch/ poor drainage of breasts which may have led to gradually lower supply. Baby may nurse poorer w/ mastitis (salty taste?). <tongue somewhat heart-shaped but protrudes well over gums while nursing> Maybe this needs further eval. May just need a change in positioning for tongue to reach better. May even need to be clipped. <mom refused consult until today and only pumped 1 - 2 times daily with avent Isis, yielding about 2 ounces total> I would recommend double hosp grade pump; the Isis I do not believe is indicated in this situation, unless financially this is what she can afford. I would recommend pump after each feeding (or as much as mother can manage) and use this as supplement, make up the difference with donor milk or abm if needed. Suppl. at breast w/ nursing supplementer device. make sure mom understands the supply and demand system, breasts need to be well "drained". I believe these early weeks are very critical to ultimate capacity and continued milk production. Of course, monitor wt gain closely. Laurie Wheeler, RN, MN, IBCLC Violet Louisiana, s.e. USA ______________________________________________________ Get Your Private, Free Email at http://www.hotmail.com *********************************************** 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