What is this baby's weight in relation to birthweight?  I have seen
babies who are not back to birthweight by 3-4 weeks, and appear content
to starve.  Often 3rd, 4th or 5th children, and mom is astounded to find
there is a problem.  Baby doesn't demand to eat, and when he does,
sleeps at the breast for the most part.  I would be more aggressive
about supplementing in this situation...and limit time at the breast
until it is productive, so mom doesn't completely burn-out.  Calculate
the baby's needs, and ask the parents to get that much into him after
~20 minutes of switch nursing/breast compressions for a few days.  When
the baby catches up to where their weight should be, a lightbulb often
goes on, and they wake up and start asking to eat, and refusing so much
supplement.

Yes, you have to keep possible causes for poor milk removal in the back
of your mind...but sometimes really "feeding the baby" takes care of the
problem.

Kathy Leeper, MD, IBCLC

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