Remember that poops (stools, bowel movements) are a much better 
indicator of sufficient breastmilk intake in the early weeks than wet 
diapers are.  We want infants to have 3-8 dirty diapers each 24 hours 
between when lactogenesis II happens and about 6 weeks of age.  Starving 
babies can have enough wet diapers, as has been seen in some of the 
tragedies that were well publicized by the Wall Street Journal several 
years ago.
Once the gastrocolic reflex subsides (after 6 weeks) the baby no longer 
stools as often, and we don't worry if they slow down.

I agree that this infant should be fed in any manner that is efficient, 
and carefully examined for cardiac, respiratory, or oral anatomical 
issues that might have led to the failure to gain weight.  Mom should be 
assessed for hypothyroidism, retained placenta, hormonal imbalances, 
breast hypoplasia, and mismanagement of breastfeeding.  The fact that 
her other babies were slow gainers increases the index of suspicion that 
there is a maternal factor, or an infant genetic factor such as tongue 
tie.  The doctor will have much more respect for lactation consultants 
if he/she sees that we care about the baby's welfare first and foremost, 
and are reasonable- knowing  when getting food takes priority over 
breastfeeding.
Catherine Watson Genna, IBCLC  NYC

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