I want to add something to the recent conversations with the babies who 
are not gaining weight, pinching the nipple, tongue tied or whatever. I 
feel strongly that test weights need to be done before and after 
feedings, and before and after interventions are added. Just observing 
is not good enough for problem situations.

I have seen babies look better with a nipple shield but the test weights 
show no intake -- worse than when we didn't use it! So we have to be 
sure what we are doing is actually going to help baby remove milk and 
get enough calories.

Babies who have lost too much weight, or aren't gaining well, are often 
weak. Once they are being fed enough calories per day, they should gain 
strength. Weak babies often can not remove milk well enough to feed 
properly but once their weight is up and they are gaining well, then 
they should improve on their feeding technique.

For example, if mom can pump 4 ounces but baby repeatedly self limits to 
1.5 to 2 ounces at each feeding, and tires out after 10 minutes to have 
zero intake at that point, then oral motor problems needs to be 
considered. I have found that the babies who can not remove a normal 
amount, when mom can pump adequate amounts, do very well with an 
assessment by a Speech Language Pathologist or an Occupational Therapist 
who is experienced with babies, especially BF babies. Someone who can 
assess the mouth, cheeks, tongue, palate muscles for weakness.

To really know what is going on, we must do test weights on an 
appropriate scale. I often follow these babies for 2-3 visits. The first 
one assesses what baby can do on his own and a care plan for supplements 
(at breast or bottle to increase caloric intake as needed) and 
increasing mom's milk supply is begun. The next visit, usually one week 
later, is to assess how much baby can take in now that he has gained 
weight vs mom's milk supply. Sometimes I do a third visit and if baby is 
not "cured" by then and mom has an abundant milk supply, then I refer to 
a good SLP or OT. I have seen some "miracle" cures for babies who 
undergo SLP or OT treatment.

Kathy Eng, BSW, IBCLC

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