Brenda,
I'd start with "horses" and move on to "zebras" if necessary. Heather has
raised very good points. What I would do would be to first get a detailed
picture of what/how baby is eating. As Heather said, baby may not be eating
at night, or may be getting water. Pacifiers? One learns that one must ask
alot of questions and get a good picture of what the last several days and
weeks have been like, feeding wise. Then examine baby closely and weigh him
nude. Discuss with mother how breastfeeding works and that baby's intake is
quite good. A ball park figure would be 19 or 20 oz minimum for baby to gain
(24 hr intake) and so if baby does a similar feed 8x a day, he would get 24
oz! Bring baby back in 24 hrs or 48 hrs at the most. The baby should gain
several ounces, in my experience like 4-8 oz in a couple days once he is
liberally being fed and not restricted in any way. It will be the same scale
and the same weigher if possible, so human error is minimized.
If you can be reassured that mother has an adequate supply and that baby is
feeding effectively and unrestricted, then something else is wrong if baby
does not gain weight. A referral would then have to be made back to the
physician to work up baby for the "zebras" i.e. metabolic, infection,
cardiac etc issues.
I think you will find the baby was not having unrestricted access to mother,
and perhaps, also, the latch was poor but was good when you assisted her. If
you can, see her for support a few times, and try referring her to a support
group.
Laurie Wheeler, RN, MN, IBCLC

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