Thank you for all of the responses! It was wonderful to see all the responses and integrate your input with my own observations and knowledge about this situation.
I do not have a scale accurate enough in my setting to do pre & post feed weights, although I think that would be a great idea.
We initially went to block feeding because baby was not gaining even though she was having copious bowel movements. This is when I learned that oversupply does not always equal wt gain! The block feeding seemed to help the wt gain. Baby had a TT clip by ENT prior to our first visit. 4m wt was slightly below 2% on WHO growth chart. MD is concerned (but not overly) about overall growth.
I forgot to say that I serve a low income rural TN population. Coconut oil, EVO, avocados are just not culturally accepted or affordable/accessible for this group of women. Most of them have never even eaten an avocado - probably a more culturally acceptable high-fat food would be butter :-)
I will suggest to the mom to schedule an evaluation with an RD - because this situation is part of a larger picture and not just about milk supply. Thank you all for reminding me of that. Mom asked me how to increase fat in her milk and I knew it wasn't such a simple request. While increase in calories may be part of the solution, I need to keep in sight the long term goal of healthy eating/growing.
Thank you for your input!
Lisa Paul
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