We had a situation similar to this at our clinic, without tongue/lip issues. Weight gain slowed down at 4 months(2% to 1%) and continued to slow down through 6 months(down to 0.2%). We encouraged everything we could think of including breast compression and massage throughout feedings and pumpings (she also works full time), scraping the fat off of her extra milk and adding it to the milk she sent to child care, mom increased her protein and added coconut oil to her diet, etc. with no increase in weight gain.  Mother came in weekly for AC/PC weights along with the weight checks and the baby transferred 4 to 5 oz each time. The mother pumps 4 times a day when working and gets about 20oz (infant takes 15oz at childcare) and nurses 5 additional times when she is with the baby. Mother was gone for a 24 hour period for work and pumped 44oz so it clearly wasn't a supply issue. The baby sleeps with the mother at night , under safe sleeping guidelines, and nurses throughout the night. We even looked at possible medical conditions the baby could have and all tests were negative. This mother brought a bottle of her breastmilk to our clinic and asked for a creamatocrit test ,which we were not able to do, but I was surprised by the fact that the layer of fat in her milk was so small. She had let it settle for 24 hours and had even taken a picture of it before bringing it. When the infant's growth began to be affected we encouraged adding the powdered formula to the breastmilk to increase the calories as her pedi had recommended. In the end,the mother had a friend who was also nursing and donated some milk to her. She is now scraping the fat off of the donated milk and adding it to her own and the infant is now gaining over an ounce a day. (Back up to 1%)
Prior to this case I always thought that if a baby was not gaining it was due to inadequate transfer or low supply- something I could help fix. Perhaps these two cases might be similar. Just a thought.
Lisa Bell, RN,  IBCLC

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