Hi Alice,

The best way to put on weight is with increased intake. Many babies in
cases like you've described are taking in way less then they truly need. I
definitely would want to be assessing this baby's intake. If he is only
bottlefeeding, then that is easy to assess. If the baby is doing some/most
breastfeeding, then milk transfer should be assessed for several feedings.
Breastmilk is the best food, of course, and so if the mother is not making
enough (you can have a peds nutritionist calculate his needs) the baby will
need more in the form of 1. increase mother's own supply, 2. some form of
donor milk (milk bank or " informal" sharing), 3. some form or brand of
infant formula.

I don't think human milk fortifier would be appropriate, as it is meant for
preterm infants. Perhaps some additional fats just to quickly increase the
calories.

Ensure that mother is using a top piston electric pump, knows how to do
hands-on pumping to increase yield and fat, breast compression. If you are
in the USA, can you help mother access all of her insurance and community
resources if she needs another pump or other bf aid?

She may find she gets an increase using an herbal or prescription
galactagogue, altho current evidence tells us that galactagogues are not
magic bullets nor are they without side effects.

A child with Pierre Robin Sequence may have other anomalies (not sure) so
it is worth investigating if that is affecting growth, and these children
may grow differently in general. Or perhaps look into how to help the baby
take more in, possibly via a different bottle, flow, or using a lactation
aid at breast?

It is obvious that this mother/family will need a great deal of emotional
support as well.
Perhaps someone in your lactation network, or someone here on Lactnet, can
recommend another mother who has been through a similar situation, for
support (with permission from mother to contact of course).

Laurie Wheeler RN MN IBCLC
Mississippi USA

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