I throw in another idea worth investigating, in my opinion.
The milk fat can stick to the plastic of the bottle and stay there.
Sometimes it can be very difficult to bring it back in suspension and get
it to the baby.

Is this mother paying enough attention to this fact?
Is she taking care of mixing the fat back into the milk?

I am not sure if this would be enough to inflence growth, but it is a
possibility.
And it would be a simple explanation.

Warmly,
Micaela

Il giorno gio 21 mag 2020 alle ore 07:45 Lisa Marasco IBCLC <
[log in to unmask]> ha scritto:

> Hi Riva,
> It seems that we are speculating all the time, and never dealing with
> facts. I am intrigued by this story, especially knowing that there can be
> quite a variation in caloric value of human milk. I am also aware of
> conditions such as thyroid dysfunction and anemia that can result in less
> fat in the milk, which translates to fewer calories. While this is rare, it
> is not unheard of. Whether or not the mother has risk factors, how about
> getting a creamatocrit done on her expressed milk, preferably a few
> samples? That would settle the major question.
>
> In the meantime, you might consider suggesting she use lots of massage and
> compression to maximize the cream content of her expressed milk.
>
> ~Lisa Marasco
>
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