Hi Kathy,
Thanks for your sugestions and  a Happy Thanksgiving!

First an update on this baby.  After 5 days gained 6 oz. Mom was
supplementing 5-6 oz of formula/day along with 8-10 brfdgs.  She also pumped
3-4 times a day obtaining 2-4 oz after a brfdg.
You stated this may be an infection (baby). I agree and after I talked with
the pedi last week I thought she was going to rule this out but she didn't.
 This is frustrating for me since I do not know this pedi but I will continue
to contact her.  I think she was satisfied with a wt gain and not to look
beyond to dx the problem(s).

Mom's supply:  There may be some diminish of her supply but she consistently
gets 2-4 oz after a nrsg.  I have adviced her to pump after every nrsg during
the day and supplement with her milk not abm.  Mom has put alot of money out
in my visits, pumps, Haberman feeders, I just am not ready to recomend
another gaget and more money so I am holding on an SNS.

Milk transfer:  This is where I think the main problem lies.  These long
nrsgs with poor suck/swallow ratio troubles me.  I oral exam of baby her
tongue is quite long, very noticeable over the gum line during a feeding but
when I place my finger in her mouth she bunches the tongue  and does not want
to groove around my finger or bring it forward.  I have sujested to mom that
baby may benefit from a referal to an oral/speech pathologist but I would
need the cooperation of the pedi to get this.

Yeast:  Both mom and baby are being treated.  Baby had some diaper rash and a
few white patches, they are cleared now.  Mom is feeling some improvement and
will continue the treatment.  I still am perplexed why her nipples are
creased after a feeding.

Any further ideas are appreciated and I'll keep[ you posted.

Ann Perry RN IBCLC