Hi Cindy,
I've seen several like this lately and your plan is great, but I would
recommend pumping, because even though the baby nurses frequently--maybe
constantly, at this point he probably has a terribly weak suck.  If you want
to give mom the chance to produce the milk, the pump will give her the good
strong stimulation to see if her body can respond and make enough milk.  IF
she responds then you can start using her milk instead of the formula in the
SNS and when the baby gets up to where he should be on the growth chart, you
start phasing out the pumping and supplementing slowly while monitoring his
weight.

To figure how much to give the baby:
baby's weight X 3 = 24 hour total of milk he needs
for instantce, if he is 8 lbs X 3 = 24 oz of milk per 24 hrs. or 3 ounces each
24 hours.  This will need to be readjusted and incresed as he grows.
Not knowing what he is getting from the breast is of course the problem, but
if he is not to birth weigh at 6 weeks he is getting much less than this.
If the mom is willing she can rent the baby weigh scales and take them home
for a week.  Doing pre and post feeding weights she can be sure baby takes AT
LEAST 24 ounces per 24 hrs.  If baby gets 1 ounce from her she supplements
with AT LEAST 2 more, etc.  I have had quite a few parents do this and they
are delighted to know what their baby is getting and to see baby grow steadily
and become pink, healthy, and energetic.  They often have trouble getting the
required amount into baby because he is not used to eating so much.
If you don't have the babyweight scales available or it is not an option then
have her come and weigh with you DAILY or EVERY OTHER DAY minumum.  Do not let
her wait a week until the doctor's visit!.
Start by offering the baby ALL HE WILL TAKE in the SNS.  As I said before
often the problem with these starving kids is getting them to take enough.
They are not used to it and have to be coaxed, stimulated, and almost forced
for the first few days.  This is an emergency and this baby needs plenty of
nourishment as fast as possible.  Stress that mom MUST keep accurate records
of how much she feeds baby and the 24 hour totals.  As you weigh baby daily,
he/she should gain immediately.  Believe me the baby won't take too much. He
needs every drop.
Once you begin supplementing baby will start having heavy wet diapers and many
BMs, and being more satisfied and going 1-3 hours between some feedings.
That's how you will find time for mom to pump.  My usual plan is for her to
pump after 5 to 6 daytime feeds for 15 minutes, (no pumpings at
night--everybody sleep) with the good double electric medical grade pump of
course.  She saves all the milk and uses that in the SNS at the next feeding.
Set her up for there being little to no milk when she pumps.  Stress she is
pumping for the stimulation.  Tell her you DON'T expect her to get anything
because you are asking her to pump AFTER feeding the baby.  You have to say
all this several times so you are sure it is sinking into her brain.
I have seen women who I doubted had enough glandular tissue respond to this
treatment plan and go on to make a full supply.  Others did not respond.
You may never know for sure what caused this situation.  Often I think the
baby started out with a weak and inefficient suck.  It was OK the first 2
weeks when mom was in the early stages of lactogenosis, but eventually without
the good strong sucking she needs her milk supply begins to dwindle and baby
was not vigerous enough to stimulate her properly. Often with good weight gain
and development the baby's suck does improve, but it sometimes takes a month
or two.  It is good to set her up that this will take WEEKS to fix, not just a
few days.
Mom is not ready to stop pumping until she can tell me the baby sucks as hard
as the pump and baby is gaining though our weaning process off the supplement
and the pump.  If she stops too soon, baby's sucking cannot sustain the milk
supply and the whole situation starts all over.
I agree with the fenugreek or tea.

Oh, and I doubt the baby is colicky.  I'll bet he is just HUNGRY.  If after
supplementation for a week baby is still fussy, then you can look into reasons
for that.
Good luck,
Jane Bradshaw RN, BSN, IBCLC
Lynchburg, VA

 6 week old not up to birth weight
 I had a consult yesterday that I am looking for some thoughts on...
 6 week old male born to a 31 yo G2 P1 mom, healthy mom per her history ,
 had a normal birth in a birthing center with a midwife, no meds,
 initiated bf soon after delivery.

 Birth weight 9.6 , 3 weeks  8.0 , 6 weeks   8.6 !

 Mom says the baby is "colicky" , had already cut out most dairy and
 chocolate as she feels baby reacts to these foods, says baby nurses
 "constantly" , for hours at a time with out stopping.

 Baby appeared thin , loose skin , nursed in correct position with
 wonderful latch on, mom never feels let down, I did hear baby do about 3
 minutes of swallowing and after that baby became restless, was pulling
 the nipple back with his mouth , pushing hands onto moms breast.  Almost
 appeared frantic. Oral anatomy and jaw all WNL, slight rash on babies
 face.

 Mom had tried Mothers Milk Tea for a few days. Reports 1 BM every 4 - 7
 days since birth, and about 4 - 5 good wet diapers per 24 hours.

 SNS 60 cc for 6 feeds per day and Fenugreek.
 Gave mom a breastfeeding log sheet for her to log input and output on
 baby.

 She is to see ped in 1 week for weight check and I will confer with her
 at that time. I feel the baby is starving! Help should of been initiated
 sooner.

 My questions are :
 What else could cause this low milk supply?
 How else can I help her increase the supply? (Didnt recommend pumping
 bacause baby nurses so much)
 Is there a certain formula to use to figure how much supplement to give
 an infant?