Lena - working with this kind of scenario must have been a bit fraught for a
while. This baby lost about l8% of his birthweight.  That's an awful lot,
and no wonder the baby has a poor suck - his nutrition has been so
compromised. Firstly, I would reassure this mom that her baby *will* suck
again - once he feels strong enough and as long as she doesn't give up too
soon.  This will be a long haul.

  Some years ago I worked with a situation that sounds similar, it was
really scary.  The baby had been born at 34 weeks, discharged at 4 days and
wasn't really *breastfeeding*, but noone had checked. He had just gone
downhill.  Mom had been expressing and *discarding* the milk (for some
unknown reason, I never did find out why), but baby's intake had obviousy
declined more and more the weaker he became.  Against all my advice mom
bottle-fed the baby (with the EBM, but I was worried about nipple confusion)
and he just wouldn't breastfeed, like the baby you describe.  So we just
went with it.

But that baby taught me an amazing thing.  It took nearly two months for him
to regain the lost weight and catch up to what he should have weighed if he
had received as much to eat as he should have had, and when he really got
going he was taking 280 ml/kg/day of milk - a huge amount - but as he
approached his "ideal" weight his suck started to improve.  He behaved like
a prem baby, taking just a little breastfeed once a day, then two, then
three.  He finally graduated back to the breast and became a proper
breastfeeding baby, with a good suck, and continued weight gain once his
actual weight reached his "ideal" weight on the graph I plotted for him.

Since then I have seen this happen again and again with low-gain or FTT
babies. I don't think you can expect a severely compromised baby to
breastfeed well, or sometimes even at all.  Patience!  Mom could keep
*offering* the breast from time to time, as encouragement to the baby, and
for assessment or practice, but if the baby can't/wont suck she shouldn't
fret.  The *most* important thing is that the baby eats and gains weight.
The method of delivery of the milk is not significant at this stage.  Mom
needs to feed the baby as much as he can possibly hold in the easiest,
quickest way for now, and focus her energy on re-building her milk supply
(frequent and thorough pumping).  The baby will re-learn to *breastfeed*
once he is well-nourished, strong and has the energy, and once the mom's
milk supply is bountiful enough to keep him interested in suckling the
breast.

Best wishes to you, and them.  Please let us know how they get on.

Pamela Morrison IBCLC, Zimbabwe
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