Mother of three, delivered first at 32.5 weeks. Was able to pump "plenty" for his needs in first three weeks while in NICU.  Went on to nurse exclusively until four months.  Quit to go to work.  Prior to first child, mom was a 32 B breast size.   

Two years later had full term child.  Nursed for three months.  Weight gain was a concern so she supplemented this one 30-50% of her needs and quit nursing at three months.  After this she was down to a 32A cup.  She decided to get breast implants to make her look "normal" (most friends and family can't tell.) 

Third child born at term.  Nursed well and she could hear swallowing after three days.  Has slowly stopped hearing any swallowing and baby is not gaining enough- barely OK at last check- tomorrow he will be checked again and probably supplements will be advised.

He will be two weeks old tomorrow.  Born weighing 6.10.  Two days ago weighed 6.6.  

I saw him nurse yesterday.  Mother has "long" nipples, and one is bulbous.  She states that the long, but not bulbous one was originally inverted with her first baby.  Thinks three weeks of pumping stretched them.  But although the bulbous one does not feel inflamed, she agrees that it may be slightly swollen.  Regardless, it appeared to me that the baby is unable to latch deep enough to compress the ducts behind the nipple.  He is averse to being encouraged to latch deeper- either with laid back or chin swipes.  His latch would be, in my opinion, acceptable with a shorter nipple.  But I could not manage to get him any deeper- he is good at backing off, obviously to maintain his comfort.  And mom gets a red stripe down the center of the nipple.  I assume this is because he is not deep enough.  He has a small mouth, which may be the key to this -I'm not sure.

At the same time, mom tells me that yesterday evening she saw him allow milk to collect in his mouth without trying to swallow it.  I think he gets passive after a few minutes at the breast, and starts to shut down.  She said she could feel a let down, but he did not respond with swallowing.  

I'm really at a loss.  Is this a mom problem or a baby problem?  ...Both?   Mom also says she has to wake him at night after four hours.  When I saw him he was quite alert during the first 10 minutes nursing at the breast.  Then, he closed his eyes, but kept suckling.  No swallowing.  What do you think?  What am I missing?  

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