Jan, I have seen many babies this old who have a weak suck or other oral 
motor problems that were never corrected or caught before. At around 3-4 
months, the supply starts to really diminish if baby isn't driving the 
engine. Often, these moms have a huge supply at first and baby lives off 
that supply. Sometimes moms go on birth control medications that affect 
their supply, or start getting lazy about nursing and drop to 5 times in 24 
hours.

My friend's 100% BF baby did the same behavior as the baby you described 
(tugging, pushing breast in with his fists) and started to really lose 
weight after an illness during the fourth or fifth month. Test weighing 
showed this baby was removing 20-30 ml each time at the breast (ONLY!). We 
went to a variety of interventions. Mom tried the SNS for a few weeks and 
this kept the baby nursing more happily. She eventually had to use 
domperidone because she could not increase her milk supply any other way and 
baby wasn't helping her. She added solids and would nurse first, give solids 
and nurse again. She had to do some short term formula bottles at first as 
she built her supply back up. (We tried everything, herbs, pumping, bottles, 
etc.)

What gave us the most information was to have mom do test weighing over a 
whole weekend (one naked per day, the rest in clothing and a dry diaper). 
When we added up daily intake, the result was obvious.

The weight gain seems a bit low to me but again, this baby started out large 
and still is normal sized for his age. I would encourage mom to do test 
weights for two days before and after every feeding and see if his normal 
intake is as low as what you found. I also think a baby this age ought to be 
nursing about 8 times in 24 hours if she isn't already. Encourage mom to 
offer the breast more in the daytime and have him nurse on each side twice.

The SNS cured my friend's baby of the tugging and pushing at the breast. 
Seemed he wanted a good milk flow to enjoy nursing! He ended up weaning 
himself around 12 months because of supply problems.

Good luck to this mom, Kathy Eng, BSW, IBCLC 

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