Thank you for all of the responses!  It was wonderful to see all the responses and integrate your input with my own observations and knowledge about this situation.  

I do not have a scale accurate enough in my setting to do pre & post feed weights, although I think that would be a great idea.  

We initially went to block feeding because baby was not gaining even though she was having copious bowel movements. This is when I learned that oversupply does not always equal wt gain! The block feeding seemed to help the wt gain.  Baby had a TT clip by ENT prior to our first visit. 4m wt was slightly below 2% on WHO growth chart.  MD is concerned (but not overly) about overall growth.

I forgot to say that I serve a low income rural TN population.  Coconut oil, EVO, avocados are just not culturally accepted or affordable/accessible for this group of women.  Most of them have never even eaten an avocado - probably a more culturally acceptable high-fat food would be butter :-)

I will suggest to the mom to schedule an evaluation with an RD - because this situation is part of a larger picture and not just about milk supply.  Thank you all for reminding me of that.  Mom asked me how to increase fat in her milk and I knew it wasn't such a simple request.   While increase in calories may be part of the solution, I need to keep in sight the long term goal of healthy eating/growing.

Thank you for your input! 
Lisa Paul

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