Diane, something is wrong with this picture if baby is not up to birth 
weight by now. I would expect 4 large yellow bowel movements in 24 hours 
and I find it odd that pees and poops are ok when the weight gain is 
poor. I would ask how large the BMs are and see if there really are 4+  
bigger than a quarter every day. Mom needs to feed more. We once had a 
mom telling us how baby had great BMs every nursing and when she came in 
a for a weight check, this poor kid was so under weight. She then 
admitted the BMs were tiny scrapes.

Test weights would help explain how much baby is transferring at the 
time of your consult. He may be removing enough milk but needs more 
feedings or maybe he is not transferring enough to gain weight.

Something you wrote about the upper jaw clenching made me thing of how 
some babies keep their mouths really tight. You will often see a white 
line around their top lip and the skin and lip muscles look very tight. 
On a wide based bottle, they can not open wide enough to put lips on the 
fat base, rather aim to where the nipple blends  into the fat base. 
Craniosacral Therapy is helpful if mom wants to do this. Some babies jaw 
clench when their chins are hanging off the breast and the nose is 
smooshed in. I would do the asymetrical latch with baby's chin touching 
the breast and the nipple by the nose before latching. The corner of 
baby's lips should be a wide U, not a V or fish lips. Jaw clenchers 
often have tight body tone, they keep their arms stiff and may arch back 
from the breast. With the asymetrical latch they do not open wide. They 
are often fussy or cry a lot before latching.

A posterior tongue tie can also cause problems like this.

Kathy Eng, BSW, IBCLC

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