Question over is it a medical problem or intake problem: One has to look 
at the big picture and sort out the puzzle pieces. If baby has 
consistently low intake as measured by test weights in addition to poor 
weight gain, I look at 1) probably low milk supply at this point and 2) 
which is the initial problem -- oral motor problems on baby or low milk 
supply on mom. I usually have mom start pumping after feedings to 
increase her supply or use supplement at the breast (whatever mom wants) 
and then recheck in a week. If mom gets her supply up, say she begins 
pumping 2 ounces after nursing, but baby still can not remove enough for 
a full feeding in order to gain weight, then I look at oral motor 
problems in the baby.

If I had a baby who was not gaining weight, and test weights showed what 
should be good intake, I would have mom do test weights at home over 6-8 
feedings and see if they all are this good. If intake is good and weight 
gain is bad, I would have baby checked out medically. I have known of 
babies with illnesses that this happened to.

Why would I want to know the intake? I know this was asked in all 
seriousness so I will be serious. We want to know how much baby is 
removing at the time of our consultation to help figure out what to do 
next and why there is a problem. Notice the word problem, test weighing 
for problems is the only tool we have for accurate and scientific 
assessment of intake.

I have asked many IBCLCs who do test weights about this lately and they 
all say that they didn't appreciate this valuable tool until they 
started using it and now they would not want to go back to guessing like 
they did before they used a scale. Reminder again: with problem babies, 
not normal where weight gain is good.

Kathy Eng, BSW, IBCLC

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