It is very good you did test weights on this baby because that leads you 
to know what is wrong. On day nine when baby only took in about 18 ml at 
the breast, supplementation at every nursing session should have started 
-- in my opinion. A baby this age should be taking in at least 2 ounces 
per breastfeeding, some feedings should be 3 ounces. If this was a 
c-section birth, or an induction with a long epidural baby may have been 
too groggy to learn to suck actively. Sounds like baby is just getting 
the initial MER, second side with just barely any intake indicates no 
MER happening. Weak babies can not suck well.

I often put these large weight loss babies on the bottle for two days 
with strict requirements to feed enough per 24 hours and have the mom 
use a rental pump to stimulate her milk supply 8 times in 24 hours. 
Enough calories would be birth weight times 2.5 ounces in 24 hours and 
maybe bumping it up some. I would have suggested 7 lbs. times 2.5 ounces 
or 18-20 ounces each 24 hours. After two days of intense feeding like 
this, baby would have been stronger and more vigorous and then test 
weights would have shown you what he could do.

Right now, I would have her feed this baby by any method she chooses as 
long as baby is taking 2.5 ounces per nursing session or bottle feeding 
and 8 times in 24 hours. Human milk is of course best but at this point 
the most important thing is to feed the baby. Supplementation at the 
breast is good but if baby will not participate in feedings due to being 
weak from losing weight and not having enough caloric intake, mom will 
have to use bottles to get him to increase his intake. She will have a 
stronger baby in 48 hours. I find most mothers dislike the SNS and won't 
use it after I leave their house.

Again, she can use 2 ounces of supplement at each nursing session by 
eyedropper if she wants. She could get a periodontal syringe from her 
dentist (10 ml each, or 3 syringes -- 30 ml -- per breast). She will 
have to be aggressive and measure this out in a cup before starting. 
Supplementation at the breast can teach a baby to suck vigorously but 
sometimes this doesn't work if baby is too weak and is not participating 
in feedings and shuts down quickly. If mom wants to feed 10 times in 24 
hours, that is fine, adjust the supplementation down a bit. Most moms 
are too overwhelmed to nurse with supplementation, then pump, and then 
do it all again every 2 hours and choose to try to get more down the 
baby less often.

Mom needs to be on a pumping regiment to stimulate her milk supply. 
Pumping after every nursing or bottle feeding or 8 times in 24 hours.

Best to this baby, hope it works out.
Kathy Eng, BSW, IBCLC

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