The birth weight of the baby in question was 4lb11oz (2.12kg). There was a 10
day hosp stay.  Without any problems, a normal baby can lose up to 10% body
weight in the first 3-4 days.  That would bring the lowest weight to 1.91kg.
Don't know if there was more of a weight loss or what discharge weight was.
If the 7wk old weight was 5lb10oz (2.55kg), then 2.55kg-1.91kg=647grams
gained.  7wk(49days) less the 4 days to reach the bottom weight (presumably)
would be 45days.  647g/45d=14g, almost 1/'2oz per day weight gain.  Ideally
30g or 1oz per day is desirable, but 1/2oz/day isn't too bad.  Obviously the
golden goodies in the diaper are coming from somewhere.  To produce
4-5stools/day,some milk must be going in and staying in.
 However you mentioned reflux.  Is this infant actually vomiting or spitting
up excessively and thereby losing calories?  If Reglan was not tolerated,
there is a newer med for reflux with an excellent safety profile, Propulsid.
 Doesn't come in a liquid but can be made up by pharmacy.
  I wonder if the fussiness in the evening is an indicator of a low point in
mom's daily  production. As to the one or both breasts per session, I thought
that there were two things to consider, the foremilk (lower calorie) and
hindmilk (higher calorie) and the flow rate. Since the flow rate is higher in
the beginning on each side, I thought that if for example one were to nurse
20 min total, that 10+10 would be better than 15+5.
Looking into some milk supply issues for mom like calorie/fluid intake for
her and rest might help.  As to problems with the baby, a normal physical
exam cuts out quite a few health problems as possibilities.  Some more subtle
things like kidney or thyroid problems or cystic fibrosis are really rather
unusual, but possible I suppose.  They always talk about Willie Sutton's
law--go where the money is.  That is, if looking for a cause for something,
look into the obvious first, that is in this case, say, the reflux or the
fussy (?supply) issues first.
Gee that was long-winded.

Hope that gave you some ideas to ponder.

Loni Leparulo
(aka Y. Leparulo, MD)
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