Judith Gutowski asks for input about a slow-gaining baby whose mother has
sore nipples and low supply.  Baby is now two months old, and weight at just
over six weeks was one pound, one ounce or 476 grams over birthweight.
Normally we'd expect him to weigh at least a pound more than that by now.
While his initial drop in weight means that he has gained over 2 pounds in
over 6 weeks, he should never have been as low as he was and should
therefore have done his catching up in the first week following birth.
Instead he continues to lag, even apparently losing half a pound from the
22nd to the 23rd of November, if I am reading Judith's post right (went from
seven pounds twelve ounces, to seven pounds three ounces overnight?)  

I'd want to know the baby's length and head circumference at birth, because
the weight doesn't tell me whether he was born skinny or born plump.  In any
case I would be very very concerned at a baby who, despite supplements the
first 3 days, lost a whopping seventeen percent of birthweight, and even
more so if the baby was 'underweight' for length at birth.  And I wonder
what kind of NICU would discharge such a baby home, eek.

In any case, weight gain since birth has been far below what one expects of
a healthy baby who is feeding well.  I'm taking a chance and assuming that a
qualified health professional has ruled out underlying disease.  Whatever
the cause, I wouldn't expect improvement until the baby has caught up with
himself, and as he seems to be getting a bare minimum of food, as evidenced
by his sluggish growth, I would want to see him taking in a lot more every
day.  It sounds like he already is doing that, since Judith entered the
scene, since he seems to have gained about as much in 10 days following
Judith's first contact with him as he gained for the first 5 weeks of his
life.

I would be cautiously optimistic that his technique will improve day by day
as his nutritional status does.  And it is possible that his mother will be
able to supply him fully herself once he has closed the gap between where he
was and where he ought to have been.  Not all mothers are able to produce
that surplus when a baby has a lot of catching up to do, but most can keep
them happily well nourished once the problem is fixed.  After seeing a
similar case myself earlier this fall I also lean toward the tongue-tie as a
possible cause of the original problem, but you won't know for sure until it
gets better, or fails to get better.  

This mother must be really determined.  She deserves the encouragement of
the probability that things will get better, likely within a couple of
weeks' time, at the same time that she is continuing to be followed and
supported to make sure there aren't relapses.  It may be that she doesn't
need as much galactogoguery either, once baby is capable of nursing
effectively, but I think I would wait to discuss that until such time as is
appropriate.  They aren't out of the woods yet.

As I was finishing this post, a follow up e-mail sailed in from yet another
mother whose third child exhibited some of the same characteristics as this
little guy, though admittedly not at as scary nor as complicated at the
outset.  She contacted me because he seemed to be preferring bottles at the
age of two weeks, which she was using to supplement because he nursed so
ineffectively and infrequently.  Supply has never been an issue and she BF
both her other children without problems.  On the phone she asked
tremulously whether there was any hope of getting him back to breast.  I
said there is always hope, and with a 14 day old it often goes quickly.
Short version: he was happy to go back to breast, but needed expressed milk
supplementation until a couple of days ago when he suddenly started waking
on his own, feeding eagerly and draining her breasts well.

Good luck, and do let us know how it turns out.
Rachel Myr
Kristiansand, Norway

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