I would definitely check out her bottle feeding schedule as well as the amount of ounces in the bottle. 
The history of her breastfeeding her other three children might reveal clues as to whether she was trying to breastfeed them like a bottle feeding mother might at the onset(very spaced feedings and mandated sleeping through the night).
My daughter has familial chylomicronemia (a hypolipidemia Syndrome in which she is missing an enzyme that digests fat so therefore she MUST have a diet very low in fat otherwise she gets pancreatitis)
Her milk has very low fat content which is obvious from looking at samples of her pumped milk. She’s currently nursing a 7 month old who is nice and round. However, she nurses lots including multiple times during the night. The family bed and  attachment parenting has made him thrive. 
I would also scrutinize her diet. With four children she may not be eating enough. Can’t remember how old this fourth baby is? Can she do more holding /skin to skin?
Laura Monin


Sent from my iPhone

> On May 21, 2020, at 10:31 AM, Janet Business <[log in to unmask]> wrote:
> 
> I am enjoying all the comments and I can’t help but say something about the ABM. Of course the babies gain more weight on it. That’s it’s whole job from what I understand- ABMs are approved when they show the baby can gain weight, not what nutrients can be derived from it. Yes, I am being a bit tongue in cheek here. 
> I wouldn’t be surprised to find out the baby is taking less volume than needed, but it would be smart to look at mom’s health issues as Lisa M mentioned.
> Janet Dombro, IBCLC 
> 
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