PTP - I hope there are enough pertinent details here.

I have been helping a Mom in a situation that feels to me that something is brewing. Baby is 1 month old. First 3 and half weeks all was fine: appropriate weight gains, eating nicely 8-10 times a day, alert and calm. Had  revision of tongue tie at about 1 week. Mom moved around a bit from hospital to grandma's house, home and back to grandma. Now home. On Sunday she reported that as of Friday and Saturday the baby was less active, hard to wake and feeding poorly. I saw an alert baby but she did not feed anxiously. Mom's supply seems to be down. According to test weights baby transfered 25 cc. Fed with tube in bottle and baby did transfer 40 cc. without a problem. Monday, Mom started Domperidone and is having an increase of about 20cc per pumping session per day. Monday, Mom reported that baby was more alert and eating nicely but on Tuesday she again became sleepy, not waking for meals and feeding poorly. Family doctor sent them to emergency room, where no tests were done and they were sent home that "all is okay" even though baby's behavior remained the same. Mom continues to pump and is getting rung out by the long meals and pumping sessions.

At this point I advised her to "feed the baby" (she is using tube with pumped milk while breastfeeding, once or twice had to add formula)
Keep building her supply (she is pumping 8-10 times a day and taking domperidone.)
Go to pediatrician to have the baby properly checked.

Initially, I had advised them that the tongue and labial frenulum were still quite tight. I was thinking maybe with all the traveling back and forth that mom's supply went down and the tight tongue couldn't build back the supply. But now she is getting appropriate amounts of supplement and she is still sleepy and unresponsive.

I considered,  perhaps she is just satisfied and they should let her wake for meals and let her determine what she needs but she gained only 30 gram between Sunday morning till Tuesday afternoon,with supplementing (granted,on different scales)

Any ideas what I am missing? I don't want to be an alarmist but could something more serious be going on?
I would love your collective insight and suggestions for the next step.

Thanks to you all for "being there"!
Riva Weissfish BA, CCE, IBCLC

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