I would not be happy with a weight gain of 3 oz per week in this baby!
And 4 weeks is incredibly early for feeding aversion to begin, typically
kids are around 3 months old when they realize that feeding is optional
if it's too stressful. I would bet there is something wrong with this
little guy.
You're really handicapped by not having been able to observe this baby
feeding. You can't tell if it's a swallowing issue, a respiratory
problem, a cardiac problem, or something else.
Clues I would look for if I saw the baby feeding:
-signs of microaspiration/aspiration from swallowing or bolus handling
problems - mistimed swallows (loud, noisy, wheezy swallows) with
increasing nasal congestion as the feed progresses
-signs of respiratory stress - short sucking bursts, stridor, long
respiratory pauses, harsh rapid respirations after sucking bursts. color
changes may or may not occur.
-signs of cardiac issues - panting or gasping after a few sucks, color
changes may or may not occur.
-signs of soft palate dysfunction - popping sounds during sucking or
milk lost through the nose during feeding or regurgitation.
Usually such a strong feeding aversion is one of the above, or severe
reflux or a painful GI condition such as developing pyloric stenosis.
I'm sure it's nothing the mother did.
Good luck with this mom and baby. Perhaps she can spend some time in a
hotel or motel near you, and you can do a daylong consult with her,
waiting for the baby to feed. If you can't, this baby deserves to be
referred to a multidisciplinary feeding team at a children's hospital,
IMHO. At the very least, you can ask her about these things over the
telephone, and see if she has noticed any of them. Often parents think
stridor is "cute", they don't realize it is caused by the baby
struggling to get air through a narrowed airway.
Catherine Watson Genna, IBCLC NYC
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