Kathy
There is a good article (I have at work) on low wt gain or slow wt gain in
Clinics in Perinatology I think, anyway the author states that w/ low gain
you should look at low intake (volume totals) *NOT* fat or cream of the
milk. If someone knows the article please chime in. I'll be at work on
Friday and could find it for you 504-244-5380 call me if you need it. So I
think you are right about
it being low supply issues. You may be able to find a ref in Ruth Lawrence
text and also about creamatocrits.
As far as the spitting up, "the baby spits up large amts occasionally" could
be perfectly normal (mine did this *occasionally* but were quite fat) or
problematic. Adding cereal is not done by all doctors, if the baby has some
sort of reflux problem, he could be on meds instead or other anti-reflux
measures. If cereal is truly needing to be added, it could be done
immediately prior to the feed and in a small amt of milk, because, as you
say, it gets digested very fast.
Unfortunately it sounds like the doctor is quite unfamiliar w/ breastfeeding
physiology and breastfeeding management, so this might not be the right
doctor for a dedicated breastfeeding mother, but then again the doctor could
be open to some info/education on this.

Laurie Wheeler, IBCLC, MN, RN
New Orleans Louisiana, s.e. USA

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