Sometimes when formula is precipitously dropped out of an infant's diet,
they take awhile to increase the milk supply sufficiently to gain well.
Mom can either go back to using the sns a few times a day if it is
critical that these babies maintain their gain, or she can breastfeed
more often and monitor the infants closely, say another weight check in
3-4 days to make sure that the milk supply continues to increase and
that the babies maintain sufficient energy to eat effectively.

Sometimes when a preterm infant in my practice transitions to exclusive
breastfeeding, I will feel comfortable with a relatively low weight gain
for the first week (4 oz or so) as long as the second week shows a more
robust gain (6-8 oz).  If not, or if the baby is no longer vigorous, we
go back to supplementing.

In your client's particular case, I would be more comfortable if the
mother were nursing both twins with the SNS, at least every other
feeding, and have a more gradual transition to having the babies fend
totally for themselves.

--
Catherine Watson Genna, IBCLC  New York City  mailto:[log in to unmask]

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