If baby is having lots of green bowel movements, then that suggests to me 
that baby is getting mostly foremilk and not enough of the fattier stuff. 
Any baby that seems to be having trouble swallowing could have a 
videoflourescent suck swallow study to rule out abnormalities. Especially if 
she can't bottle or finger feed and isn't gaining weight. I have used a 
Medela Haberman Feeder quite successfully for those babies who can't suck 
and swallow on either the breast, finger, or a regular bottle.

At this point, if you feel the weight gain is too low which it sounds like, 
then concentrate on getting food down baby the easiest way possible. Mom may 
need to be on a rental pump  (8X/24 hours) if baby is not able to remove a 
good 2-3 ounces at each nursing. This is where test weighing really helps us 
make an assessment. Her supply may be low at this point if baby has not been 
removing milk well.

I have seen normal babies tolerate a too fast MER for the early weeks but at 
some point they start to get really upset about it. These babies are usually 
gaining weight more than average and often seem fussy after nursing. I like 
test weighing on either a Baby Weigh or a Tanita BLB12 scale to see how much 
intake occurred when baby pulled off. Test weights usually show a 3+ ounce 
intake at the first breast. I also observe the baby and see if she is 
choking or making loud and unusual swallowing noises. Sometimes baby has 
been making stridor sounds or hiccups after nursing for weeks and mom just 
thinks it is some cute baby noise.

If it just seems to be a too fast MER problem with a good intake at the 
breast and healthy weight gain, have mom pump off a half to whole ounce 
before nursing and see if baby can tolerate the slower flow better. The 
positioning you tried can help sometimes too. I also think your idea of 
having baby checked for throat or ear infections is a good idea just to make 
sure. If you suspect it is a too fast MER, there are lots of good suggests 
in THE BREASTFEEDING ANSWER BOOK, and Dr. Newman has a handout about Colic 
and the BF Baby that addresses this issue.

Kathy Eng, BSW, IBCLC 

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