Jessica, may I suggest some kind of oral motor problem in which baby has 
trouble transferring milk? I work with many babies that seem to have 
over abundant MER problems but when you do test weights and observe 
them, they simply are not transferring milk properly. Often they can not 
eat much at one time, breast or bottle and stop gaining weight. They are 
sometimes really really quiet but often they cry after feedings, breast 
or bottle, because they can not remove enough milk to satisfy their 
hunger. I have seen them look great at the breast but with no milk 
transfer. (What I do is keep putting them back on the breast, test 
weights every 5-10 minutes to see at what point baby stops transferring 
milk.) Mom often thinks she had lot of milk at first but after a while 
baby stops gaining and if she is not pumping regularly she is low 
supply. If baby is living off her MER and not transferring milk herself, 
the supply usually decreases. I would watch how the baby latches and 
sucks on a wide based bottle nipple. Narrow based nipples are easier to 
grip with weak lips. Does milk dribble out the mouth? Does baby not grip 
with one lip on a wide based bottle? I will see the top or bottom lip 
very loose on the bottle. Does baby gulp and make loud swallowing or 
breathing sounds on the bottle? Does the baby take a long time to bottle 
feed, or have periods of sucking but no milk removal? Reflux can also 
make some babies self limit on their intake. Smaller feedings but more 
often is what the Breastfeeding Answer Book suggests.
Kathy Eng, BSW, IBCLC, Houston, TX

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