The first thing I'd do is evaluate the breastfeeding, to see if the baby 
is getting a normal amount of milk (which for a little boy his age would 
be about 28-40 oz per day if he's not eating much solid food).

If the baby isn't taking in much milk, the care plan is simple - feed 
more solid foods and work on getting mom's milk production up, and 
figure out what went wrong and try to fix it.

If baby is taking sufficient milk but not growing, malabsorption or 
other illnesses might be responsible. Cystic fibrosis sometimes has 
delayed recognition in bf kids because they usually do not present with 
infections like artificially fed kids do. Allergies do sometimes cause 
malabsorption and reduced growth.

The fact that there was little fat on mom's expressed milk probably 
means her pump wasn't very effective at emptying her breasts! The fat 
content increases as the breast empties... If she got 6 oz of low fat 
milk in one pumping, that means she probably has a good production.

Once it is known whether the baby is taking in sufficient calories or 
not, you'll be able to know whether he just needs more food or has a 
medical problem that requires more assessment.

Catherine Watson Genna, BS, IBCLC   NYC

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