Dear Dr. Mira,
Something else is wrong here.  Your post makes me want to see this baby.
Although there are many opinions on this, if this baby has a dysfunctional
suck I would be teaching the mom to do some suck training with this baby.
I've seen some remarkable results. Also has this mother been checked for low
thyroid?.  Once a baby gets too far behind on its weight, they often have a
poor suck because of habit, and because they are weak.  The suck can't improve
much until baby gains some weight and energy.
Some suggestions:
*  Has mom been checked for medical problems? low thyroid? breast development
during pregnancy?  other medical problems?
*  Is everyone SURE this baby is not tongue tied?  Have a high palate?  Is
this a mother problem, a baby problem, or both?
*  Suck train properly before nursings, between breasts, and anytime for
pacification to teach baby to put his tongue down, cup the breast properly,
and pull the breast back to the junction of the hard and soft palate
correctly.
*  Suggest she take some galactogogues.  Does she have access to fenugreek,
blessed thistle, etc.  Yes, I would suggest a prescription such as Domperidone
or Reglan for her.
*   Feed the baby well to achieve excellent weight gain.  #1 choice is to keep
baby at the breast by tube feeding  (if no specialty devices are available,
how about a #5 French feeding tube, hooked to a syringe or into a bottle--a la
Dr. Jack) Cup or finger feeding would be alternative choices before bottle.
With great weight gain, some babies can then have the energy to learn how to
suck better.
*   Pumping shouldn't hurt with a mini electric.  She should wet the flange
when she begins.  Sometimes when mothers with low supply pump the breast and
pump are dry causing a lot of friction.  If this doesn't help, why not?  If
her nipples are  still sore, it goes back to the baby as the cause.  He must
be hurting her and nursing poorly.  If she can't pump she needs excellent
instructions with a handout about hand expression.  Mothers the world over use
hand expression.  She can hand express after nursings,for the stimulation and
of course save any milk expressed.
*  Stress relief for mom.  Does she have some help so she can get adequate
rest?
*   And--yes, I have seen mothers increase their milk supply even at 2 months
with the right treatment plan and help.
Good luck
Jane Bradshaw RN, BSN, IBCLC
Lynchburg, VA
(Sob-not at Boca)
And if this turns out red again would someone on aol please tell me
specifically what settings I need to change.  I've checked the settings on my
email window.

 Baby now 2 mnths old, 4000gr (at birth 3,300, down to 3,000)

 They saw a peditric gastroenterologist yesterday, and he said baby has to
 get 150gr milk 6 times a day. He knows this will end nursing, but is
 concerned about the baby, and has no other solution.

 I suggested pumping to get supply up, and to use EBM as supplement, but mom
 is physically very uncomfortable pumping - hurts, pulls to much, and almost
 no milk. She tried the Medela mini elecctric. This is the best pump
 available here in Israel. I knnow only of one LC renting PNS or Lactina,
 and she went to the US for the summer, and so did the LC they saw in the
 beginning. (They will probably be in Boca...). She didn't get any
 instuctions how to pump, and tried only once or twice, because of the pain.

 My questions are:

 - Any chance that the suck may still improve at this age - 2 mnths?
 - What can be done to improve the suck - maybe osteopathic tmt?
 - Any ideas on making pumping more comfortable? Mom is very dedicated to
 bf, and would at least like her baby to have EBM.
 - Could Domperidone help the supply at this stage, assuming mom will be
 able to pump, or baby's suck will improve? I think I read that this is
 useful only in the first weeks.

 Any other ideas will be welcome.

 Thanks again for all your help.

 Mira Leibovich, MD