A set of twins I have been seeing for three weeks are gaining slowly but
steady.  I would appreciate opinions from you regarding them.

Birthweight 5 and 5#0.5 oz. born at 36 weeks gestation.  They lost 1 and 3
ounces respectively in the first week home from hospital.

Mother has a 3 year old she breastfed but who had a problem with milk
supply, ear infections, etc.  She used an SNS the whole time she breastfed him.

Mother's nipples are rather large and bulbous and she has very, very small
breasts.  Baby's were latching on to only the nipple when I saw them the
first time.

Baby #1 breastfed actively, latched on better than #2 from the beginning.

Week one I sent her home changing breasts during the feeding to encourage
baby #2 to feed better and to take advantage of the MER's and hindmilk left
from #1.  I also had her use her SNS giving 1/2 ounces as necessary to
encourage baby #2 to suck better.  It worked and babies gained 5 and 7
ounces this week.  Both weight 5# 4 ounces now.

Week two, we worked more on latch-on as babies tended to slip to the end of
the nipple frequently and mom's nipples were sore with milk blisters on the
right nipple.  Baby #2 had only been getting about 2 ounces of supplement
from the SNS each day so we cut the supplement out.  Mom mentions that
stools are frequent but spinich green and mucousy.   Babies want to spend
every waking moment at breast.  Its really hard to get them to sleep well
for more than 15-30 minutes.  Weight gain at the end of this week was 6 and
3.6 ounces respectively. Suggested simplifying feedings by feeding one baby
per breast per feeding, switching babies to different sides at each feeding.
Sg going off milk products for a two week trial period. Give baby #2 some
extra feedings if necessary since she seems to be the fussiest

Week three babies are feeding much better.  Latch-on looks great, although
they still slip when fed at the same time. Milk blisters are almost gone and
mother's nipples are not as pink and tender looking.  Mom's breasts are so
small she needs to plaster them against her chest to keep them there.
Baby's still feed about 10-11 times per day and want to spend every waking
moment at breast.  Stools are still spinich green with mucous in them.  A
stool with each feeding.  Mom has been off milk products for 1 week.  Weight
this week was up 4.6 ounces and 5.6.  Both babies now weight 5# 13 ounces.
Weight gain is slow but steady.  I called the pediatrician who was okay with
the weight.  would have prefered 7 ounces per week but said to watch for a
couple more weeks.

What do you think?  have I missed something or do you think we need to wait
out the milk allergy issue?

Denise Parker, BA, IBCLC (La Crescenta, CA)
To Avoid Criticism, say nothing, do nothing, be nothing