Royce Anderson gives a great example of a situation about which on this
side of the Atlantic breastfeeding people would be saying 'er, where's the
problem?'

Here is a baby who is in obvious good health and has had someone who knows
what they're at observing, at least once, how the baby latches and
(presumably) the entire feed.We would probably wait and see at this stage,
and do very little.

We would be very unlikely to test weigh - in fact I  think I can probably
say this would never happen in this situation (Katheleen A's recent post
reminds us of the severe limitations of test weighing, esp when done once)
and I think we would compare benefits vs drawbacks of pumping and conclude
that *in this situation* the drawbacks would win - if you want me to
elaborate, just ask!  We would not suggest supplementing (presumably with
formula if pump not used) - again drawbacks vs benefits.

Sometimes in these cases the history of the baby, and the way he has been
cared for,  is very relevant. What sort of birth did he have? Labour meds
still in system mean he may  *need* to feed *a lot* after the first few
days of poor feeding or lots of sleeping.  Some babies *need* the security
and the comfort of being at the breast all the time - they don't want to
'fall off' the breast spontaneously because they get stuck in a crib if
they do this, and 'hanging on' even when dozing is one way of communicating
to the mother they want to be next to her! We would not, I think, take this
as a sign of poor breastfeeding when the sucking and swallowing and latch
and health of the baby is okay.

I'm interested in the mother saying he is 'never satisfied' - if this just
means never falls off, zonked, and preferes to feed rather than lie in a
crib, then there is not a bf problem, IMHO. Of course if it means he is a
fussy baby who cries all the time and takes a while to latch, then clearly
there is a bf problem. But I take it it's not the latter scenario.

Wt gain, I agree, is a bit slow if weight is still 9 per cent below bw at
11 days - but this baby is doing all he can to make up the difference, and
if the mother continues feeding ad lib with lots of skin to skin, we would
expect her baby to start gaining satisfactorily soon.

In short, we would watch this baby's progress carefully, support the
mother, observe what's happening, and do v. little intervention, and
suggest the mother avoids frequent weighing of her baby (which we know
gives misleading information).   In the absence of underlying problems,
weight sorts itself out.

Heather Welford Neil
NCT bfc Newcastle upon Tyne UK