Paula
It is late and I had a very busy LC day, but I will try to tackle your case.
Actually this problem can be looked at as:
part A. low wt gain - fairly easy to treat
and/or part B. pretty complex sucking problem?

Let's look at #1.
Rule #1 - feed the baby. Do a few milk transfers pre and post-feed wts if
you can to see what the baby is really getting when bf. Probalby very
little. Sounds like the baby has not bf optimally and then mom's supply has
dwindled. Couple this w/ mom being away and pumping. Pumping long-term and
for a long day will usually not keep up a good supply, esp. if mom has
tendency to low supply. And it does sound like it started when mom ret'd to
work. Probalby increased use of bottles, less bf, more pump use yada, yada,
yada. Now, baby will probably need to be supplemented w/ appropriate
volume/calories for his current wt. Once you know what amt milk baby is
getting, then you know how much to supplement.  Have mom choose the method
of supps (cup/sns/bottle)and the milk to use (ebm/donor/formula). Solids can
be added as well for a 5 mo old - hi calorie solids not low calorie baby
foods. But not as a replacement for the milk. Also MAKE SURE TO RULE OUT
MEDICAL PROBLEM/ILLNESS.
Rule #2 is support the milk supply. Work on increasing the mom's supply -
make sure it is a good pump like the Medela classic she is using. Try
herbs/reglan/breast compression/massage/oatmeal. Try to improve baby's bf
technique. Can mom work less and be w/ baby more?
Rule #3 Fix the actual bf - this is the hard part, see part B above. This
may need referral if you don't feel able to suck train/whatever. Maybe needs
CST therapy or chiropractic. Sometimes an OT/ST can help too. Good luck.
p.s. credit to Coach Linda Smith for the original bf "rules."
Laurie Wheeler, RN, MN, IBCLC
Violet Louisiana, s.e. USA

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