hi sally tried to send this last nite but my computer fainted in mid-post. i think you did a fine job and you've already identified a couple areas where you might do differently next time. my motto is live and learn, we all do it. i agree if things looked basically good at day 3 i may not have done a fdg observation, unless there were risk factors of which a bili of 13 i think would be an indication of less than great fdg (unless other factors like bruising were present to account for this). that is a tough call as when milk is in and everyone is getting their acts together, moms and babies often turn right around and do great. from day 3 to day 10 or 11 baby only gained 1 oz. also mom felt her milk was going away. these were big red flags which you identified. here is where i would get more aggressive. yes, i would calculate how much baby needs to take 2.5oz/# and divide it into q2 or q3 hr fdgs. it would be expressed milk or formula (if needed). if baby wants more, give more. if baby won't take these minimums i want to know about it asap. then you should follow this baby very closely like every day until things turn around, i.e. supplementation decreases and mom gets to full bf. mom needs lots of support. these babies usually gain very quickly once they are getting adeq. amts of milk. i like a gain of 5-8 oz per week but most of these "cathcing up" babies gain even more til they catch up. you have great physical assessment skills and sound LC practices. (see, nurses do make good LCs!)! you will change your practice based on your experiences and outcomes, as we all do. you will just get better and better ! Laurie Wheeler, IBCLC, MN, RN New Orleans Louisiana, s.e. USA _________________________________________________________________ MSN Photos is the easiest way to share and print your photos: http://photos.msn.com/support/worldwide.aspx *********************************************** The LACTNET mailing list is powered by L-Soft's renowned LISTSERV(R) list management software together with L-Soft's LSMTP(TM) mailer for lightning fast mail delivery. For more information, go to: http://www.lsoft.com/LISTSERV-powered.html