mom with low milk and fussy eater baby

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Mom has exclusively pumped for 9 m.o. boy, born 22 June 04 at 38 weeks, 5.6lbs. He has refused all attempts to latch since birth (Hospitalized briefly post birth, fed only EBM by artificial nipple...mom asked for #5 French feeding tube in order to finger feed as per my suggestion. Hospital staff gave her the feeding tube but refused to "let" her finger feed.)

Was 14.3lbs at about 7.5 months (about 6 weeks ago) which is most recent weight.

Mom has started solids; no known allergies or sensitivities of any kind with exception of lactose intolerance on her husband's side, no Sx in baby yet. He is a light eater and refuses more than two bites of any food. Always slow gainer at about the 5%.

Pattern of bottle feeds until about one week ago has been; one feed from 6 am to noon, several feeds in the afternoon and then every hour or two at night with 3-4oz per feed. Mom has been able to keep up her supply until about one week ago. Mom started power pumping (Purely Yours which has been the pump the entire time) and started Fenugreek Friday night, has had about eight doses so far with no improvement in milk output. She bought formula today because she was unable to pump enough for his night feeds last night. She REALLY doesn't want to use it. We talked about mixing EBM with ABM for tonight.

I will see her tomorrow with all her gadgets (nipple shield, SNS, sippy cup etc.) that have, thus far, not succeeded in getting him to latch.

I have not been in touch with her since he was d/c from the hospital at about one week of life until this past week. I have, so far, encouraged to her let him play with the nipple shield, the SNS, the sippy cup (not all at once!) and anything else "food" related during meal times and to put samples of food on the tray when he is in his highchair at the table with mom and dad vs playing on the floor during meals. We are being very careful not to force feed, especially because mom is feeling pressure to get him on more solids so that she does not have to use ABM and in case she can't get her supply back up.

Her goal is to pump for one year, if she could get him to nurse at the breast she would nurse longer. She has been attending LLL meetings and has a lot of good support.

I have suggested Reglan and Domperidone but she has not had a chance to get Rx for those yet. We also talked about blessed thistle. She has been drinking 3 cups of MM tea/day for about one week also. I am going to teach her hand expression tomorrow also.

I saw baby at LLL meeting last week and he looks GREAT! Very active and alert and happy. Mom stated she tried to put him to breast the next day and he CRIED and bit her when he did get breast in his mouth. When she called me and told me this I told her go back to STS, co-bathing, anything non-BFing related that puts her breast in the vicinity.

What else can we try? I have told her that adoptive moms have gotten older babies/children to latch and suckle; about how long are we looking at for a nine month old in that situation just to give us a ball park est.? I know this will be a LONG process, especially given his aversion to being at the breast. I don't think he will suckle at the breast w/o good supply so that is our primary focus right now.

Thanks in advance.

Christie Pillado

El Paso, TX