Christine

It is so hard to get a client at 8 wks when so much has already happened on 
a downhill slope!
My handout on establishing a good milk supply says something like this at 
the very end, "contact your lactation consultant if there are any signs of 
low milk production or signs that the baby is not getting enough. Work with 
her right away!" But that's beside the point right now.

For your client, I would suggest a nursing supplementer. It sounds like the 
baby will go to breast if there is a good flow. Mom could latch him and use 
compression then turn on the supplementer as soon as his nutritive suck 
slows down. I know you said he figured out the tube, but perhaps you can use 
a different one. Moms seem to like the lact-aid or you could even use the 
home-made one with a 5 French feeding tube threaded into a bottle. Perhaps 
you could tape the tube underneath the breast coming up. I've heard several 
LCs say that works the best anyway.

I agree with the More Milk herbs, pumping extra, and evaluation/treatment of 
the infant (speech-language pathologists and occupational therapists for 
infants/peds can also be used). Mom could hand express after each 
breastfeeding, too, to get the breast fully drained. The mom can be checked 
for polycystic ovary syndrome type features, insulin resistance, 
testosterone levels; is she very anemic? What about adding metoclopramide or 
domperidone? How was her initial week of lactation? Did her milk come in 
full? Did her breasts go through changes during the pregnancy?

Laurie Wheeler, IBCLC, MN, RN
New Orleans Louisiana, s.e. USA

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