Moshe Shulman asked for input on a 2 mos old who was previously gaining at
breast and now isn't.  I have great concerns that mother and baby were not
observed breastfeeding, especially in such a serious situation.  The
acceptance of breastfeeding problems not being physically assessed is
maddening and would make a good Lactnet discusssion (if it hasn't been
before).  How is it you scream on E-mail? I am very curious what state this
mother's milk supply was in at the time of the visit with the nurse
practitioner.

Over the years clinically, I saw many mothers who at 6 wks - 2 mos.,
suddenly had no milk.  Everything was great until then just like this
mother.  The only common thread was regular pacifier use.  After observing
this a good number of times, I finally felt confident to say the pacifier is
interfering with the sucking cycle of the baby.  The inital milk supply is
supported by a hormonal thrust but once that wanes at about 6 wks, the
autocrine (Peter Hartmann) system takes over.

I felt greatly supported when I read the the work of Victoria, CG et al. Use
of pacifiers and breastfeeding duration Lancet 1993;341:404-6.  I believe
they published a later article on the subject.  I have taken to hand this
article out!  A classic article is from Jack Newman in JHL 6(2), 1990 -
Breastfeeding Problems Associated with the Early Introduction of Bottles and
Racifiers.

Without a thorough assessment it is difficult to know if the pacifier is the
sole issue.  I would certainly start there and work on the mother's milk supply.
Hope this helps.

Joanne Burke Snyder MA, IBCLC
Latch-On Services, a Private Practice in Indianola, Iowa