I have stayed away from practice questions for a while, but thought I
would jump in on this one.

I think the important thing is to observe the breastfeeding and teach
the mother how to know the baby is getting milk.  (Open--pause--close
type of sucking).  When the baby is doing that, the baby is getting
milk, and no supplement should be given.  When the baby no longer does
that type of sucking on his own, the mother should use breast
compression to continue the flow of milk.  When that no longer works,
the mother should switch sides and repeat the process.  Then open up
the supplemental nursing system.  In that way, if things get better,
the mother will start the supplementer later and later.  The baby will
know how much he needs.  Cutting down, or stopping cold turkey, rarely
works well, in my opinion, and the latter is often dangerous.

Jack Newman, MD, FRCPC