Janna Zempsky and all, Janna asks about how to help a mom with 2 week old who is getting supplemental formula and transfering .5 to 1oz of milk (per test weights) with each breasffeeding. I rent the scales and find it to be a mixed blessing. When a mom is measuring the breastfeedings she will supplement to compensate for what is not received at the breast. As long as she continues to do this there is no demand placed on the breasts to make more unless of course she is pumping but as we have all seen, many moms don't respond as well to pumps at they do the baby, especailly with regard to increasing low supply. Moms seem to have a very difficult time with this concept when they have the scale and understandably are reluctant to reduce the supplements because they view it as withholding food from their hungry baby since they can see the baby will not get enough from the breast. Certainly she should be pumping and making as much of the supplement breast milk as possible but frequently only small amounts of the supplement is breast milk due to the mom's unresponsiveness to the pump.........sigh.......... a big catch 22. What I have had some success with is to suggest to the mom that instead of doing pre and post feeding weights she should only weigh the baby in the nude once a day in the AM and gradually and systematically reduce the formula. I ask her to start slowly to reassure the mom and protect the baby. If the baby is getting for example, 8oz each 24 hours, I tell her only give 7oz formula for a few days, watch the weight and output and call my voice mail each day with her 24 hour totals of breastfeedings, output, and daily am weight and any other improtant info so I can monitor. Mom leaves the message on my voice mail and indicates whether I should call her back or not. I record the information on a flow sheet on her chart. I also reassure her that if any of the numbers sound concerning I will call her anyway. If the baby gains appropriately at the reduced supplement amount we bump it down again by one ounce of the daily total for the next few days, and so on until the mom is totally breastfeeding OR until I can actually see mom's supply is not likely to respond appropriately and then of course we look at other options. If all is going well the supplements amounts can often be taken down more rapidly depending on mom's comfort level as the supplement amounts get smaller. I find this very slow, very monitored process works to calm the fears of most moms with regard to reducing formula supplement. Of course some of the moms are giving some formula and some expressed breast milk. I have them reduce the formula first and when the baby is getting only breast milk supplement we decrease the supplements much more quickly and mom is usually very reassured to see her baby is gaining on her milk alone. If we try this and the supply does not respond we have not placed the baby at risk (usually mom's biggest concern) because we only reduce the formula as long as appropriate gains are achieved. If the supply is not coming up with this added demand, the baby usually doesn't lose because the drops in supplement are so small, the baby usually just fails to maintain the appropriate gain so we discontinue the reduction of the supplement past that point or we hold at that spot a few more days or even increase and try to reduce again but maybe only in 1/2 ounce increments of the daily total. I usually find that a drop of 1oz of the daily total per every 2 to 3 days is a good starting point for most. I am sure many of you have done this or something very similar, but just wanted to share the specifics of how I monitor it. I have found this to be a great use of my voice mail system that will take up to a five minute message. It allows me to monitor many patients each day easily, without time consuming phone calls when they aren't needed. Most of the moms have liked this system because they can also leave the messages quickly at their own convience ( my voice mail is only voice mail and is available 24/7) and felt comforted by the knowledge that I am looking at their chart daily as they call in the weights, etc. As the process proceeds I often "wean" mom from daily phone messages and we drop to every other day, every few days, weekly and so on. Hope this helps in your situation. Kathy Kuhn Private Practice LC ParentsPlace.com LC mom of 4 sons Eastern PA (snowing like crazy here today 6-8" and much more expected) *********************************************** 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