Hi Kim
Yes, these mothers are at nutritional risk (as Cathy Genna points out) and 
should be seeing a nutritionist or RD. I also wonder about underlying 
metabolic issues such as PCOS. Perhaps that could be looked into (prolactin, 
testosterone levels, glucose testing) and treated if appropriate. I also 
believe that the experience of preterm birth can have an impact (possible 
c/s birth, mother baby separation, delayed initiation, stress). I am sure 
you are doing all the pumping stuff - what about a large size flange?
I am findiing more and more often that mothers feel more comfortable and get 
more milk with larger flanges, even when their nipples appear to be quite 
small.


Laurie Wheeler, IBCLC, MN, RN
Tupelo Mississippi, s.e. USA

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