PTP.

I first saw Mom and Baby three weeks ago. Baby was 4months and 11days old. He had gained just a little more than 2 lbs from birth-weight. He was content and meeting milestones. Mom was feeding him 5-6 times a day and he was sleeping through the night. He had a very poor suck, restrictive lingual and labial frenulums. He had cranial, trunk and hip asymmetry and intermittent strabismus.

Mom had just been told by a gastroenterologist to supplement with 24 ounces of formula daily and if baby didn't begin to gain more quickly, he would be hospitalized.

We started with appointments for TT and LT revision, CST and very frequent feeds (12 a day) with side switching and breast compressions.  The more frequent feeding upped his gain to 1/3 an ouce a day within 3 days. He has CST two days after our visit  day and laser revisions of tongue and lip 4 days after our visit. On day 6 he figured out how to use the supplementer and Mom began supplementing with some milk she had stored. SHe started out with 8 ounces a day and gradually reduced the amount over the next week due to his taking less from the supplementer. When she was down to just 4 ounces of supplement, she ran out of extra milk. While she was supplementing, Baby was gaining over an ounce a day but when she ran out, he only gained an ounce a day for the next two days and is now back to 2 ounces gain in 6 days.

He is still content and is gaining normally for his age but he hasn't caught up enough to be even back on the WHO growth chart. Mom is willing to consider supplementing but isn't very comfortable with donor milk or formula. Baby is now just 5 months old. This mom has worked so very hard and done everything she can to keep him on only her milk. She is also taking some herbal galactagogues that she just started a week ago.

My question is are the risks of formula greater than the risks of not catching up on the weight gain when the baby is developing normally in every other way, meeting milestones and content? My gut feeling is that supplementation would be best until he is back on the charts but I don't know if this is correct. Maybe starting solids early would be best?

Laura Spitzfaden, LLLL, IBCLC, APL 

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