Wendy Brodribb writes:

"The mother really wants to continue to breastfeed this baby as she feels her
supply is not the problem, and changing to formula in the past has not
helped her babies. "

Just two things came to mind.  She might benefit from a one of the
specialized scales designed to measure breast milk intake during
breastfeedings through pre and post breastfeeding weights.  That way it could
be determined the exact volume of milk the baby is getting.  If the volume is
low, measures could be taken to improve that such as using a supplementer at
the breast.  The scale would continue to provide accurate and valuable
information about the baby's actual intake.  If the volume of milk taken from
the breast is appropriate then the baby needs to be checked further for
problems of metabolism and supplementation might be fruitless as it was with
her siblings.

Also, might this baby benefit from mom pumping off some of the fore milk so
the baby has the higher fat hind milk for feedings.  Idealy it would be great
to have her do a creamatocrit as described and used by Paula Meier in her
NICU (sorry I don't have the reference right now, rushing out to see
patients) to determine the exact fat content of mom's milk and at what point
into the pumping the fat content reaches the desired level to increase the
caloric content to an appropriate level for this baby.

Kathy Kuhn
RN, BSN, IBCLC
ParentsPlace.com LC
private practice LC
Eastern PA USA

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