I mean that first, if there is a problem, whether minor or serious,
e.g., fussy baby, or baby at risk for hypoglycemia, the *first* thing
the HCP does, is fix the positioning, fix the latching on, and use
compression to help the baby get milk.  The HCP needs to know if the
baby is actually receiving milk and has to be able to impart this
information to the mother.  If the baby drinks well, there is usually no
need then to do anything further except reassure the mother.  However,
if the problem is not resolved with a good, experienced, effort, then it
may be necessary to intervene further.  This may require a supplement.
If the baby is less than 2 or 3 days old, sugar water is perfectly
adequate, especially if it is being used with a lactation aid at the
breast.  Of course, colostrum should be tried first as a supplement,
either alone, or mixed with sugar water.  If the baby is actually not
latching on, or if it is difficult to use the lactation aid, as it
sometimes is, though with increasing experience it becomes easier and
easier, then alternate methods, such as finger feeding or cup feeding
should be used.  Only if nothing else works should a bottle be used.  I
have not used one for months, and no more than once a year, and I see
1000+ new patients a year.  Only rarely do I feel it necessary to use
formula, and so rarely that I cannot remember the reasons.

Thus, before any supplement is considered, fix the breastfeeding.  Why
not formula?  Because it is risky (one drink has the potential to
sensitize the baby, or set off the set of reactions which eventually
lead to juvenile diabetes).  Is this madness you might ask?  Well, think
of how many mothers have been told to stop breastfeeding because they go
on penicillin, for example, because of the risk of sensitization to the
penicillin.  Why are we so indulgent towards formula, but so intolerant
of breastfeeding.  If we use formula as the first choice, the message to
the mother is 1. there really is no problem in using this, 2. there
really is not enough milk in the first few days.

All this is explained in the handout I think was in the package in
Stockton:  Either the article from JHL on dehydration and the "Immediate
Postpartum Breastfeeding Decision Tree", or the latter alone.

I hope this helps.

Jack Newman, MD, FRCPC