Kind of a long subject, but saw a nursing couple today with several issues.
 Baby is 6 1/2 mos old.  She and mom have had a number of issues to date --
tongue-tie (fixed,) thrush and yeast (treated by my partner while I was out
of office with nystatin, resulting in allergic reaction for both of them),
milk protein allergy (resolved with elimination diet.)  Mom returned to work
at 7 weeks and has been exclusively breastfeeding and pumping at work.  Mom
initially had a huge supply.  Daycare apparently not very used to breastfed
babies, and suspected of using bottle instead of other comfort, resulting in
baby taking 21 oz a day expressed milk at daycare since age 3 mos.  Mom just
recently started adding solids (cereal with breast milk) and tried carrots
briefly, but baby became very constipated, so she backed off again.  Mom is
now having a very hard time keeping up with pumping, but due to baby
reacting strongly to dairy, she really does not want to add formula at all.
 After baby's reaction to starting solids, she is at a loss for what to
offer next.  I have seen several times someone here list foods that rarely
cause allergies (something like turkey, squash etc.)  I wonder if I could
recommend those foods to her as first ones to introduce to baby?  Also, mom
and I reviewed her current daily schedule, and I think she's not getting
quite enough breast stimulation through pump or baby to maintain a full
supply, so have advised her to use an upcoming 3 day weekend as a "baby
moon" to increase supply if possible.  Also, this baby has been sleeping
through the night for some time, so I suggested she consider adding a night
feeding to help with supply also.  Baby has also developed an extreme side
preference as well, so her right side is producing less and less.  She has
already tried most of the tricks I know for increasing supply on one side,
baby is pretty good at resisting them!
What else can I suggest to this mother?  She has been amazingly dedicated
with the pumping and is feeling very discouraged about being able to keep up
for baby's needs.  I think increasing her supply will help a great deal, but
also think having a few food ideas to offer baby would make her feel better
also.  With all the early difficulty this baby has had, we could write a
case study on lactation problems I think!
Jennifer Tieman
Family Physician
Mom to 3, and new baby #4 expected 5/31/03

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