Heather,
  Thanks for your comments, but let me make myself clear, since I feel you got me all wrong.  I do not go supplementing on the first jump.  Im refering to failure to thrive and the sort.  I think when we are all talking it is understandable that we all follow the rule for supplementation...
  1.  Mother's own milk
  2.  Mother's expressed milk
  3.  Milk from a milk bank (not available where I live)
  4.  Formula
   
  I probably assumed that we all knew this and this is why I probably didnt explained myself well. In these cases where it is obvious that supplementation is neccesary, it is not wise to tell the mother "feed more often" and go home, or you'll definitely have a very sick baby.  The babies I was referring to are those who are obvious they are not doing well in all feedings; not the ones that probably didnt do well on one feeding, but when you see their chart, they are gaining at least 4 onces a week and the sort...
   
  Like I said in my prior post, I try to regulate the amount the baby is going to receive in supplement (following the choices mentioned above).  The total is mostly the difference between the intake (measured by the digital scale) and the amount of ounces the baby should be receiving--I use the tables provided by Gedes Production (they work for me).  In some cases, I follow up, up to three times a week.  As the baby's intake increases, the supplement decreases.  

I chose to supplement in every feeding, because I rather supplement with small amounts than do token bf and supplement feedings.  Remember, Im talking about posibly extreme cases where the baby has fallen into the "vicious cycle" of "Im feeding poorly"...therefore..."Im not taking enough calories...therefore..."Im weak"...therefore..."Im feeding poorly"...  A few "extra" calores in every feeding is like a push of energy for the baby.  By the second week most of this babies are no longer supplementing (about 99%).
   
  Like I explain to the many health professionals I teach, we cannot generalize about bf.  I explain it this way...not all sore nipples are due to poor positioning...there could be skin problems, new pregnancy, candidiasis, etc.    Likewise, the explanations you offered me unfortunatelly do not work in all nursing couples...they mostly work with well babies.  
   
  Any way, I do appreciate your concern and comments.
   
  Carmen Cabrer, IBCLC, RLC, LLLL
  [log in to unmask]
  www.lacted.com
  lacted.com/blog
  San Juan, Puerto Rico
   
   



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