Devorah,
As this is a grand multiparous mother, I am interested in your post. A while
back I shared some info about a client of mine with a similar presentation.
She was a proven producer, successfully nursed 5 of seven children, but had
lactation insufficiency with last two no matter what we did to assist.
Consult the archives for the thread, as there were speculations about what
might have been going on -- tho nothing conclusive.  Pumping nor
re-positioning, nor reglan improved my client's situation.  Perhaps there is
a physical kind of depletion which affects some grand multips' lactational
capacity.

Another possibility is there is some physical problem with baby which hasn't
become apparant yet because the milk is offering some protection.  Often
these are maturity related issues, tho sometimes it is an underlying organic
problem like cystic fibrosis or a heart defect.  I personally doubt its
related to yeast. If baby has profound allergies -- esp. environmental --
adding solids too early will really increase the body burden.  Sound like
the choice of a formula like Alimentum was reasonable.  It produced some
growth.  I agree with you that some post-feed pumping and supplementing with
hind milk would have been reasonable seeing that baby was weak and the
access to the higher calorie milk was probably suffering (along with breast
stim.)

Remember to appreciate that the pedi nurse practicioner is your colleague,
and someone whom mother needs and wants to trust.  Share insights to mom and
to others on the care team, but be sure to share friendly.  (In Texas, our
roadsigns say DRIVE FRIENDLY.  While we don't always, its a good thought!)
Barbara
Barbara

Barbara Wilson-Clay, BS, IBCLC
Private Practice, Austin, Texas
Owner, Lactnews On-Line Conference Page
http://moontower.com/bwc/lactnews.html