Wondering what recommendations others give regarding ABM when you have a mother
who simply is unable to produce enough breastmilk and appears to need to
supplement long-term.

At my institution we currently use a hydrolysate formula for any breastfed
babies who have a medical need for supplementation.  Since the cost of
hydrolysate ABM is high, we supply any ABM needed after discharge while we are
working on increasing mom's supply (the only advantage I can see to the free ABM
we're given).  If she decides to wean completely or it appears that
supplementation will be needed long-term and there is no family history of
allergies we leave the choice of ABM up to her (and her MD) but recommend a
dairy-based formula.  I'm wondering what might be the best course of action if
there is a family history of allergies.

How do the hydrolysate formulas compare nutritionally to the regular stuff
that's out there?  If they have no drawbacks nutritionally, might it make sense
to continue to use it for supplementation if the parents are willing?  Right now
I have a mother about 2 weeks postpartum who is producing about 1/3 to 1/2 of
the milk needed by her baby and has seen no increase despite being into her
fifth day of metoclopramide (Reglan).  We've been on top of this from the start
(the shape of her breasts raised a red flag) so I'm fairly certain this is
pretty much it.  She does have a history of allergy, primarily hay fever-type
stuff, medications, and reactions to cosmetics and lotions.  She is willing to
pay the high price of the ABM if it's worthwhile and also wondered if the bad
taste of the stuff might not be helpful in keeping her baby willing to keep
breastfeeding despite the low supply (good thought!).

If someone with more background in these areas would offer an opinion, I'd be
grateful.  Thanks!

Becky Krumwiede, RN, IBCLC
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