Dear Lactnetters,

        I am perfectly aware that some women feel they have less milk when,
in fact, everything is going well, that they may believe this because
their breasts are not as full as they used to be, that they don't
leak, that this is a growth spurt, etc.  I am perfectly aware that
babies are distractable at 4 months, but this is not what I was
describing.  I also was not describing the case of a baby who is being
bottle fed expressed milk and the mother finds she is pumping less.

        However, there are cases, and I observe they babies nursing, where it
is obvious by history that eveything was going well and now it is not.
The baby is at the breast, the baby is sucking, but *not* drinking,
the baby pulls away from the breast and sucks his hand, or cries,
wants to go back to the breast, but does not get milk when he does,
and then pulls of and cries.

        These cases exist.  I do not use domperidone just for the hell of it.
These mothers will start supplementing or wean altogether if something
is not done, and patience, and keep at it, it'll get better, in these
cases, does *not* work, at least from what I have seen.

Jack Newman, MD, FRCPC