Gloria, I have found it notoriously hard to get a baby this age to nurse
enough to get the milk supply up.  It tends to be a downward spiral--baby
only nurses long enough to get the fast-flowing milk, so milk supply goes
farther and farther downhill.  I wouldn't spend the money for an SNS even
if you had access to one because a 4-month old may not readily accept it.
You could get a feeding tube from a medical supply store fairly cheap and
poke it through the teat on a bottle (a la Dr. Jack) to see if baby will
accept the tube at breast.  This would be a good solution and she could
supplement *with formula if necessary* at the breast.

I would definitely agree with taking baby to bed--she might get a whole lot
more relaxed nursing during the night with baby not caring quite so much
about getting a good milk flow.  I would also probably jump right to the
Reglan if you could get a prescription, otherwise try the fenugreek +
blessed thistle (I believe 3 capsules each 3 times a day has been suggested
recently).  Pumping with a hospital-grade electric pump after feedings
would be worthwhile, especially if baby won't increase the nursing, which
he may not.

The main issue here, I think, is that while you are doing everything in
your power to get the milk supply up, the baby does need to be
supplemented.  It is *not* okay for a baby to gain nothing in two months at
this age.  Looking at the weight chart I have, this child was at about the
80th percentile at birth, the 25th at 2 months, and is now *way* below the
5th percentile at 4 months.  If she can get some expressed breastmilk,
fine, but I wouldn't count on it for a while at least.  If baby won't use a
tube at breast, maybe giving the supplement by cup and eliminating the
pacifier would keep him wanting to suck at the breast.  Even if he would
reject the breast in preference to the cup, if she could get her milk
supply to increase by pumping (+meds or herbs), he would go back to the
breast when he got adequate milk there.

I hope you will encourage her to follow her doctor's instructions in regard
to supplementing--just help her do it the best way.  It would be a shame to
further compromise this baby and subject him to medical testing when he
probably just needs more food.

Becky Krumwiede, RN, IBCLC, Appleton, Wisconsin
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