Helen writes:
"Has started SNS with this baby. Do you feel that the weight loss is related
to her vegetarian diet?  She is a thin woman of 40.  What about supplemental
fats i.e. omega fats?  Any thoughts if this would increase the calories in
the milk?  She is pumping.  I suggested giving the baby more hindmilk."

I am really surprised at this question. Why would you suspect a vegetarian diet as the cause of deficiency? This question reflects a bias about nutrition that has been defined by the marketing interests of the meat and dairy boards, not science.

I saw no comments in your post about assessment of the infant at the breast, about latch and feeding patterns (ie is baby fed on cues, fed on a schedule, co-sleeping, etc). Has mom experienced breast changes during her pregnancies? Why did she supplement the last baby? What factors in the birth may have influenced the baby's feeding behaviour? You say the mom is pumping--is her supply actually low or is the baby just ineffective at milk removal?

Most Americans are deficient in EFA's--being vegetarian is far from the cause. The cause is the Standard American Diet (SAD), which involves over-consumption of trans-fats, high consumption of junk food, too much protein and unhealthy saturated fats (such as in meat and cow milk), extreme sugar intake, over-reliance on grains and almost no fruits, veggies or omega' 3's. If this woman were an omnivore, would you consider her diet to be a problem? If not, you should, since the diet of the avg American is pathetic. A vegetarian or an omnivore may have a poor diet--and in the US, both are likely to, but being veg or omni would not be an inherent cause for concern. I worry much more about vegetarians who consume cow milk--cow milk is so nutrient-poor and so allergenic that it is often the cause of poor health in mothers, and of food allergies in babies.

IMO, there is almost no one who would not benefit from EFA's in the diet and it can only be helpful--to mom and baby.  But, first there is so much in the scenario you describe related to latch and management that needs assessment, followed if needed by a consideration of possible allergens.
Jennifer Tow, IBCLC, CT, USA

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