Hi Moe,

Let's back track a minute. The weights you gave were: 16 April was 3.01kg (3010g), on 5th May was 2.65kg (2650 g), weight on 9th May was 2.95kg (2950 g).

The initial wt loss was 12%. But this is a gain of 300 grams, not 30 g, and shows average wt gain of 75 g per day over those 4 days.



Expected wt gain would be around 20-30 g per day. If in fact this was gained on bf plus ebm, that is a stellar wt gain, and probably indicates 'catch up' gain which I see very often in the first day or two when a poorly feeding baby is generously supplemented. It would not appear that this baby has any metabolic problems.



So if this is the case (you can see the importance of very accurate weights) all the formula was unnecessary. However, at this point, if formula has been used regularly and mother has stopped or decreased her expressing, then her supply could have fallen. Or perhaps baby is now feeding well, and mom does not have a large amount of reserve to express. So my recommendation is to go back to the history and the numbers, go back to the evaluation of the breastfeeding effectiveness, what is the milk supply right now, etc.



Hopefully the formula can be discontinued, but I do question the 30 cal extra per feed and (are you saying?) another formula which will provide 60 cals extra per feed? There may be a formula providing 30 cals per OUNCE, but that would be just 10 cals more per oz than (what formula makers consider the calorie count of ebm to be) 20 cal/oz breastmilk, which we know varies and can be itself 30 cals/oz. The take home point to me is that some of these healthcare providers seem less informed than they could be, or possibly there is some miscommunication about these numbers.???



Laurie Wheeler RN MN IBCLC, Mississippi USA









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