OK, there are 2 main things I would be looking for: oral anatomy like tongue-tie or a bubble palate, OR insufficient milk syndrome. Reading your case notes (see below) and maybe *reading between the lines* a little, and I believe there is ample evidence for insufficient milk syndrome. To wit: I would wonder how lactogenesis II presented itself, how much milk she obtained through pumping, how much weight did the baby lose (gaining 660 grams in the first 2 weeks is ALOT, as it is approximately 22 oz, which indicates to me that baby had lost a great deal and this was catch up growth (or the weights were inaccurate, with clothes on perhaps), and then gaining 220 grams the next 2 weeks, this is only about 7 oz in 2 weeks. All the while the baby is being supplemented, so her milk supply never seemed to be enough. I would also want to know about the jaundice, were there risk factors for pathologic jaundice or was this really starvation jaundice. I agree with Cathy Genna about the harder suction trying to get milk out as a possible culprit. I would investigate in detail the history (is the baby premature?) and risk factors for IMS and I would recommend interventions accordingly. It seems she is now on the right track with galactagogues and pumping. I am not a fan of the Lactina, however, for these scenarios. This sounds like a mother who could use a supplementer device at the breast.

<<a one month old ... suffering since the first time she breastfed >>  <<baby was "really eating"  since she felt such a strong pull,  though it was obvious to me that he was getting very little milk.  He very quickly got frustrated from lack of flow.>>
<<pain is less when her breasts are fuller.  Her milk supply is obviously down. >>
<<  Oral anatomy and tongue movement seemed normal. >>  <<  breastfeed in hospital but ...supplemented as well. "he was just very hungry".  ...jaundiced and stayed in the hospital for a week under the lights, nursing and bottle-feeding.  Mother pumped as well. Mother began almost exclusive breastfeeding at home with the exception of one bottle a night. >> <<gained 660 grams in the first two weeks and 220 grams in the next 2 weeks. He does not come off of the breast alone and does not fall asleep on the breast. >> 

Laurie Wheeler, IBCLC, MN, RN
Mississippi, s.e. USA

_________________________________________________________________
Check the weather nationwide with MSN Search: Try it now!
http://search.msn.com/results.aspx?q=weather&FORM=WLMTAG
             ***********************************************

To temporarily stop your subscription: set lactnet nomail
To start it again: set lactnet mail (or digest)
To unsubscribe: unsubscribe lactnet
All commands go to [log in to unmask]

The LACTNET email list is powered by LISTSERV (R).
There is only one LISTSERV. To learn more, visit:
http://www.lsoft.com/LISTSERV-powered.html