PTP. I am working with a mom of a 3.5 month old. This is her second child. She had difficulty with her milk supply with her first so she sought me out as a LLL Leader when her newest baby was 2 weeks old and not gaining well without supplementation.

She has reactive hypoglycemia, so I shared information with her about insulin resistance and myo-inositol. This seemed to help significantly with supply but she was pumping and using a SNS to feed because her baby was not transferring well without the help of the SNS.

She decided to see me as an IBCLC when her baby was 6 weeks old. Baby had some cranial molding and a tendency to turn to one side. She had a choppy suck and did not much engage her temporalis muscle while feeding. She also had restrictive lingual and maxillary labial frenums. She did not transfer well at the breast though Mom had available milk. She only transferred well with the SNS.

Mom followed through with multiple visits for CST and a frenectomy of both restrictive frenums. I have had excellent experiences with both providers. The CST provider thinks that Baby is dependent on SNS and is not used to working for the milk. I feel like there is more to it.

A follow-up visit showed improved tongue mobility and good sucking on a finger but I could feel a lot of pressure on my finger from Baby's upper gums. Transfer was not any better. 

Mom is still pumping 9x a day and feeding 9x a day with the supplementer at 3.5 months. Mom reports that when she tries to challenge Baby with slower milk flow from SNS, it results in poor transfer for the rest of the day. Mom weighs before and after feeds with a scale sensitive to 10 grams which is not ideal for accurate transfer amounts but gives a pretty good picture and the amounts transferred correlate well with weight gain.

Mom has tried goat’s rue, iron, b12, magnesium, and moringa but did not have success with these increasing supply. She has only had success with the myo-inositol. She recently increased the amount she takes and it has given her a boost in supply. She produces a total of 21-24 ounces a day and supplements with 1 or 2 ounces of formula every few days to maintain weight gain.

Does anyone have any suggestions for continued help for this dyad?

Laura Spitzfaden, LLLL, IBCLC

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