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I have been working with a mom for the last month whose, then 5 month, now 6 month old baby has had slow growth.  His weight at birth was near the 85th percentile and had fallen to the 7th by 5 months (WHO chart).  He was gaining at the low end of normal for most of the time but dipped to 4 ounces a week for a few weeks.  Then mom had a death in the family and a funeral and he stopped gaining at all for a few weeks.

He is very social, active and alert, he was crawling on elbows and knees at 5 months.  He will only nurse for a few minutes; if the milk isn't flowing, he will not work for it, he'd rather be playing.  He also refused more than 2-3 ounces, at the most, when he bottle-fed at daycare.  I also assessed that he had a very tight posterior tongue-tie and a lip-tie that mom chose to have revised by an expert in the field.  She did all the exercises afterward and baby has had two sessions of CST afterward.

After the revision, and first CST baby gained 5-7 ounces a week for a couple of weeks and I did a before and after weight that indicated a 5 ounce transfer at one feed.  Previous to this, he took 2-3 ounces at some weighed feeds.  A couple of weeks later, mom felt like her supply had dropped again and took baby in for a weight check and he had lost 2 ounces in two weeks.  I wasn't too concerned because I thought that the scales could have been off and the 5-7 ounces a week for two weeks was really high for a 5 month old.  However, mom also was unable to pump much during this time (baby goes to daycare for a couple of days a week) and really felt like her baby wasn't getting much milk from the breast.

We discussed the possibility of cycling contributing to the fluctuation in milk (she had just re-started her period the month before) so she began taking Cal/Mag supplements and also took baby for his second CST at this time.  The next day she was able to pump again and it seemed as if things were better but a few days later she reports that baby did not have many wet diapers (we've had some hot weather) and she is very worried.

I've watched this baby nurse.  He is very distractible and will frequently stop nursing after a few sucks.  Mom frequently has to go to a quiet dark place to nurse him.  She has tried getting him sleepy to nurse and has tried RPS to get a letdown to happen more quickly so he doesn't have to wait.  Her baby just won't stay at the breast for long.  She has also introduced solids (baby is 6-1/2 months) he has tried avocado and loves it.  Mom is concerned that her supply will drop further with his eating solids.  She is also scheduling another CST since his best weight gain has coincided with this bodywork.

Does anyone have any clues as to what can make a milk supply fluctuate so dramatically?  Our next step is that mom is going to have some bloodwork done to check for thyroid issues or adrenal problems.  Anything else we should look at?

Laura Spitzfaden, LLLL, IBCLC

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