Hypoplasia is rare, but those of us who are helping moms with 
breastfeeding problems are more likely to see it than health care 
professionals who see the general population.

There definitely seems to be a "problem du jour phenomenon" in this 
profession. You'll see 3 tongue ties in a day, then 2 or 3 cases of 
toddler moms with mastitis, etc. I saw 2 cases of hypoplasia in one day 
last week, after having not seen any for months.

The good news is that when hypoplasia is mild, moms can often increase 
milk production with frequent stimulation over the first 6 weeks 
postpartum. (Petok and Huggins did a study, published in Clinical Issues 
in Human Lacatation, 2000 I think). Sometimes goat's rue or domperidone 
help (Lisa Marasco will chime in here). There's one case report of 
progesterone given for a luteal phase defect causing breast growth and 
improved lactational performance for the second baby in a mom with 
hypoplasia.

If hypoplasia is very mild, I might not mention it on the first visit, 
but will encourage mom to track babies stools carefully, and will follow 
up closely. If it is obvious, I will explain gently and offer a LactAid 
or SNS to ensure baby gets sufficient milk, and a referral to a local 
breastfeeding med doc (we have 2 wonderful ones) for further assistance.

And of course, one of the standards of IBCLC practice is to communicate 
with the dyad's health care providers. LLLL's can educate the mother to 
advocate for herself.

Diana West and Lisa Marasco are the folks who have been working hard on 
maternal causes of low milk supply, and Marianne Nieffert, MD (might 
have misspelled that) has been interested in this issue for a long time.

Catherine Watson Genna IBCLC  NYC

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