Sometimes it is very hard to get to the bottom of things especially with a baby who is older and 
when the situation is atypical.  This is especially hard in support groups and I always wonder 
about the "missed" opportunities because you can't talk in depth.

I had one of those reminders slap me in the face recently because I had a beautiful older baby 
attend support group.  Mom originally had a copious milk supply and was one of those "on cue" 
feeders and slept with her baby at night.  She had worked hard to overcome latch on problems 
initially and finally used a nipple shield.  If you looked at this baby you would be absolutely certain 
all was perfectly fine.  YET, this intuitive mom was worried about supply.  She was worried about 
supply because her baby had shifted from feeding beautifully to feeding once an hour and being 
very fussy.   She also had bleeding nipples and soreness that she attributed to teething, but no 
open lesions.  So, I sent her to the breastfeeding medicine specialist just because I was nervous 
about the bleeding.  Its the kind of situation where one could easily try to reassure her all is well.  
The baby's intake was low at support group ~ 1.5 oz the week before when my colleague was 
doing the group.  But I've seen plenty of distracted older babies just plain not eat at support group 
because its just too exciting.  And the baby is one of those pink rolly polly active babies that look 
great.  The next week the baby took about the same after feeding pretty much the whole 2 hours 
and again took 1.5 oz.  Again, I've seen some older babies do this during growth spurts or 
developmental leaps and again it could be the time of day, teething - so many factors.  So, I said, 
let's keep a close eye on this - something does seem to be off in terms of behavior, but she's still 
looking great.  Only after much discussion did the potential problem emerge as an "Oh, I forgot to 
tell you..."  - her thyroid hormone levels were way off which was only picked up by the 
breastfeeding medicine specialist testing her levels.  

I've had other situations where mom thinks there isn't enough milk and everything really looks 
great and only after lots and lots of discussion and trying to explore every angle and watching the 
baby for several weeks does something pop out that explains what is going on.  Usually one of 
those "Oh I forgot to tell you that...." and it will be some critical piece of information that explains 
why mom's supply has slipped.  It invariably is the one item that I forgot to ask about thinking I 
had covered the whole range of possibilities.

Thankfully, most of the time when moms of older babies worry about their supply it isn't a 
problem and really all that is needed is reassurance, but I always remind myself to keep an eye on 
things when mom has this perception because sometimes mom is right.

Best, Susan

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