I have permission to post. A mother in the US has contacted me about her son's upcoming cleft palate surgery. He is fed almost exclusively expressed breast milk, occasionally formula when the mother can't pump enough.
The mother has contacted two surgeons about her sons palate surgery and they both reccomend she fortify her BM "since he's a bit underweight and will need more body weight in order to recover faster after surgery".

He was born at 2.5kg (5lb8oz) and is now almost 3.5 months and weighs 3.9kg (8lb8oz)

I have checked the WHO charts and he was born on the 3rd percentile. According to the chart, at 3.5 months a baby on the third percentile should weigh 5.4kg (11lb14oz).

The baby has Pierre Robin Sequence along with the cleft palate, but, apart from some initial breathing difficulties which were resolved with a lip/tongue tie, I don't think he has any other problems. He does appear to be very small for his age. Does anyone have any references or experience regarding weight gain for surgery? Is there any evidence that a higher weight improves healing or recovery?

The mother asks if there is anything she could supplement with other than formula - such as an oil? 

She says that when she offers formula, he prefers to wait for her milk. She doesn't want to mix formula with her milk in case he refuses it (she is very worn out from pumping). She also mentioned human milk fortifier (used for preemies), but wonders whether that is suitable for older babies? She says that it is very expensive.

I know about fortifying milk by double pumping and collecting the fore and hind milks seperately and using extra hindmilk, but this mother is not pumping enough to have any extra to do that. I don't think it is an option.

I have searched the archives but have found mostly posts on fortifying milk for preemies. One post from 2002 mentioned nutritional supplements for the mother to increase fat content of her milk such as barley grass, wheat grass, alfalfa, etc for the high chlorophyll content, a product called Kyogreen (based on dehydrated greens) and Brewers yeast. I have not heard of nutritional supplements for increasing fat content in human milk before - does anyone have experience with this?

Alice Farrow
Rome, Italy
www.cleftlipandpalatebreastfeeding.com
www.languageofinclusion.com

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