I have posted numerous times about my friend and client who has exclusively
pumped for her neurologically impaired baby for the last 15 mos.  You all
may remember that last I posted, he was still growing poorly and mom had
been chastised by the developmental pediatrician for continuing to pump for
him.  Mom was very distraught by this visit and not interested in ceasing to
provide breastmilk for this infant until at least the winter was over.

First, some good news.  While we waited for a consult with a
gastroenterologist, we started him on a proton pump inhibitor empirically
for his vomiting.  We also more rigorously tried to ensure that he got at
least 20 oz of breastmilk a day into him (probably not enough total
calories, but more than he had previously managed.)  He fed some of these
feeds by mouth with a bottle, and had one top up feed overnight through his
G-tube.  In addition, mom added extra fat to his solid foods in the form of
coconut oil.  
In 7 weeks, he gained 2 whole pounds!  (He only weighed 13 lbs to start
with, so this was a huge gain for him.)  His skin also looks beautiful, and
he has taken on a more healthly chubby baby appearance.  
When they finally had the consult with the gastro, mom was very pleased with
him.  He was thrilled that the babe is receiving breastmilk, and feels her
current plan lacks only about 100 calories a day of optimal nutrition.  He
recommended continuing exactly the same as now, except that he plans to mail
her some recipes for nutrient-dense solid foods she can use with him, and
even some that could be put through the g-tube for days when he won't eat
well.  He stated that he felt switching to a commercial artificial infant
milk would add no calories and detract from the immunologic factors baby is
getting.  He also felt going to a higher calorie commercial product such as
Pediasure was not worth it, as the extra calories/oz would in no way make up
for the loss of breastmilk.
The mom was pleased with his support, and his creative ideas for getting a
few more calories into the baby.  She also told me it was nice to have my
opinions to her validated (especially after the developmental pediatrician
suggested I was not a good physician for her baby!)

So, here's the question.  This mom has taken domperidone since the very
early months to help her supply with good success.  She has tried numerous
times to stop it altogether, with a resulting dip in supply.  She originally
tried metoclopramide , and had some success with it, but thought it worsened
some depression she was having.  The problem is that she can no longer
afford the domperidone.  She can get metoclopramide for free with her
medical insurance and wonders if it might work as well as the dom for
maintenance of supply.  Also, we are wondering if the risk of depression is
seen as much outside of the early post-partum period.  (Mom otherwise feels
the depression is completely resolved now.)  Any ideas on reglan/dom would
be helpful.

Thanks as always!

Jennifer Tieman
Family Physician
Mom to 4, including my nursling Caroline Rose, age 32 mos.

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