Dear all:

I have mom's permission to post.  Baby is 4 months old.  Has gained 1 oz in
the last month.  Previously had been gaining well.  Mom reported that baby
slept through the night at an early age.  Menstruation resumed at three
months and baby started waking up at night again.  She reports that he
tugged at the breast and seemed unhappy and dissatisfied much of the day.
In the last several days she had noted that she was unable to pump, but the
night prior to the consultation was able to pump 3 oz. again.  Her 2nd
period had stopped 3 days ago.

The baby fed for 1/2 hour prior to my arrival from the right breast and
took another 1.8 ounces from the left breast.  He was still hungry,
scratching and pulling at the breast and scratching himself.  He was alert,
physically active (reaching and grabbing and playfully kicking), responsive
to verbal communication, and laughed easily.  Mother reports that he had
eczema for the last month that had cleared.  He absolutely refused formula
from all feeding devices (cup, bottle, tube at the breast, and tube on the
finger).  Mother reports that he will ocaissionaly take some breast milk
from a bottle.  The pediatrician has recommended cereal.  He will only take
cereal mixed with water or with breast milk, not when it is mixed with
formula.

My sense from the mother's history and the way this baby feeds at the
breast is that the mother was initially an overproducer and the sleeping
through the night caused the prolactin levels to drop so that now her
supply is low.  She is being seen by a breastfeeding medicine specialist
who prescribed domperidone and a pumping regime.

My concern is that this mother must feed him constantly at the breast to
keep him satisfied and may not have the time to pump.  I'm also concerned
that the cereal recommended by the pediatrician is too low in caloric and
nutrient density to really make a difference in the weight gain.  Also, the
eczema and formula refusal indicate that food allergies should be explored.

My dilemma is that since there is clearly NOT enough breast milk at this
point in time to satisfy his needs and he would rather starve than consume
formula, what should we feed to this four month old? I'm going to start
with the milk banks, but I'm starting to think about those developing
country recipes we had for enhancing the caloric content of cereals out of
total desparation.  This approach does NOT make me happy.  In the long run,
I'm fairly certain the domperidone will work, but what to do in the short
run?

Any RDs out there with some good suggestions?

Best regards, Susan Burger, MHS, PhD, IBCLC

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