Jan writes; >> what I'd like to know is if there is any particular standard upon which LCs determine a baby w/ FTT needs to be supplemented.<< I don't know if there is any particular standard and I would worry if we relied on "one" because the variables can be so very different. Most often, I adjust the amount of supplement to allow for the very frequent feeding necessary to increase the mom's supply (we have ruled out all other factors, thus we know it is low) and to make it workable for Mom. Obviously, if we have a baby in crisis mode, the issue of increasing supply becomes second to immediately improving intake and visa versa. >>How do you work w/ a baby that is FTT that needs supplementation for a period of time?<< The management differs from case to case. I have one Mom that I am currently working with and have been for about a month (I posted to Lactnet about help with managing), whose baby was below birth wt. at 1mth, looking very malnourished, she with very low supply (probable lack of glandular tissue) and now continued issues with supply. She had been supplemeting with an SNS (totally at first then more and more bottles) until about a week ago when she stopped the SNS and consequently nursing entirely and is now pumping 5x/day and bottle feeding. We were able to up her supply somewhat with the normal measures including fenugreek and finally reglan (she wouldn't try domperidone) but I figure the baby was probably taking 1/2 and 1/2 at the peak of her supply. She is now pumping 10oz. of the 30 the baby takes each day. He has gained 7lbs. !! in the last month!! (which DOUBLES his weight from 1 month) and looks normal!! On first consult he was IN crisis mode but because he was very vigorous, thus willing to eat, and I felt that the feeding adequacy could be improved quite a bit (and because this Mom was very reluctant to suppmt!), we tried two days with improved fdng. effectiveness and very frequent feeds. His weight stayed the same and at that point I convinced her to suppmt. BUT the suppmt amount was adjusted to allow for very frequent feeding at the breast. In retrospect, I would have suppmtd earlier but in other instances I have seen babies "take off" with seemingly minor changes in positioning. Great discussion topic! Lynn Shea Rn,Bsn,Ibclc Franklin,Massachusetts- off to help out at my baby's (almost 7yo :( ) school and then play tennis in the cont'd 70 degree weather! *********************************************** The LACTNET mailing list is powered by L-Soft's renowned LISTSERV(R) list management software together with L-Soft's LSMTP(TM) mailer for lightning fast mail delivery. For more information, go to: http://www.lsoft.com/LISTSERV-powered.html