In a message dated 5.8.03 10:31:31 PM, Mellanie writes: > working with a mom whose baby is slow to gain > mom is nursing baby every 2hrs, pumping with a double pump, = giving baby pumped milk and following up with formula. The total amount = baby gets via bottle (mom does not want alternative to bottle) is 2oz = (usually 3/4oz ebm followed by 1.25oz formula). I showed the mom a proper latch and how = to tell if baby is swallowing. Hi Mellanie, A few important ideas come to mind here. I think your positioning suggestions are great. You don't mention but did you speak to Mom about compression? The use of this is vitally important at this point and should, perhaps dramatically, increase the amount taken at breast. She should concentrate its use towards the end of each position at each breast. If doing effectively, she should notice baby start to swallow much more frequently (as typically the swallowing frequency has slowed down dramatically at this point). When she notes that the swallowing again has diminished DESPITE compression, she should remove baby, invigorate him if necessary and change breasts. She should repeat this to allow for 4 different feeding positions, 2 on each breast (eg/ f-ball and xcradle) per feeding (changing breast between each position). This will allow for the most complete emptying of each breast and make the time spent as efficient as possible, a vital factor in managing the fatigue inherent to this frequency of feeds. The fact that this Mom is able to pump 3/4oz after each feed every 2 hours and the fact that this baby takes an additional 2 oz, THEN is willing to feed again in 2 hrs., suggests strongly to me that this baby is NOT feeding anywhere near as effectively as is necessary to dramatically increase the production!! I also think that every 2 hrs, particularly if this frequency is maintained throughout the night, may be a little TOO frequent. Assuming that the above routine takes 45 min (this would be very efficient!), I might suggest 2.5 hr intervals. I also would not maintain this frequeny at night and would give more supplement, if needed, to allow for more sleep. I say "if needed" because these changes should give more milk. Over the next few days, as she notices her supply increasing, I would try to cut out the supplement during the day but continue the pumping to offer the accumulated amts at night. A few more days and she may be ready to give up the nighttime as well. Feel free to give her a copy of this and if you are unsure of any of my (less than perfectly explained!) instructions, she should see an LC. As for the supposed negative comments by the NP, these need to be addressed. Lynn Shea Rn,Bsn,Ibclc Franklin,Massachusetts *********************************************** To temporarily stop your subscription: set lactnet nomail To start it again: set lactnet mail (or digest) To unsubscribe: unsubscribe lactnet All commands go to [log in to unmask] 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