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. *********************************************** 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(R) mailer for lightning fast mail delivery. For more information, go to: http://www.lsoft.com/LISTSERV-powered.html