I have a strange case, I'd like to bounce off my learned friends.
23 y/o g2 p2. Nursed her first baby for 10 months without any problems. No
noticable breast changes this pregnancy. States she never felt post-partum
fullness or engorgement with this baby but the baby *nursed all the time*
from day one. No post partum hemmorrhage or unusual labor findings.
By 2 mo. baby loosing weight--still nursing all the time, mom started
supplementing after feedings w/ soy ABM (baby vomits milk based) about 2
weeks ago. Baby up to 6 oz per feeding. Baby spaced out feedings to every 4
hours. Now has cronic nasal congestion and has been diagnosed with *asthma.*
Baby collapses standard bottle nipple but mom's nipple is round after
nursing.
Breasts are small (A-B cup), milk expresses in small drops.
Only history of cronic disease is according to her:  borderline anemia--mom
did not know values.
Baby looks OK at breast, suck swallow ratio about 3 to 1. No decernable
let-down. (mom remembers stinging *like crazy* with last baby.)
One last confounder--this mom has never used birth control, married 5 years.
She has not had a period since age 17.
Here's what I did:
Started brewer's yearst and fenugreek tablets.
Put baby on scheduled feedings every 2-3 hours
Switched ABM to Nutramigen
Started her reducing the amount of supplement by 1/2 ounce per feeding per
day (I call this technique reverse weaning) She declined a supplementer.
Ordered the following lab tests:
Prolactin
Thyroid panel
Hgb and Hct

Did I miss anything?  Any ideas?
Marie Davis RN, CLC
Moreno Valley, CA