I have seen a number of moms who come in because their baby "isn't
gaining enough" and the doc has ordered a supplement.  When I assess
it as a management problem rather than obvious problems in ability
to produce enough, I will call the doc, tell him/her what I have
observed and indicate that I feel we can improve the gain with some
improvement in the breastfeeding.  I will ask if mom can hold off on
the supplementing for 24-48 hours, try the suggestions to increase
milk transfer, reweigh and then decide about supplementing.  Most
are open to this as baby isn't usually showing any signs of trouble
other that the weight gain not being "satisfactory".  Another day or
two isn't going to be a big deal.  If the baby doesn't turn the
weight around in that time, then we talk about how to supplement to
have the least impact on the nursing success.  This always involves
supplementing first with whatever EBM mom can obtain and increasing
her production.

Winnie

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