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In a message dated 3/22/05 8:02:02 PM, [log in to unmask] writes:
> Weight gain of 3 ounces in next two weeks,
> at which time mom contacted me again because she felt her milk supply was
> dwindling. Previously she had been getting 4+ ounces total per pumping and
> was
> now down to 1-2 ounces when she pumped
> I advised resuming pumping after most feeds and supplementing
with 1 to 2 ounces EBM and/or formula thru SNS and she started fenugreek.
Milk supply increased slightly with this regimen, but transfer
weights continued to be less than 30 cc's total.
Fenugreek and any feeding at the breast was discontinued last week by
mom's choice. Mom only getting total of 10-11 ounces per day and giving
about 20
to 22 ounces of formula by bottle.
I'm unclear as to the age of the baby at this point. Clearly her supply
dropped dramatically over the 2 wks of nonpumping BUT a milk transfer of only 30cc
or so may have been expected with the decreased stim AND seemed to coincide
w/ a 50-75% decrease in EBM. The poor transfer may have been closer to
optimal when compared to available volume thus It is difficult to assess whether
this baby was improving her suckle p/t it's abandonment. With this in mind and
because suckling is preferred to pumping when attempting to up production, I
would encourage Mom to resume SOME feeding at breast, along w/ domperidone use
and reiteration of the importance of compression, changing positions and switch
nursing when swallowing has dropped off. Hopefully she is skilled at all of
the above by now!
If the baby is spitting more w/formula than it seems safe to presume that the
formula is the cause, I'm skeptical as to how a GI specialist can help with
this. IME, most often they advise a more elemental formula AND discontinuing
breastfeeding.
Lynn Shea Rn,Bsn,Ibclc
Lakewood Ranch, Fl
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