My friend continues to pump for her baby who has anoxic encephalopathy and
is unable to feed.  He is G-tube fed.  I hope some of you with experience
with ill babies and exclusive pumping may be able to help me with a couple
questions.  He is a few days shy of 7 mos now.

First, when a woman is exclusively pumping, how does supply usually fare?
She  pumps with a rented Lactina most of the time, occasionally uses an
Avent Isis when out and about.  She now pumps 6 times a day, with about a 6
hour gap overnight.  She has followed this pattern for about the last 3 mos,
but in the last month she's had a harder and harder time with supply.  She
has been taking Domperidone for 4 mos or so, and has increased to 80 mg a
day total, and is just barely making his needs, and occasionally not quite
keeping up.  Is it common to see a decrease in supply despite keeping the
same pumping schedule?  I've encouraged her to pump more frequently, at
least short term.  However, this is hard for her as she also has a very
active 3 year old, plus therapy appts for the little guy.  Also, his feeds
take quite a while as he can only tolerate his bolus feeds very slowly or he
spits up a lot and seems miserable.  He does come to breast for recreation,
but is unable to even latch, although he seems to like to be near his
mother.  Is she unlikely to maintain the same supply without increasing
pumping in the second half of the first year?

Incidentally, she had trouble with supply with her first child, but always
felt that was due to poor latch issues in the first 1-2 weeks.  The first
child was born at home, and my friend had no experienced breastfeeding help.
 The baby lost nearly 2 lbs after birth (started just over 8 lbs) before she
realized she was having a problem.  She then went to stay with her mother
for a couple weeks and her mom nursed her daughter part time (she was
nursing an older baby herself at the time)  My friend pumped and worked on
building a supply, and then worked at getting the baby to latch better.  She
never produced a full supply for this baby, although she came close.  The
baby developed a bottle preference and had a nursing strike at 8 mos and was
not persuaded to breastfeed again.  This time, though, she initally was
pumping 32 oz a day or more, so I think at least initially her supply was good.

Second, in the last 1-2 mos, his weight gain has really slowed.  He has been
physically healthy, but he has gained only a few ounces in the last 2 mos
He is occasionally supplemented with formula when she is unable to keep up.
  Despite a lot of effort, she has been unable to increase his daily volume
much, as he just spits up more if more volume is offered.  She doesn't have
extra milk to do any lactoengineering.  Any ideas on good ways to supplement
him some extra calories?

Jennifer Tieman
Family Physician
Mom to 4, including my toddler nursling Caroline Rose

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