Hi Diane,

When breastfed babies eat a lot of solids before the middle of the 
second year of life
for me it's a red flag that mother's milk supply is low...

I know many babies seem eager to start solids-
they watch everyone else eating and they reach and grab for it,
but once the get over the novelty of it they don't actually eat a lot 
of solids
unless they are HUNGRY because their mother's milk supply is low...

I would ask this mom what her breastfeeding goals are...
Since she worked hard at increasing her supply with a hospital grade 
pump
I would think she is pretty motivated...but still her management is so 
appalling it makes
me wonder if she is one of those moms who wants to breastfeeed but she 
expects it to work
on the way she wants it to work...you've got to get a handling on 
whether she is just ignorant
of good breastfeeding management or if she is resistant to it...

Since four nursings is half the recommended minimum for a baby under 
six months,
she's got to nurse more...she can be encouraged to take advantage of 
the extra prolactin levels at night
by nursing at night...and she needs to be told that night nursing is 
necessary for keeping the milk in...
it must be explained to her that even though some babies will gladly 
sleep through the night
the brain makes a hormone that works against milk production whenever 
breastfeedings
are about four or more hours apart...if she is willing to manage 
breastfeeding this way
then you can talk to her about *jump starting* her milk supply 
pharmacologically
if that is necessary for getting the baby to go to breast more....
If she is resistant to night nursing there is no point in *jump 
starting* her supply...

[The only time I recommend a pump to increase supply is when the baby
has latch/milk transfer problems...otherwise the baby is the best *pump
It seems unlikely at this age (but not impossible) that baby has latch 
issues...]

I would stress with the mother that breastmilk (or formula :-() should 
compromise the bulk
of the baby's diet in the first year, and too much reliance on 
complementary foods
is the number one cause of infant malnutrition...

Please share with us how this turns out,

Jen O'Quinn IBCLC


.
On Jul 21, 2005, at 12:20 AM, Diane Perrone wrote:

> A mother with a four month old baby came into my office today to feed
> her daughter and weigh her ac/pc.  She has come in a few other times 
> and
> rented a hospital grade pump for a month when she did not have an
> abundant milk supply.
>
> This baby had a 10% weight loss the first few days and took more than
> two weeks to regain birthweight.  That's when her mother first came in
> and we worked on deep latch on and she began pumping with a personal
> pump to supplement her daughter and increase her milk supply.  When the
> baby continued to be fussy, unsatisfied and slow to gain weight, she
> rented a hospital grade pump for a month  and her supply increased; 
> baby
> began to gain weight.  At three months she was still in a low 
> percentile
> for weight and quite fussy, so the ped. had mother start cereals.
>
> Now at four months of age, she is gaining well and is bright-eyed,
> content and smiling.  However, she takes three meals a day and four
> feedings at breast.  The meals consist of 3 Tbsp. dry cereal mixed with
> mother's milk and a four ounce jar of either baby fruit or vegetable.
> She eats it eagerly, mother reports.  But mother is concerned because
> she nurses only four times a day and those feedings are getting 
> shorter.
> Baby sleeps all night (started this at two months of age even when she
> was fussy and hungry all day).
>
> Today her ac/pc weight gain was just 1.6 ounces and she was quite
> content.
>
> Any suggestions or advice for this mother?  Does this seem like a lot 
> of
> solids for a four month old?
>
> Diane Perrone, RNC
> Materna Wellborn
> Algonquin  IL  US
>
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