This  mom is making 24oz/day and baby is taking 35-40oz/day?  May I suggest
cutting baby's milk back?

See Kent, J. C., Mitoulas, L. R., Cregan, M. D., Ramsay, D. T., Doherty, D.
A., & Hartmann, P. E. (2006). Volume and frequency of breastfeedings and fat
content of breast milk throughout the day. Pediatrics, 117(3), e387-395.

"Total 24-Hour Milk Production-- The overall 24-hour milk production for
both breasts combined was 788  +/-169 g (range: 478-1356 g; Table
1)."

750mls = 25oz. Girls average 25oz/day, boys 28oz/day. Plus or minus a bit.
I'd like to know this baby's rate of gain. If it is much more than an ounce
a day, then he is likely overeating and this is likely a big contributor to
the reflux. It is not an uncommon scenario for reflux babies to want to eat
more when they don't need it-- for some, feeding seems to be a comfort even
though it makes things worse. And bottle-feeding tends to lead to more
overfeeding than feeding at the breast. I don't know what nipple they are
using, but if a bottle is necessary, consider something like a breastflow.

For mom's PCOS, I'd suggest two other things-- if she's ever been on
metformin and is not on it now, see if she can get back on it. Secondly, saw
palmetto and fennel both have anti-androgen properties (androgens seem to be
the issue with PCOS lactation problems) and also stimulate breast tissue and
milk production. She is so close to a full supply! If domperidone became an
option, it would probably put her right over the top.

Lisa

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