Permission to post.
I have a patient with a very demanding, fussy, gassy, cannot-put-her-down 8 week old baby who was diagnosed with reflux and on prevacid, which is helping.  Baby had a frenotomy at 2 weeks for a type 2 TT but tongue was still tight afterward, still unable to fully lift the tongue.   Mom continued to experience sore nipples even after the frenotomy through a nipple shield.  A direct latch was even more painful.  She declined to persue a second opinion on the tongue because she is so consumed with the baby's care.  
Baby had slow weight gain in the first few weeks before the frenotomy so mom was pumping and bottle feeding her milk and formula until she caught up her weight.  Now baby is thriving, 95% on WHO curve.  Mom also had suppressed lactation, due in part to the baby's TT but I suspect potential PCOS, she has tubular breasts, and had an intrauterine insemination to get pregnant.  
After fenugreek, goats' rue and lots of pumping, mom's supply is up to 24 oz pumped milk/day but baby takes in about 35-40 oz so she was still using formula (Alimentum) to supplement.
Pedi GI doc suggested she take a week off breastmilk and just give Alimentum, after which there was worsening of symptoms plus foul smelling stools:-)  They are suggesting Neocate now but I think she just needs to go back to breastmilk from the breast and have mom go on an elimination diet.  So mom hasn't nursed in a week and she is willing to try without the nipple shield to see if it still hurts.  If it does, I will suggest a second opinion for a posterior TT.   Once this baby gets to full breast, I suspect mom's supply will fill in accordingly.  I just hope we haven't lost our prolactin window, which declines after 2 months.  This mom is determined to BF.
Any suggestions?
Annie Brown, FNP, IBCLC
Greenwich CT

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