Terri, I never recommend Reglan because of the experiences of women who
experienced severe depression, sometimes within a short time even if they
had no history of depression.  In my opinion, the risk is too high. Have
the MDs in your area stopped prescribing domperidone since the FDA sell-out?

One thing that I find is that day-care workers over-feed the
babies.  Babies learn quickly that they are held only when they give hunger
cues and they will do so frequently, taking in more milk than they need.  I
recommend pacifier use following feeding for babies in group care.

Also if the bottle nipple is too large or car-takers don't want to spend 20
minutes or more in feeding, the baby will drain an adequately full bottle
and long for more. Baby doesn't know that she is, in fact, full when she
feeds too fast.  It is like us if we eat too fast; in about 20 minutes we
are groaning from over-filling. I suggest getting a bottle/nipple that is
truly slow flow (many claim this), one that takes at least 20 minutes to
empty.  This has often resolved the problem of not enough milk for employed
mothers. I have bought dozens of nipples labeled "slow flow" and have
tested them with a bottle of water.  Some are very fast.  The one that I
have settled on at this time is the Playtex Premium, a knock-off of Avent
but slower.  If any of you know of a very slow one, I'm open to expanding
my recommendations.

Remember that a breastfeeding baby doesn't have to continue to drink more
and more as she grows.  The milk becomes more concentrated as baby gets
older, and baby is well-nourished with less milk than her formula-feeding
counterparts, whose milk composition remains the same.  The calculation of
2.5 oz X weight for the total daily ounces to thrive is not applicable to a
baby over 9-10 #.  Most of my clients' babies max out at 4 ounces or a bit
more. I think that Peter Hartman passed that information early in his research.

I had a client whose 5-month old was satisfied and thriving on 4 oz per
feeding. One day Gramma said that the baby was not satisfied and needed
more.  Mom panicked as she worked on increasing her milk supply.  She
called me and I questioned the increased need. Mom discovered that Gramma
wanted to get the feeding over in 10 minutes so she had enlarged the holes
of the nipple.  After some serious tension in the house new nipples were
purchased and baby resumed her satisfaction and thriving on 4 oz.

Pat Gima, IBCLC

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