Immediately pick up the phone and contact this family's primary health care
provider.

Immediately.

There is far more at play here than homemade formula ... and based on your
description that alone would be reason enough for you to be expressing
concerns to the pediatrician. Especially since the family seems to be
"pushing away" your very natural questions about the baby and its feeding
history/reactions.

As an IBCLC, and allied healthcare provider, you do not operate in a
vacuum. You are part of the healthcare team, with duties under your scope
of practice and code of professional conduct to share clinical concerns
with the HCPs for the mother and/or baby.   There are plenty of concerns
here, that should not be relegated to a written report (which may not get
read; a phone call cannot be ignored).

Your objective when you get on the phone is simply to tell the HCP you have
some concerns, that are hard to put your finger on, about this baby ... and
is the HCP aware of the supplementation regimen that is going on?
 Basically read your Lactnet post.  This isn't you making accusations ...
this is you alerting the **primary** healthcare provider to the very things
that left you uneasy enough that you felt you had to post to Lactnet.

I have only felt compelled to pick up the phone like this a handful of
times in my IBCLC career.  In a few of those cases, my uneasy feelings
--thankfully-- turned out to be unfounded.  In EVERY case, the primary HCP
was extremely grateful to have had the phone call, even though there turned
out NOT to be clinical cause for alarm.

-- 
Liz Brooks JD IBCLC FILCA
ILCA President (2012-14)
Wyndmoor, PA, USA

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