Riva Weissfish asks for input on this case: a 2 1/2 week old first baby whose tongue-tie was dealt with at 9 days, at which time mother also started taking domperidone and 'increased pumping'.  Baby is feeding frequently, seems satisfied and alert and settles to sleep after feeds.  Baby is also getting fed the milk mother has expressed, plus some formula, for a total of 120 ml of supplemental feeds daily, divided into two portions, and is gaining 150 g per week.
Riva's question is how to proceed when the baby now has not stooled for 36 hours - should the mother supplement more? Should they try pre- and post-feed weighing?  How long can they observe the baby and wait for it to stool? 

First, I would say Riva is not missing anything :-)  The baby is getting fed and the milk supply is being protected, while they are being followed closely.  I would, however, like to know how much weight the baby lost initially in relation to its birthweight, and whether it has passed its birthweight yet. 

Second, I would say not to bother with test weighing at this point, since you already know all the pertinent information, in my book (baby is gaining but not rapidly, baby is alert, feeding frequently, and mother is able to express small amounts after feeding, after baby has signalled satiety).  It's still early days.  Only about a week has gone by since the tongue tie was fixed, and it was done relatively late so a delay in the big surge of milk production is to be expected.

If the baby is above its birthweight now, I would also support not increasing the supplement for another day or so, since the baby seems to be otherwise fine and content.  It's likely that the mother's production is still gathering strength.  As long as it is possible for you to keep track of the baby's weight gain over time, with no more than a week between weight checks, the mother should be able to use the baby's signals as her best guide for when to supplement and how much.  BUT if the baby still is far below birthweight, I might be more inclined to recommend a cautious increase in supplements, while still following them closely so the supplements may be stopped as soon as possible.  In my experience many women who experience obstacles in the beginning are perfectly able to exclusively breastfeed once the baby is back on its own growth track, but for many of them it is difficult to provide that extra amount of milk the baby needs to catch up with itself.  At this point, lack of stools in an otherwise contented baby should prompt the mother to have the baby weighed, NOT to supplement automatically.

Please let us know how it turns out - and let the mother know she has the odds on her side for being able to breastfeed exclusively.  The most likely cause of her delayed milk production is the baby's anatomy and she is already supplying nearly all the baby's nutrition (pumping 8-10 times a day for 10-20 ml means that of the 120 ml baby is being fed in addition to the breast, nearly all of it is the mother's own milk).

Good luck,
Rachel Myr
Kristiansand, Norway

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