Hi there, I'm posting this for the LC I'm training under... any ideas, suggestions 
are most welcome.

This mom is expecting her 10th (yes 10th) child sometime this month. She is 
41 years old and her oldest child is 21 years. 

After the birth of her sixth baby she had her thyroid removed. She is currently 
taking synthroid, although I'm not sure of the exact dose. I can find out if 
that information is helpful.

Babies 7, 8 and 9 all had insufficient weight gain. Mom supplemented ABM with 
2 of the three. She starts solids at 4 months and stops supplementing with 
ABM at that time. After solids are introduced, the babies no longer have 
insufficient weight gain.

She contacted the hospital LC by phone for #9 when her pediatrician 
suggested stopping supplementation cold turkey. Mom was concerned about 
negative effects this could have on the baby's weight gain. LC suggested 
weaning off the ABM...

She is currently pregnant with #10 and came to see the LC to develop a plan, 
hoping to not have to supplement with this child. The LC believes that 
supplementation was required sometime after 2 weeks of age in the babies.

So other than increasing mom's fat intake in the hopes it would bolster the fat 
content of her own milk, are there any other suggestions? Mom reports that 
there is a good cream layer on her milk when she pumps...

LC is interested in getting the mom's milk analyzed for fat content, but is 
unsure if the military hospital lab where she works would be able to perform a 
creamatocrit. She is going to look into possibly purchasing the new 
creamatocrit tool available through Medela. Do any of you have experience 
with this tool and know of it's limitations in this type of situation? Are there 
any outside labs that could perform the correct analysis of the mom's milk in 
the hopes it would provide answers as to why her milk is not rich enough to 
allow the babies to gain weight? Would there be a benefit to using something 
such as the prolacta human milk fortifier for preemies vs. ABM to add fat and 
calories to EBM? I'm not sure if it would be cost prohibitive, though (i'm sure 
it's extremely expensive).

I forgot to add that her supply is not the issue. She has an abundant supply. 
She also has a history of gestational diabetes, does not require insulin 
(regulated with diet) and it has resolved at birth each time.

Are there any other things that might cause her babies to have poor weight 
gain that we haven't thought of? 

Do any of you have suggestions for other ways to help this next baby gain 
weight without supplementation of ABM?

many thanks! 

Anne Hinze

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