Dear friends around the world,

Thanks so much for the insightful comments and suggestions.

I called the mother today.  She returned the call this
evening.  I verified some history questions.

Baby boy born on April 4, 2001 weighing 6 lb. 4 oz. at 40
wk. gestation.  The 9 lb. weight the mother quoted is at the
one month check-up.  Mom denies breast surgery or thyroid
problems.

Since I last spoke with her, mom has been hand expressing,
keeping only one ounce per bottle.  She feeds the baby
whenever he is hungry, giving a second ounce at one feeding
if necessary or 30 minutes later if baby acts hungry again.
If no expressed milk is available, she breastfeeds on the
right breast.  With complete nipple rest, the left breast is
starting to "fill in."  She still plans to see me tomorrow,
at which time I plan to do a thorough physical assessment of
mom's breasts and baby's mouth.  I will also plan to weigh
the baby.

What are your thoughts on recommending vitamin E for one or
both nipples.  I know that there has been a concern about
babies getting too much vitamin E this way.  However, it
appears that the concern is primarily for preterm babies,
and this is a term baby nearing 2 months of age.  I was
thinking about suggesting that she get the lowest potency
vitamin E capsules available (probably 50-100 mg.), pierce
the capsule with a small needle, and apply sparingly.  Do
you think this would be safe?  How many times a day do you
think it would be okay to do this?  For how long?  Her
doctor would no doubt be happy to prescribe anything that is
safe and would help her continue to breastfeed.

Thanks again for your interest and suggestions.

Bonnie Jones, RN, IBCLC from the S.W. USA

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