Dear Chris,

I'm assuming the fortifier they want Sophie's mother to use is Human Milk
Fortifier which costs $50 a box.  I have spoken with Mead Johnson about my
concerns related to the inappropriate use of this product.  It is explicitly
written in the product information that it is intended to be used for low
birth weight premature infants.

I recommend increasing the caloric density of breastmilk with powdered infant
formula instead.  I usually add 1/3 tsp. per ounce of breastmilk.  This will
make it 24 cal/oz.  If she tolerates that without vomiting, she can try to
double that amount to provide 28 cal/oz.  To this I usually add enough
polycose to make it 30 cal/oz.

Sophie may have other GI problems (reflux?) causing her not to tolerate oral
feeds.  Or she may require supplemental tube feeding.  In any case she should
be seen and assessed by a pediatric dietitian and gastroenterologist who can
make appropriate recommendations.

Rachelle Lessen, R.D.