Hi everyone,
I need some guidance . History goes like this...
Baby is 3 weeks old. First bb - term - birth wt - 7 pounds 1 ounce.  Has a 
subtle posterior tongue tie which we can not get clipped in our small town. 
Initially did a real number on mom's nipples from biting. Mom became 
extremely engorged for a few days with responded poorly to all attempts 
including RPS. Is now feeding well using shield with deep latch and 
transfers milk well with switch nursing and breast compression every 2-3 
hours. I do not have access to a finely calibrated scale so can not test 
weigh but looks like she is getting lots of milk. Mom pumps after every 
feed for better breast drainage and obtains between .5 - 1 ounce EBM. 
Weight gain was very poor and supplements were added after week one. Is now 
giving 1.5 ounce by cup- mom's choice ,of  EBM if available or ABM. 
Maintaining a good gain with this and is now back to birth wt. Mom started 
Domperidone 80 mg daily one week ago but no noticeable increase in supply 
yet. My questions are:
1. How long in cases like this does it take for domperidone to kick in in 
your collective wisdom? I know Jack Newman says to give it at least a good 
3-4 weeks before ruling it out but what is the norm.
2. What should I advise about decreasing supplements. How fast, how much to 
decrease by etc. 
I will see them again in the morning so am anxious for your advice.
Leaving for ILCA conference on Monday and very excited to learn all that I 
can. Hope to see some lactnetters there.
Kim Scott RNBN IBCLC
Miramichi NB
Canada

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