I don't post often to Lactnet, but have learned a tremendous
amount by lurking for the past 2 years!  Thank you all for
taking the time to share your collective experiences and
wisdom through this resource!  I need your assistance with a
baby that I am helping.  Baby was born at 40 weeks gestation
with Down Syndrome and congenital heart disease (complete AV
canal defect).  Baby will be having heart surgery in the
next few months.  Baby is currently 12 weeks old, and was
gaining well until about 3 weeks ago, when I first met him.
The cardiologist is watching baby for signs that he is
getting weaker and that will tell him when it is time to
perform surgery.  He wants baby to grow as much as possible
before surgery.  Meanwhile, mom is very committed to
breastfeeding and was providing all nourishment at the
breast, until 3 days ago.  Baby is sleeping more and more
(as the cardiologist said that he would).  Baby nurses for
about 30 seconds and gets a good MER with lots of
swallowing.  Then he pulls off the breast to catch his
breath and falls asleep.  Baby wakes up 10 to 20 minutes
later and repeats the process.  Stools are now green.  The
pediatrician wants baby to continue gaining weight, so he
has suggested supplementing with formula at this point.
Mom's milk supply is very low from lack of complete emptying
of the breasts.  I rented mom a pump today and she is taking
fenugreek seed capsules.  Hopefully we can supplement with
EBM once mom's supply is back up again.  In the meantime,
the pediatrician has recommended that mom mix powdered
formula in a concentration of 3 parts formula to 2 parts
water in order to raise the caloric content of the formula
and supplement breastfeeding with this.  Are there concerns
about mixing formula in concentrations other than what is
recommended on the can?  Thanks for your help!
Janet Talmadge, IBCLC
Naperville, IL