>I have a mom with baby #7 whose milk supply is not sufficient for this
>baby.  She nursed 6 other children with no problems, good weight gain,
>etc.  She went back to the doctor for a 2 week weight check, and this
>baby had not gained from discharge weight.
  Baby had had appropriate wet diapers, but not much
>stooling.  Mom had not picked up on the lack of stooling as something to
>be concerned about... She had
>not noticed anything different with this baby's nursing.  Pregnancy,
>labor, and delivery were all normal... After
>a week of pumping at least 6x/day, starting out with a 24 hour trial
>pumping to evaluate supply, she was getting a max of 5-6 oz/day.
>Baby has been willing to go to breast and will suckle 15-20 min on one
>breast, but not very long on the other breast...  She has noticed that the
>non-preferred breast has been smaller than the other breast all along,
>something she did not notice with other children.
>Pat Bucknell, IBCLC
>Avon Lake Ohio
>

Pat -

        My first thought on this case was an imbalance with foremilk and
hindmilk.  This was further supported by the fact that baby goes to only one
breast per feeding.  The baby was urinating well which indicated a good
supply of milk, but was probably getting mostly foremilk. Perhaps mom's milk
supply is low at this point because baby has not been adequately stimulating
both breasts.  Were you able to do a suck eval or was it a phone consult?  I
would be curious as to the positioning of mom,  of the baby at the breast,
and the feel of baby's suckle.  Has the baby been a sleepy baby?  Sleepy
babies have that tendency to give up on suckling unless the breast is
offered in the perfect position.

        I wonder if mom is able to adequately evaluate the baby's suck if
she did not pick up on the baby's lack of stools.  With 6 other children to
care for, it may be difficult for her to make a thorough assessment.  I also
am wondering about her ability to get enough rest and recovery and this, in
turn, negatively affecting her milk supply.

        In sum,  I would rule out the following two problems:

        1.  Poor weight gain initially due to foremilk/hindmilk imbalance;
currently due to low milk supply

        2.  Low milk supply due to poor breast stimulation and possible
maternal overactivity


        Let us know what happens.

        Donna Zitzelberger  RN BSN  IBCLC