I have only worked with one child with hydrocephalus.  He breastfed
beautifully when healthy.  There is a photo and brief case study of him in
The Breastfeeding Atlas.  When he stopped bfg (at any point during his 4 yr
or so bfg experience) it was always a marker for his mom that he was ill.
In the case of Pam's client, the baby has been in the NICU.  You mention at
least one factor (excessive weight loss) that  can impact suck.  In my
experience, once baby's lose a certain percentage of their weight they can't
suck their way out of a paper bag.  Focusing on intake is impt. Once his
weight re-bounds his suck and feeding affect should improve.There was a nice
study some years back that documented that human milk is the reference
standard for recovery from even severe malnutrition.  So if there were
enough milk, the baby wouldn't need fortification.  It the mom's milk supply
is inadequate, then you are stuck with formula or fortification unless you
can order some human milk from a milk bank.

It sounds like this mom's milk supply has sadly downregulated.  Whenever a
baby (for whatever reason) isn't adequately stimulating milk supply, immed
and assertive protection of milk supply should be instituted.  These
interventions would include assessing her for primary insufficiencies,
managing any management related issues (poor pump, poor pump frequency,
treating infections, checking on meds being taken, etc)  The time frame for
galactagogue use that makes most sense to me is early and concurrent with
pumping stimulation.  So I wouldn't assume it is hydrocephalus (or JUST)
hydrocephalus that is the problem.  It may be that everyone is so focused on
the big issue that some of the fairly common reasons for milk downregulation
and poor suck haven't been corrected yet.

Barbara Wilson-Clay, BS, IBCLC
Austin Lactation Associates
LactNews Press
www.lactnews.com
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