Judy I do sometimes recommend "switch nursing" when a baby is a sorta "sleepy newborn" maybe jaundiced, but otherwise normal in my opinion. I advise the mom to watch the baby and when the good open- pause-close or what I sometimes call the "long strong" sucks cease, to do breast compression to get more swallows then switch to the other breast. And keep doing this til we get a good amt into the baby. As a general rule, though, I advise the finish first breast first rule of thumb. Now regards your client "10 week old infant, who MD feels is not gaining well enough, gaining 1/2-3/4 oz. per day". Judy, on the face of it this seems not very problematic becoz it works out to 3.5 to 5.5 oz per week, which I think is normal or maybe low normal, but if consistant and all devel. milestones intact, then I would advise to assess mom's bf and bf practices and counsel to optimal bf practices. "and MD has gradually increased suggested formula supplements to 12 oz /day. I really am having a difficult time understanding the need for all this formula". Yes, I agree. If the formula has been gradually added BUT THE MOM HAS NOT COMPENSATED BY WORKING ON KEEPING UP or improving HER OWN SUPPLY and bf management then this will lead to her supply going down the toilet. Also the baby may come to prefer or respond better to the firmer or longer artificial teat and/or the faster flow from the bottle. THIS IS A CLASSIC CASE OF SUPPLEMENTATION LEADING TO BF FAILURE, IMO. Now I must add that you have to carefully assess this bf dyad to see if the mother or baby has a primary problem, a management problem, or reallly needs some supplementation. However when supplementation is used, the mother should AT THE SAME TIME be working hard to improve her supply to its optimum. [I use the caps for emphasis only - not flaming of course]. Laurie Wheeler, RN, MN, IBCLC Violet Louisiana, s.e. USA ______________________________________________________ Get Your Private, Free Email at http://www.hotmail.com *********************************************** The LACTNET mailing list is powered by L-Soft's renowned LISTSERV(R) list management software together with L-Soft's LSMTP(TM) mailer for lightning fast mail delivery. For more information, go to: http://www.lsoft.com/LISTSERV-powered.html