Pat, i'm going to address your questions out of order, fastest first. Soy formula does not contain lactose, which is an important fuel for the brain (breaks down at the exact rate that the brain needs energy) (See Lawrence) and is important in the maturation of the gut (The Biological Specificity of Milk, old LLL publication). Mentioning this issue to my sister in law the Ross labs rep caused her to freak out in denial. Formula co's try to sell this lack of lactose by citing transient lactose intolerance in bottle fed kids with severe diarrhea. The fact that their products caused the condition in the first place never enters the discussion! HIV: There was a hospital in the USSR which reused a syringe without sterilization, infecting multiple infants with HIV. About 7 infants passed the virus to their bf mothers. 5 of these infants caused mom's nipples to bleed, all 7 had oral candidiasis, a possible source of blood exposure. This was reported on OB/GYN update (cable tv) about 4-5 years ago, I have not seen it in print. So there is a theoretical risk to nursing an adopted baby. Adoptive nursing: My moms with previous pregnancies, even if they ended in spontaneous abortions had more success inducing lactation by pumping that those with no previous conception. I have found mammary hypoplasia to be common in the latter case, the same mechanism that caused the infertility also caused a marked reduction in glandular tissue. All of this is perfectly logical if one reviews the development of the mammary gland during fetal life, adolescence and pregnancy. I have also heard of women taking hormones to induce this glandular development, but have no experience with this. Personally, I would work with mom to clarify her goals: bonding, immunologic benefits, nutritional benefits, oral motor benefits? Few of these are dependant on a large milk supply. The history and her goals will guide your recommendations from there. I hear on the grapevine here that the Lact-Aid nursing trainer induces a larger milk supply than the SNS for adoptive moms because of the active vs passive (gravity) feed of the devices. I have personally found pumping in advance to be most helpful for my moms with normal breasts. Some of these issues were discussed before you came on board, you can check the archives. Good luck, Catherine Watson Genna, IBCLC