IN my greater than 10 years experience, I have noticed this problem of moms that do not initiate lactation adequately (either with effective nursing or pumping) developing low supply. In my practice, typically these were either moms pumping but not pumping adequately or with ineffective pumps or committed nursing mothers who believed that everything would go well if they just kept the baby at the breast enough. These co-slept, nursed around the clock, etc. When they finally came to me, they were usually 6-7 weeks post-partum with low weight gain or weight loss babies with ineffective suckling (high palate, short frenulum or other such oral problems too) now needing supplementation. Many of these also had "reflux" and ended up unable to tolerate anything but expensive hydrolysed formulae. With these moms, even effective pumping and/or effective latch-on did not necessarily increase supply to adequate. This substantiates what Woolrich and Hartmann have said in their research. This is why early assessment and intervention is so important and why we cannot ignore babies who lose weight below the 7 1/2% mark or who do not gain weight by the 2 week mark. It is NOT to undermine breastfeeding and IMHO is not supportive of breastfeeding to pat mothers on the back and tell them "just take your baby to bed and nurse around the clock". Thank God there are more and more knowledgeable pediatricians out there that do not take this approach. If we observe closely and keep track of our clients, we can see that experience usually follows physiology. We can take a scientific approach to breastfeeding without fear. I think that in the past we promotors of breastfeeding have had an unspoken fear that somehow breastfeeding as a process cannot stand up to rigorous scientific study and scrutiny, I believe the more we work to dispel the myths and mystery, the more we enable moms and babies to discover that the magic of mothers' milk is just the expected and anything else is abnormal! Jane Kershaw mailto: [log in to unmask]