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Protocol for "Not Enough Milk"

Here is the way I proceed for "insufficient milk supply" (actually, most mothers have lots, but the problem is that the baby is not getting the milk which is available).

1. Get the best latch possible. This needs to be shown by someone who knows what they are doing. Anyone can look at the baby at the breast and say the latch is good. The accompanying diagram, or the one available at the second website below shows how to get a good latch.
    
2. Know how to know the baby is getting milk (open-->pause-->close type of sucking). See handout: How to know my baby is getting enough milk.
    
3. Once the baby is no longer drinking, use compression to increase flow to the baby. See handout Breast Compression.
    
4. When the baby no longer drinks with compression, switch sides and repeat. Keep going back and forth until the baby does not drink even with compression.
    
5. Try fenugreek and blessed thistle. These two herbs seem to increase milk supply and increase rate of milk flow. There is more information on the handout Treatments for Problems 2
    
6. In the evening when babies often want to be at the breast for long periods, get help to position the baby so that you can feed lying down. Let the baby nurse and maybe you will fall asleep. Or rent videos and let the baby nurse while you watch.
    
7. It is not always easy to decide if a baby needs supplementation. Sometimes more rapid growth is necessary. If possible get banked breastmilk to supplement if you can. If not available, formula may be necessary. However, sometimes slow but steady growth is acceptable. The main reason to worry about growth is that good growth is one sign of good health. A baby who grows well is usually in good health, but this is not necessarily so. Neither is a baby who grows slowly in poor health, but physicians worry about a baby who is growing more slowly than average.
    
8. If it is decided to supplement, the best way is at the breast with a lactation aid. Introduce the supplement with a nursing supplementer (lactation aid), not bottle, syringe, cup or finger feeding. See handout on Lactation Aid at the websites below. Supplement only after steps 3 and 4 above and the baby has nursed on at least both sides.
    
9. If the baby is older than 3 or 4 months, formula is not necessary and extra calories can be given to the baby as solid foods. First solids may include: mashed banana, mashed avocado, mashed potato or sweet potato, infant cereals, as much as the baby will take, and after the baby has nursed, if he is hungry.
    
10. Domperidone is a possibility. It is not a panacea. Check the handout on Domperidone.

Questions? (416) 813-5757 (option 3) or newman@globalserve.net

Protocol for "Not Enough Milk" Revised January 2000
Written by Jack Newman, MD, FRCPC
May be copied and distributed without further permission

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