Lactation Note (Low Milk Supply)

Note type: Lactation Note (Low Milk Supply)

Visit type: [inpatient postpartum / outpatient / home visit]

Date & time: [Date and time of encounter]

Author: [Author name and credentials]

Birthing parent: [Parent name] ([Parent identifier])

Infant: [Infant name] ([Infant identifier]); [Infant age in days] days old; GA at birth: [Gestational age at birth]

Reason for visit: [Parent-stated reason in quotes]

Data sources: [Parent report / chart review / feeding log / clinic scale / home scale / pump logs / prior lactation notes / pediatric notes]

Clinical Snapshot

[Postpartum day and infant age]. [Current feeding pattern: direct breastfeeding / exclusive pumping / mixed]. [Latest weight with date/time and percent change from birth]. [Diaper output summary and bilirubin status if relevant]. [Supplementation volumes and method if any; pumping output if applicable]. [Primary working hypothesis: low supply vs low transfer vs perceived low supply with reassuring indicators]. (Provide 2–4 concise sentences. Do not infer adequacy without objective anchors.)

History

Presenting concerns: [Key parent quotes capturing concerns and perceptions]. [Timeline of concern and recent changes].

Feeding goals: [Exclusive breastfeeding / combination feeding / exclusive pumping]. [Duration goals]. [Acceptable supplement types and preferences].

Feeding pattern (24 hours): [Feeds at breast per 24h] with [typical interval] and [typical duration]. [Single breast per feed / both breasts per feed]. [Night feeding pattern]. [Reported audible swallowing and satiety cues]. [Concerning behaviors: sleepiness at breast / clicking / prolonged cluster feeding / none]. [Devices in use: nipple shield / SNS / bottle / pacifier / none]. (Write as a cohesive narrative rather than a list.)

Supplementation regimen: [Content: expressed milk / donor milk / formula] at [volume per feed in mL] and [total volume per 24h in mL], via [method: SNS / cup / syringe / paced bottle], indication: [medical concern / bridging during evaluation / parent preference]. (Required if any supplementation is occurring or planned. Specify exact volumes. If none, state "No supplementation." If unknown, state "Volumes not tracked.")

Expression: [Pump type/model] with [flange size and fit/comfort]. [Frequency per 24h including overnight]. [Total daily output and time window measured]. [Hand-expression use if applicable]. (Omit entirely if exclusively direct breastfeeding with no expression.)

Relevant clinical history: [Birth complications: hemorrhage / separation / NICU / none]. [Timing of lactogenesis II: onset of fullness/engorgement/leaking]. [Breast/nipple history: prior surgery / hypoplasia concerns / none]. [Endocrine risks: thyroid disease / diabetes / PCOS / none]. [Relevant medications]. [Fatigue or mood concerns impacting plan sustainability]. (Document as "not available" if unknown.)

Prior interventions: [Latch coaching / shield use / pumping changes / power pumping / galactagogues / frenotomy evaluation / other] with [observed or reported response].

Objective

Growth Data

• [Current weight] ([date/time], [scale source: clinic / home])
• Birth weight: [weight] | Nadir: [weight and date if known] | Intervening weights: [weights with dates]
• [Percent change from birth] | [Average daily gain or loss over stated interval]

Intake/Output

• Wet diapers: [number per 24h]
• Stools: [number per 24h] with [color and transition status]
• Dehydration signs: [lethargy / dry mucosa / urate crystals / sunken fontanel / none]
• Bilirubin: [status and management if clinically relevant]

Exam (if in-person)

• Birthing parent: [Breast and nipple findings: symmetry, tissue distribution, tenderness, nipple integrity, edema, vasospasm]
• Infant: [Tone, alertness]. [Oral findings: tongue mobility, lift, lateralization, cupping, suck quality, palate shape]. [Note if referral needed for formal assessment]

Feeding Observation

• [Position used]. [Latch quality]. Pain score: [0–10]
• Transfer signs: [audible swallowing / suck–swallow pattern / breast softening / infant satiety cues]
• [Time to rhythmic suck]. [Need for stimulation or waking]
• Interventions trialed: [positioning adjustments / asymmetrical latch / breast compressions / switch nursing / nipple shield / SNS / paced bottle] with [observed response]

(If feeding not observed, state explicitly with reason.)

Assessment

1. [Problem 1: e.g., Infant weight trajectory concern] — [Contributing factors linked to findings]
2. [Problem 2: e.g., Suspected low milk transfer] — [Contributors: latch/positioning, oral-motor factors, pain]
3. [Problem 3: e.g., Milk production concern] — [Primary lactation impairment vs secondary to inadequate removal; rationale]
4. [Problem 4: e.g., Nipple pain impacting removal] — [Etiology and impact]
5. [Problem 5: e.g., Feeding plan sustainability] — [Caregiver capacity, fatigue, resources]

(List in order of clinical urgency. Explicitly distinguish primary lactation impairment, secondary low supply from inadequate removal, and perceived low supply with reassuring indicators. Do not conclude primary low supply without addressing transfer/removal.)

Plan

1) Safety and Triage

• [Urgent actions if indicated: pediatric evaluation timing, bilirubin follow-up, hydration assessment]
• Weight check: [interval and location]
• Emergency criteria reviewed: [decreased wet diapers / lethargy / poor feeding / worsening jaundice / dehydration signs]

2) Optimize Milk Removal at Breast

• Feeding frequency: [target per 24h] with [waking parameters including overnight]
• Positioning/latch: [techniques taught] (teach-back confirmed)
• [Breast compressions and switch nursing instructions]
• [Nipple shield or SNS if applicable: size, application, plan to reassess need]

3) Protect/Increase Supply with Expression

• Expression frequency: [sessions per 24h including overnight timing relative to feeds]
• Equipment: [pump model, flange size, fit adjustments]
• [Hand-expression technique coaching if indicated]
• Sustainability: [assessment of caregiver capacity and modifications]

4) Supplementation

• Indication: [medical concern / bridging during assessment / parent preference]
• Content: [own expressed milk / donor milk / formula] with [prioritization rationale]
• Volumes: [mL per feed] and [mL per 24h]; [guidance to adjust based on cues and weight]
• Method: [SNS / cup / syringe / paced bottle] (pacing technique taught, teach-back confirmed)
• Weaning criteria: [objective targets: weight gain rate, diaper output] with [timeline for reassessment and stepwise reduction]

(Required if any supplementation is in use or planned. Must include content, exact volumes, method, and indication. If volumes unknown, document and establish tracking plan.)

5) Follow-up

• Interval: [24–48 hours if higher risk / within one week otherwise]
• Measures: [weight, transfer assessment, diaper counts, supply indicators]
• Contact earlier if: [decreased wet diapers / lethargy / worsening jaundice / no weight gain / escalating pain]

6) Referrals

• Maternal: [thyroid panel / anemia workup / retained placenta evaluation / mental health / none indicated]
• Infant: [oral-motor assessment / frenulum evaluation / pediatric follow-up / none indicated]

7) Galactagogues

(Include only if discussed.)

• [Confirm milk removal optimized prior to discussion]
• [Agent considered; risk–benefit discussion; contraindications reviewed; informed consent documented]
• [Dosing, monitoring parameters, stop criteria]

8) Education and Care Coordination

• Education: [topics covered; resources provided; teach-back confirmed]
• Communication: [providers contacted: pediatrician / OB / midwife] with [key points discussed]