With regard to the recent mention of Failure to Thrive in an infant with
Turner Syndrome:  I 've worked long-term with the families of two girls with
Turner Syndrome.  Both girls both thrived on exclusive breastfeeding, and
continued a long time with partial bfg.. They are not easy or especially
capable feeders as infants -- but it can be done and is very important to
do!

 The first girl with Turners provided a real learning experience.  She had
numerous feeding problems that the pediatrician denied had anything to do
with her condition.  However, reading the lit on the subject, I discovered
that these children often have feeding related issues connected to some of
the physiologic differences they may have. They frequently have unusually
shaped, grooved palates, and usually have initially poor facial tone that
impairs suck.  Sometimes they have difficulty with under-lying issues such
as heart defects that affect feeding stamina.  The second baby with Turners
that I saw had hip dysplasia and casting that made her hard to position, a
heart defect that needed surgery by 2 months pp, and serious reflux.

Infants with Turners are very important babies to closely follow and assist.
The breastfed baby generally enjoys excellent early growth.  As these girls
are going to have abnormally short stature, my strategy is to capture the
opportunity to get them growing optimally during the time period when humans
grow the fastest.  Neglecting their feeding related problems (and ignoring
the risk that they may be poor early milk supply stimulators) is therefore
dangerous for their long-term development.  Delays can be costly. Their
mothers need insurance pumping and the baby needs on-going intake
monitoring.  They sometimes appear to do ok during the engorgement phase
when they coast on the early milk abundance, but can fade out when they must
maintain lactation.  They often need assistance with shields to improve
their intake, bottles to supplement intake of hindmilk, feeding tube
devices, and certainly the families should receive the information that
long-term intake of milk is beneficial.  I stay involved during the
vulnerable early weaning stage as well, as this is the time when low cal,
high-fiber foods such as cereals can too easily replace the higher caloric
density of milk.  I cautioned both mothers to go slow with solids, to use
meats, egg yolks, avacado, etc as early solids.  We talked a lot about
nutrition, as both girls were picky eaters.  The one girl who had a channel
palate tended to get stuff stuck in the palatal groove and would stop eating
until the mom scooped out the  food (and once paper!) that got trapped.  (If
you want to see a photo of a channel palate, there are two in The
Breastfeeding Atlas).

I got a Christmas card from the family of the one little girl I've been
following for 7 years. She is now in the 1st grade and has been weaned for
over a year.  (She nursed 5 1/2 years.) The mother writes:  "Her growth is
still pretty "normal" -- she's in the 50% tile on the regular growth
chart...[Her endocrinologist/geneticist] said this past summer that she
still doesn't need growth hormones.  It seems every year she says we'll talk
about it in the next year or two."

Superior nutrition is tremendously important for individuals whose long-term
health is affected by syndromic conditions.

Barbara Wilson-Clay, BS, IBCLC
Austin Lactation Associates
LactNews Press
www.lactnews.com
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