Dear All:

I have a friend who gave permission to post.  Her son is 2 and a half years
old.  He has a tight frenulum (which I haven't looked closely at it since
he was about 3 months old) that caused him to have a truly forked tongue,
but he never had the least bit of difficulty nursing. Mom is a copious
oversupplier.  From the beginning he gulped at the breast.  He now gulps
down water frequently during the day.  Parents are vegetarian and have him
on what sounds like a relatively high carbohydrate diet.  He nurses
frequently at night (about 5-6x) and gulps at the breast.  Also, mom is a
lawyer and has very long hours and so nighttime becomes a time to be close
with her children. Her daughter would often stay up until mom came home and
then would be very sleepy for school.  Her son is physically active.

The pediatrician examined her son recently and he is 37 lb and at 80th
centile for length - so basically off the charts for weight for age and
weight for length. The pediatrician (whom we both like in all other areas
than breastfeeding) suggested abrupt weaning.  My problem with this is
several-fold.  Why is this baby such a gulper?  and could this persist with
other liquids.  Will this baby just substitute other foods and continue to
gain at the same rate while mom has lost a valuable nursing relationship.
Is there something a little off about insulin resistence in this situation?

I have suggested she contact our local breastfeeding medicine specialist
who is skilled in over and undersupply issues and has some knowledge of
insulin resistance from dealing with PCOS.  I have also suggested that,
rather than abrupt weaning, mom might let her son sleep with dad and
perhaps the night nursing would diminish without abrupt weaning. Dad is
very attentive and often does story time with their son.  I also suggested
that a skilled dietician who works with vegetarian diets and is
knowledgeable about breastfeeding might be able to examine the diet in more
depth to problem solve what foods might be contributing to the weight gain.
I'm hoping to get a few referrals from some of the breastfeeding friendly
pediatricians in the area.  My expertise in nutrition is on a population
level (and the dietary deficiencies common to developing countries) - not
the individual level that an RD should have.

Any thoughts on this toddler?  Any and all suggestions appreciated.


Susan E. Burger, MHS, PhD, IBCLC

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