Ann,

A friend had a similar situation and one other suggestion that worked for
her (and kept the GI guy happier) was to start giving the pediasure with
the Lactaid device, so that baby tolerated the pediasure better.  We also
had her stick with high fat foods (cheese cubes, cream cheese, avocado,
soynut butter, etc.) and cook or mix other foods with olive oil, butter,
and heavy cream.

Also, if I'm not mistaken, the fat content of mom's milk should reflect
her diet, so perhaps encourage her also to eat some highly fatty foods
prior to nursing.  I can't remember where I read this or how valid it is,
but it probably wouldn't hurt.

There was a recent discussion online about a med student's online notes
listing extended nursing as a potential cause of FTT.  This
(unsurprisingly) caused an uproar and I researched it a little further.
Basically, the only publication was a case series out of Ohio of six
children that were considered FTT and were linked to frequent nursing and
minimal solids intakes, and who improved after hospitalization and tube
feedings + pushing solids.  However, 2 of the children also had severe
illnesses (leukemia and something else) and all the mothers were in
extremely high-stress situations that probably led to decreased milk
supply.  The article "blamed" the FTT on stress leading yo  mother's
psychological need for baby to keep nursing, leading to limitation of
solid foods, and FTT.  I suspect it was stress causing poor milk supply in
a baby that was not interested or not ready for solids.  But, this may be
factoring into the GI doc's views.

I agree that the baby needs more evaluation to rule out another cause,
especially with the unusual stooling history and developmental delays.

Shannon Tierney McElearney
BFing mom to 10 month old Jack
PGY3, General Surgery (with an interest in breast surgery)
University of Virginia

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