>I had a mother call me this week who I am seeing on Monday who just had
>
>her 6 month check and the baby only gained 1 pound since then. In spekain
>g
>with her, she feeds him only 4 times per day because he naps for long
>stretches and sleeps through the night. He began cereal 2 weeks ago and
>
>Emily Lindsey, BSPsy, CLE
>Private Practice
>Merced, CA

I think you can definitely make a case for increasing the 
breastfeeding here!  Four feedings per day is not enough for a 4-6 
month old (I assume the previous well-baby check was at 4 months). 
Does the baby use a pacifier as well?  The mother must have a fairly 
large storage capacity for the 4 feedings/day to have resulted in 
even 1 lb of weight gain.  Perhaps there is an oversupply/OAMER issue 
that discouraged this couplet from more frequent feedings.

A mother I know stopped breastfeeding at 6.5 months after her baby 
(fifth child, all breastfed) did not gain *any* weight from 4 to 6 
months.  At the 6-month checkup the mother was devastated to learn 
she had been underfeeding her baby.  The MD recommended that the 
mother drink a gallon of water per day and eat more (mom was slender 
& had been dieting) but did not suggest increasing the breastfeeding. 
SIGH.  I didn't hear about all this until after weaning was complete 
so it was too late to offer my observations -- which were that the 
mother often ignored feeding cues, held the baby off with a pacifier, 
and was nursing only about 4 times in 24 hours.  This baby spent a 
lot of time in a carseat/carrier, swing, exersaucer, etc -- not being 
held or carried.  The mother was simply very busy with the activities 
of the older children and the baby had a complacent personality.  So 
this fifth child of a successful breastfeeding mother ended up having 
the shortest period of breastfeeding.

Perhaps you can suggest working intensively on the breastfeeding and 
returning for a weight check in two weeks.  The AAP statement 
recommends about 8 feedings per 24 hours for babies past the newborn 
stage.  In my observation & experience, 6-8 nursings/day is pretty 
average after the baby is eating complementary foods.  The AAP also 
notes, "Introduction of complementary feedings before 6 months of age 
generally does not increase total caloric intake or rate of growth 
and only substitutes foods that lack the protective components of 
human milk."  This is a good argument for working on the 
breastfeeding instead of just feeding more solids (even though this 
baby is now older than 6 months, breastmilk is still more nutritious 
than solids).

Margaret
LLLL
Longmont, CO

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