Dear all:

Having not read the original post --- and being too tired tonight to read back through--- 
I'm just going to post general comments --- not specific to the case in question.

In terms of calorie intake --- yes, usually a caloric intake that is too low will result in less 
activity. However, that does not mean that you don't look at a "slow gainer" which I 
prefer to use rather than "failure to thrive" baby to rule out potential problems.  I've 
never liked the term "failure to thrive' as a description for a "slow gainer" because many 
are thriving but still may have health problems and manage to compensate through 
adaptive mechanisms.

Among things to look into and rule out are whether there is sufficient zinc intake, sunlight 
deficiency (often called vitamin D deficiency which I consider and inappropriate label) and 
anatomical issues which may inhibit intake.  

My son is a prime example of one of these situations.  He was born big and became a 
slow gainer.  I obsessed about this because I had a fibroadenoma removed and was not 
told by the surgeon that she would make a periaerolar incision.  In retrospect, I think he 
was actually gaining slowly because he had silent reflux and limited his intake because he 
would never take more than 2 oz from anyone and he was a frequent feeder.  I never 
counted and fed him African style.  Plus, my husband is 5 feet 4 inches and I am 45 feet 
tall.  Neverthless, my husband noticed an enlargement in my son's neck when he was 
about six months old.  That and his slow gain were our only clue to his swollen adenoids 
and tonsils which ultimately caused sleep apnea.  He was very bright, active, never slept.  
By the time we were paying attention to this more fully he was four years old and having 
severe sleep apnea.  Within 3 months of removing his tonsils and adenoids, our 
extremely active bright son gained 10 pounds.

So, while I have seen many slow gainers who are just slow gainers --- I always look 
closely to see if there is something going on that may be an early signal of a problem 
that needs attention.  Usually these slow gaining situations have NOTHING to do with 
breastfeeding and often to do with something else that takes a long time to figure out.

I don't like alarming mothers, but I don't like false reassurance either.  I do like looking 
into situations deeper to make sure nothing is being missed.  There is nothing more 
annoying to mothers than that feeling of "if I had only found someone who noticed this 
earlier."

Best, Susan Burger

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