Hello to all,

I have a problem that I would like feed back on, if you please.  If you
would respond to me privately as well as to the list I would appreciate it
since I am currently no mail.

My question is:  Is there any research that shows a child with slow gain who
is otherwise developing normally is at risk for future developmental problems?

Case History:  Baby girl born 2/24/97.  Pediatrician is unsatisfied with
weight gain and although baby seems to be developing normally, warns mother
that if she does not make the baby gain more weight she "might have
developmental problems in the future."  Baby feeds very frequently.

I first saw the baby on 2/28, because she was "sleeping at the breast all of
the time." was losing weight, and supply seemed low..  Mom's nipples were
very long and baby's palate was bubbled.  Baby seemed to push nipple into
palate and not compress sinuses.  Improved positioning increased the amount
of milk and when the baby had lost more weight 3 days later, we started
using formula in SNS.  Baby gained 10 oz in the following 3 days and
continued to gain weight as her strength increased and formula was
decreased.  Doctor's advice at this time was to feed 2 oz formula 2 times
per day.

The next visit was in July after a traumatic visit with the Dr. who told her
to wait at least 4h between feeds, feed for 15 minutes on each side and then
feed formula if the baby is still hungry after or between feeds. Baby was
nursing about every 30 to 120 minutes for 5 - 10 minutes.  Test weights
showed she was getting about an ounce each time.  We pumped some extra milk
and offered it to her - she spit it out.  To satisfy Dr., mom pumped after
feeds for a couple of days getting as much a 3 oz after feeds and baby still
did not want extra milk.  At the July 1 visit baby was alert, active and if
I held her hands, could stand on my lap.

Baby saw the pediatrician again a couple of days ago.  He insisted that the
baby be fed formula after feeds again and gave the dire warnings quoted
above.  The mother called me in tears, confused.  I suggested she ask for a
referral to a developmental specialist if the pediatrician was truly
concerned.  I also referred her to another pediatrician who does understand
more about breastfeeding.

Weight history:
     2/24/97 8# 11 oz (3.95 Kg) birth weight
     2/28/97 7# 12 oz
     3/2/97 7# 7.9 oz (3.40 Kg) lowest recorded weight after birth
     3/3/97 7# 14.9 oz (3.6 Kg)
     3/5/97 8# 2 oz (3.69 Kg)
     7/1/97 12# 1.8 oz (5.5 Kg)
     9/15/97 approx. Pediatrician says 1/2 # (225 g) gain in 2 months.

Linda Pohl, IBCLC
Phoenix, Arizona USA
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