To recap: 16 m.o, no wt gain 12-15 months, some anemia (resolved?)
> My questions: IF breastmilk is the nearly exclusive source of
> nutrition for a baby of this age ... What else should we be suspicious of about the cause of
> this problem, since we know that breastmilk and breastfeeding are not the
> problem?
>
First of all, did baby grow in inches? It seems the body gains weight OR
grows inches but not both at the same time and this is the age of a
normal slowing down of weight gain anyway. (Works the same in reverse
too - hence our "weight-loss plateaus" during dieting - that's when
we're losing inches). If so, it is probably OK. But I'd watch it.
Next, how big are the parents and what were their infant growth charts
like? I've often put the whole problem "to bed" once this information is
acquired (it is amazing how genetics play into this, though I know that
nutrition can and does allow genetics to manifest as intended.
Nonetheless...)
Finally, are you certain breastmilk and breastfeeding are not the
problem? While working in pediatric GI research at Childrens Hospital
Los Angeles, I was aware of an older infant in this age group (18
mo)-exclusively breastfed with little or no solids - admitted in serious
condition with Kwashiorkor (AKA protein-energy malnutrition) right here
in Los Angeles!!. Your reference to "some anemia" (how recently was this
anemia?) reminded me of this case. The underlying problem? Mom was a
strict vegan, i.e., *not even* lacto-ovo, *but only* vegetables and
grains. Mom's nutritional status was anemic with significant lack of
B-12 among other things. Her body could not produce for baby what wasn't
there to begin with.
Another case we had of an exclusively breastfed infant admitted in
severe electrolyte imbalance (though I believe this one was closer to 6
months old) was, again, a nutritional problem in mom. This time it was
because mom resumed her anorexic eating patterns after the pregnancy -
she was a Major Anorexic, too.
I would do a very careful dietary analysis of mom's diet and do alot of
listening.
Why does she think baby isn't eating solids? Is it an aversion to food?
If so, can you rule out esophagitis or esophageal ulcers?
Is it because of poverty and there is no money or knowledge of community
resources to purchase food? I once consulted with a family who was
destitute and *needed* to exclusively breastfeed their 1 year old (they
were not eligible for WIC - it's a long story - but I encouraged mom to
drink an instant-type breakfast drink at least once daily and helped her
choose quality food with the money she had) - I recommended demand
feeding at least 8-12 times daily (lots of water for mom) with careful
weight checks regularly - it worked - baby was small (10%-ile) but she
was small to begin with and actually kept her own growth curve. She is 8
years old now and in the 34%-ile - completely healthy (and quite smart).
Is it simply a lack of culturalization to eating? Does baby get to "sit
in" on meals with the rest of the family? Have her sit on a parent's lap
and allow hand-grabbing/finger-feeding (with appropriate foods, of
course).
Just some thoughts. Hope they trigger other thoughts for you.
Katharine West, BSN, MPH
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