I'm writing today looking for some support and feedback.  I've been
     working with a breastfeeding mom who has recently come with concerns
     regarding her daughters weight gain. Or maybe I should say come with
     her physicians concerns over her daughters weight gain. With her
     permission, I'll share the story with you.

     This toddler is now 18 months, 17lbs, 30 1 1/4 in. and is <3rd
     percentile for head circumference. (This has been the pattern since
     birth). Her birth weight was 4lbs. 10 oz. Today she is healthly, not
     wasted and developmentally normal. She eats small portions of table
     foods (x3 daily with family) and has snacks inbetween. She generally
     breastfeeds 4-8x's/24 hrs (including night feeds) plus numerous
     breastfeeding snacks. I would say that her intake is 80% breastmilk
     and 20% solids. She plays with her other siblings and is sleeping on
     average 9-11hrs daily. The other siblings in this family were all
     small, just not quite as tiny as this little girl. Prior to this visit
     with their physician the parents were not at all concerned about her
     growth and development. They have now been told that she (the
     daughter) will be followed up in two months regarding her weight.

     I think I've given you the pertinent details. What things should this
     mother be looking for with her daughter? Do you think there is any
     reason for concern? What advice can I give her regarding her
     physicians concerns.

     Thanks in advance for your help. I think that this is just a tiny
     little girl and she is otherwise healthy. But unfortunately, the
     family physician has now planted a seed of doubt and I would like to
     be able to help prepare these parents to deal with the physicians
     concerns. (especially when changing her breastfeeding habits is not an
     option!)

     Erna Snelgrove Clarke RN, MN, IBCLC
     Halifax, NS. Canada
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