Hello, All:  Permission from mom to post.  I saw a 4 month old yesterday in 
the office who was referred by ped for slow weight gain.  He is exclusively 
breastfed.  I know mom from her 1st baby who was born at my hospital - she 
nursed her for 5 months. 1st baby was a 34 weeker and was in our SCN for a 
couple weeks.  This baby was born full-term at another hospital and mom 
until now was very confident in her ability to breastfeed - she feels this 
2nd baby is a much better nurser.  She had persistent plugged ducts with 
1st as she felt she was a lazy nurser - this guy nurses like a "vacuum 
cleaner".  Baby does not look skinny, very long, though.  Mom says all the 
men in her husband's family are well over 6 feet and his nickname as a kid 
was "Beanpole".  Baby is in 50th percentile for length and only 5th 
percentile for weight according to the "old" growth charts.  He nursed 
beautifully in office - mom had concerns about his easy distractability.  
We discussed nl 4 month-old growth and development.  Mom was told by ped 
that she was only giving her baby "skim" milk and needed to give the baby 
more "hindmilk".  Told mom she would have to start supplementing with 
formula - both soy and cow's milk base present a potential food allergy 
problem.  Mom has already priced Nutramegin, based on ped's recommendation 
and is not happy with the expense - she's been given 2 weeks to get his 
weight up.
Well, I plotted baby's weight on the new growth charts based on breastfed 
babies and he plotted out in the 93rd percentile for weight!  95th 
percentile for height and when I plotted his length/weight against himself, 
he was hanging off the bottom of the chart which was not surprising, given 
that his appearance is long and lean!  His head circumference is within 
normal and developmentally, he assess out at or above the 4 month 
milestones.  We discussed possibly starting solids a little early, if need 
be, rather than going to formula, which mom really does not want to do.
I faxed copies of baby's breastfed growth charts with my report to the ped 
and will be interested in what her reaction is.
I am distributing the growth charts to the moms in my support group.  They 
are interested in plotting and comparing their babies' progress when they 
take their babies in for the well baby checkups.
I will also distribute the growth chart packets at the July pediatric 
department meeting to the peds offices.
I am astounded at the difference in the growth charts, even tho I know I 
shouldn't be!

Pam Hirsch, BSN,RN,IBCLC
Clinical Lead, Lactation Services
Advocate Good Shepherd Hospital
Barrington, IL   USA

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