LLL's recommended weight gain guidelines are a bit low on the bottom end.
They talk about a 1/2 oz/day (14 g) wt gain as being WNL.  It probably is
for a 10 month old, but it isn't for a baby in the first 4 months when 28g
or 1 oz/day is more normal.  If the baby has always gained at the 1/2 oz/day
rate, then this is prob. a very thin baby.  It is when babies drop across
percentiles that docs get worried.  There are all sorts of reasons why some
mothers don't perceive their baby as being in trouble with growth issues.  I
have had several moms with eating disorders who just couldn't bear their
babies to be "fat".  One had a child who was actually failure to thrive, and
she would not accept this information. Kept saying the baby "ate just like
her daddy"  i.e. was a picky eater. This kid was so malnourished she caught
every virus that came her way!

Sometimes a baby has a zinc disorder and has a poor appetite. Sometimes the
baby really does a lot of catch up growing as soon as adequate calories are
delivered.  The trick is to avoid empty calories and to focus on foods that
are nutritious.  Often moms over-emphasize carbs when breastmilk is already
a good source of carbs.  They might profit from skipping the cereal and
using pureed meats (buy range fed and stew them and puree at home -- much
superior to nasty comercial baby meats!). Other good foods are sweet potato
or avacado mashed up with postfeed pumped cream.  They can try rich foods
like egg yolk.  Strained fruits and veges are high fiber/bulk, but very low
cal.  Too much juice is associated with malnourishment.

  It doesn't sound to me as if the doc is being a beast per se.  He does
sound concerned.  I think it is a bit lazy to just push formula rather than
to find out why this child's growth is so slow.  Perhaps a few tests to rule
out anemia, zinc deficiency etc. and some better counseling about solids.
She can certainly increase her breastfeeds and use tried and true techniques
of breast compression etc.

Be aware that some moms 'doctor shop' and 'LC' shop until they find someone
who will tell them what they want to hear.  Denial is a powerful thing in
some people.  I wouldn't crucify this doc just on the info presented.

Barbara Wilson-Clay, BS, IBCLC
Austin Lactation Associates
LactNews Press
www.lactnews.com

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