Mellanie,

It seems to me that this pediatrician’s suggestion is rather extreme. Is the
baby showing other signs of “failure to thrive” other than a drop in
percentiles on the growth charts? Is the baby otherwise happy, healthy and
reaching developmental milestones? Is the baby receiving only breastmilk or
has the mom started offering lower calorie foods (water or juice?) in place
of breastmilk? If so, she might be able to help the baby gain more weight by
substituting breastfeeding instead.

My daughter had a growth pattern similar to the baby in question. At birth
she was in the 90th percentile and although she continued to gain weight,
appear satisfied after each nursing and met all her developmental milestones
on or ahead of schedule, she was below the 5th percentile by age 1. Now,
nearly 3, she continues to be small for her age, with her weight completely
off the charts. My pediatrician expressed some concern about her weight gain
but I was able to convince him that she was fine by pointing to the fact
that she was developmentally on target and that my older son (19 months her
senior) had a similar growth pattern and also falls below the 5th percentile
on the weight charts.

The most recent edition of the Breastfeeding Answer Book (page 148) states
that an average weight gain for the breastfeeding baby six to twelve months
is two to four ounces (57 to 113 grams) per week. The references for this
statement are cited as follows:

Butte, N. et al. Infant feeding mode affects early growth and body
composition. Pediatrics 2000;106(6):1355-66.

Hashke, F. et al. Euro-growth references for breast-fed boys and girls:
influence of breastfeeding and solids on growth until 36 months of age. J
Ped Gastro Nutr 2000;31(Suppl 1):560-71.

Cohen, R. et al. Determinants of growth from birth to 12 months among
breast-fed Honduran infants in relations to age of introduction of
complementary foods. Pediatrics 1995;96(3):504-10.

Dewey, K. et al. Growth of breast-fed infants and formula-fed infants from 0
to 18 months: the DARLING study. Pediatrics 1992a;89(6):1035-41.


Hopefully this mom will have some luck sharing these references with her
pediatrician. Or perhaps she might want to consider getting a second opinion
from a more breastfeeding-friendly/savvy pediatrician.

--Karen Meade
LLL Leader, Suburban Philadelphia, PA, USA

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