Ann writes:
"A mother called me yesterday asking for advise.  Her baby daughter is 1 year
old with very poor weight gain and constipation. <snip>This baby was born in
the 50th% then over several months dropped to 25th%, then 5th% and at the last
appointment lost some weight.  Her height has maintained in the 50th%.  We
did not discuss head circumference. This baby enjoys breastfeeding and continues
to nurse 8-10x/day."

Perhaps you or someone else has ruled out food allergies, but if not, I am
surprised at the recommendation to feed this baby dairy foods. This is a very
common scenario with food allergies--abnormal stooling patterns, poor weight
gain and developmental impairment. In your post, you say that the baby was
"constipated" before solids, lending even more credence to the idea that this baby
may have food intolerances.

You also say:
"She started solids at 6 months but this baby has never been very interested
in eating and had difficulties handling food."

Again, delayed interest in solids is also common with allergies.  You do say
that there is no history of food allergies, but I often find that this is
untrue, even when parents believe it is true. For example, people who constantly
produce mucous or are constipated often think this is normal, when it is
actually symptomatic of allergies. There are far better foods to help babies gain
that dairy foods, IMO. I would suggest flax oil, cod liver oil, avocado, coconut
milk and coconut oil, rice protein powder, beans (like in hummus or refried
beans) and nut butter (like almond).

"She said the baby would go 7-8 days between stooling, then the day before
and the day she stooled she would be miserable, appearing uncomfortable and in
pain.  She would have 6-7 stools in one day.  I did not get a description of
the stools.  She has since put her on metamucil and now she goes 3-4 days but is
still just as miserable."

Stooling more often by force would not make anyone more comfortable,
especially when there is an underlying problem, so I am not surprised the baby is
miserable. Someone needs to be willing to find out what is causing this bay's gut
distress. I beleive 100% that gut health defines  neuroligical health, so
developmental delays sure make sense here.

"Her pediatrician sent her to a GI doctor who told her that the number of
nursings a day was not normal for a baby this age and contributing to the baby's
trouble and why the baby won't eat.  This doctor told her to cut the nursings
down to 3/day, give Pedisure (which is 29cal/oz) and stop all feedings at
night.  "

This would eliminate this doc's credability , IMO. Even a robust baby might
well be nursing this often at a year. And, since Pediasure is junk food at its
worst (contains most common allergens--soy, cow milk, corn, contains
artificial flavors, synthetic vitamins, sugar and poor quality oils). I would again
encourage this mother to seek better care. I would want to know if this baby has
been evaluated for gluten intolerance and cow milk allergy. Has the baby ever
been exposed to artificial milks? What is the mother's diet like and what was
it like while pregnant? Are the stools pasty, is there any blood or mucous?

"She also pointed out the baby is very slow at meeting developmental
landmarks. She was very slow to roll over and is just now pulling her self up."

While I agree that a thorough evaluation is in order, I think it would be
premature to rule out diet as a factor. Beyond food allergies, how about a zinc
deficiency--a situation we are seeing more and more often? This is simple to
solve, but would account for every symptom you describe, especially the
disinterest in solids.

"My assessment was not to stop the night nursings, since the baby needs all
the intake she can get and be happy.  Do only one side nursing so the baby
could get a higher fat intake.  The solids introduced should be high fat/calorie,
such as avocado and butter. "

Ann, have you considered whether or not this mother's supply was compromised
all along--perhaps an oversupply that led to loss of supply later on,
inefficient latch, use of chemical contraceptives, smoking, anything at all? What
about the mom's nutrition--perhaps it is really quite poor and fat content of milk
has been a problem?

" Talk to her pediatrician about the baby's delayed develomental growth and
difficulties handling solids, and seek out an OT who does feeding evaluations.
Also to ask more about tests for her baby."

I do agree that all avenues should be explored, if needed. Still, I prefer a
CST or PT who does Integrated Manual Therapy to an OT in almost all cases.

"My feeling there is something going on with this baby and she is fighting to
survive with nursing.  To take that away would be very detrimental.  I could
use any insights from this group that I could pass onto this mother."

I agree. Have you looked into this baby's birth? What has her personality
been like--fussy, content, too placid, colicky, etc? I recently saw a baby who
was diagnosed as FTT at 8 mos (had been weaned by 3 mos), was delayed
developmentally and was facing a feeding tube--ped told her to relactate. I referred her
to a PT who does IMT, as her weaning story didn't sit right with me. She said
that she was constantly engorged and having recurrent bouts of mastitis. I
was convinced that her baby was breaking suction while nursing, not emptying
well and causing plugged ducts. When the PT saw the baby, he said that her
problems stemmed from birth trauma, affecting the mobility of her diaphragm and
causing her to have to open her mouth to breathe. A cascade effect was set into
motion and the ensuing leaky gut escalated her problems. IMO, bodywork is often
called for when babies are not gaining and are developing poorly.

Again, I do not know what has been explored, but I hope this is helpful.
Jennifer Tow, IBCLC, CT, USA

Kathleen Fallon Pasakarnis, M.Ed. IBCLC
Nurturing Family Lactation and Parenting Services

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