This sounds like a complicated situation that the nurse in the doctor's
office is mishandling by trying to forcefeed formula.

It is not unusual for breastfed children to drop percentiles in the
latter half of the first year, but this child has gained almost nothing
in 3 months. That is unusual during the period from 6-9 mos (though not
so unusual at 9-12 mos).  The mother's pregnancy might be partly
responsible, especially if there is a reduced milk supply, but so might
the type and amount of solids offered, the history of allergy, and the
baby's oral motor skills and gi status.

Things to look for:
Can the baby handle coordination of swallowing and breathing with the
cup and solid foods?  Some kids refuse to eat because they have
difficulty handling the solids.  I have seen several tongue tied
toddlers who were losing weight because of difficulty eating, despite
being able to breastfeed with the tongue-tie as infants.

What specific foods is she eating or being offered?  At 9 mos, most
children can handle true solids- scrambled eggs, bits of meat, veggies,
fruits, grains and breads.  If the mom is only serving low calorie jar
foods (which contain a lot of water in order to puree them) the child
may be filling up on volume and not getting enough calories.

The hx of allergy is highly significant.  Some allergic babies refuse to
take solids before about a year old, due to discomfort from allergy.  It
is very unfortunate that this mom is pregnant again so soon, her milk
would have been able to maintain her child better than formula and
solids will if she is a picky eater.  I'd explore the possibility that
the baby is allergic to the soy as well.

GI issues such as reflux that make it uncomfortable to feed should be
checked out too.

Finally, parenting issues are important to explore.  Is mom doing some
program where she slaps the baby's hand for exploring the food?  Are
mealtimes forced and disempowering for the baby?  Is mom so frantic that
the baby is getting the idea that food is dangerous?

I'd also want to reassure this mom that this is not necessarily a
breastfeeding problem, but more a problem with other foods in the baby's
diet (or the reduced availability of breastmilk due to the new
pregnancy), so that this mom does not think that she has endangered her
child by bf her.  This is obviously the impression she has gotten from
her health care provider.  Sigh.

A great book to read for strategies for these complex feeding issues is
PreFeeding Skills by Marsha Dunn Klein and Suzanne Evans Morris
(available from Therapy Skills Builders, http://www.psychcorp.com ).
It's a bit on the expensive side, but well worth it.  Less than 10 cents
a page!
Catherine Watson Genna, IBCLC   NYC

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