I wondered if someone out there has some words of wisdom with this difficult
case I saw today. I will just give the most pertinent information. This is
the mother's fourth baby, exclusively breastfed, 6 weeks old, and still
significantly below her birth weight. The baby is otherwise bright and alert
and meeting her milestones. The baby seems to feed well at the breast, and
has at least 6-8 very wet disposable nappies, plus a couple of breastfed
bowel motions/day.

The interesting thing is that all three of the other children have had
failure to thrive, one not regaining his birth weight until over 3 months of
age. At that stage he was entirely formula fed, plus having medium chain
fatty acid preparations naso-gastrically overnight. Introduction of solids
also had very little effect on weight gains.  The next baby also received
naso-gastric supplementation. Although numerous investigations were done, no
specific diagnosis was ever reached. At one stage the FTT was thought to be
caused by a pancreatic insufficiency, but later discounted. By the time the
children reach 12 mths they are thriving.

The mother really wants to continue to breastfeed this baby as she feels her
supply is not the problem, and changing to formula in the past has not
helped her babies. She would like to supplement the baby with MCT mixed with
a little breastmilk with a syringe or feeding tube. Does any one have any
experience with this, or any other suggestions which will increase the
weight on this baby without compromising breastfeeding.

The mother is a well educated nurse who has read extensively. Her husband
has a PhD in a science of some description.
She is seeing the paediatrician for the first time on Tuesday.

Thanks for your help

Wendy Brodribb
Toowoomba, Queensland, Australia, where the first signs of autumn are
appearing.

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