I need some input from you all on this case.
A mother called me yesterday asking for advise.  Her baby daughter is 1 year
old with very poor weight gain and constipation.  This is her second child.
Her first did not breastfeed well so mom switched to formula.  That child's
weight had always been in the 50th%.
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.  Some
feedings are short and mom always nurses on both sides.  She has the baby in bed
with her at night.  She started solids at 6 months but this baby has never been
very interested in eating and had difficulties handling food.  Does not like a
spoon, only takes food in with her hand.  Just now, at 1 year can handle
eating a cheerio.  There is no history of any food allergies in the family.  The
mom recalls that the constipation started prior to the introduction of solids.
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.
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.  There has been some blood tests taken recently also.
This mom tried this and is down to 5-6 nursing, the baby does not like the
Pedisure and unhappy not nursing.  Mom does not feel this is the right plan.
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.
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.  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.
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.
Sorry for such a long post.
Ann Perry, RN, IBCLC
Boston, MA

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