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Subject:
From:
Scott and Kate <[log in to unmask]>
Reply To:
Lactation Information and Discussion <[log in to unmask]>
Date:
Sat, 3 Mar 2001 09:53:56 -0500
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Dear Alexis,

First of all, infant heights are notoriously inaccurate especially if they
are done in the usual pediatric office way- lay the kid out on the paper and
draw lines. It sounds as though mom is also long and skinny so why shouldn't
her child be too? To be sure, you need to confirm all the important stuff-
that the infant is actually nursing plenty, that the mom's diet is adequate,
that the mother is actually letting down, etc. Is the infant falling off her
own growth curve or just skinny? Even the most well intentioned parents may
not really be feeding their kid for whatever reason and if she is mostly
nursing, the mom's diet needs to be excellent. This may be a mis-guided
well-intentioned pediatrician OR this may be a very astute and well-informed
pediatrician with a very reasonable concern and a kid who is grossly failing
to thrive. My chart puts this child at the 90%ile for height and the 5th for
weight. That's a pretty striking spread but one point does not make a curve.
What was this child before? Is this a significant drop?

Second, there seem to be two problems (or perceived problems) THe first is
that the child likes breast milk a lot and is not really interested in
solids and the second is that the infant will not chew. I am far more
interested in the second problem than in the first. I think that the first
problem is going to fix itself eventually. Anecdotally, my daughter was not
even INTERESTED in food until 10.5 months when one day she suddenly decided
to eat.

Getting the child to chew is in my mind more important. Will she eat
Cheerios? These are a good way of getting a kid to chew since the slightly
grainy texture makes them move it around in their mouths. Start with crushed
1/4 cheerios (yes, I actually break each one in 1/4's). Crush each one
individually and put it in the child's mouth. You then work up to 1/4
cheerios gradually and then to 1/2 and then to full size cheerios.

Also, find out of this mom has a baby food grinder (my favorite is the Happy
Baby food grinder available from the natural baby catalog for about $10.95-
no, I don't have any investment in them.) That's really good for mashing up
food while still retaining some consistancy to aid with chewing.

I agree with offering high fat foods: refried beans (not the fat free
version) are a good example. I also like avocados if there isn't any history
of allergies. Who said she had to give yogurt, her or the doc? Regardless,
make sure that the yogurt is whole milk- not fat free or low fat.

I think that it makes sense to offer food first then breast milk but I think
it's not so great to LIMIT the breastfeeding- if you see the distinction. I
would also try to emphasize the social aspects of eating- eat in front of
the baby, share mom's food with her. Let her eat off mom's plate (safe foods
only please). A 15 month old will probably like feeding her mom just as her
mom feeds her. You might also suggest some role playing of feeding a doll or
stuffed animal.

Let me know if this helps. By the way, I have a recipe for risotto if she
wants it.

Take care,

Kate

Kate McIntosh MD FAAP
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