I am Peggy Talsness... an RN., BSN, IBCLC working for Otter Tail County WIC and Public Health in Fergus Falls, Minnesota.  We have 4 grown and growing up children, ages 17-26, all breastfed for a long time...and a 2-year-old grandson, breastfed almost to age 2, with a sibling on the way in July!  We live in the wide-open countryside near Phelps Mill.  
I am seeing a 24-year-old woman, 1st pregnancy, EDC 9-14-02.  She has a diagnosis of "hypophosphatemic Vitamin D resistant congenital rickets", which she translates as "my body doesn't 'recongnize' calcium--it is excreted in the urine."  The condition is a chromosomal abnormality limited to her family--father and female siblings.  She has had multiple fractures in her lifetime and lives with fibromyalgia.  And she REALLY wants to breastfeed her baby.  She sees an endocrinologist for management of symptoms.  He encouraged her to breastfeed and supplement with formula to be more sure of meeting the nutrient needs of her baby.  Her body must retain and properly use SOME calcium or nothing would work.  I would appreciate some insights on advisability of breastfeeding (the baby would be getting all those immunities and other nutrients--but would it be missing critical ingredients?) and management.  I know we'll be working closely with the pediatrician but I want to have a more solid foundation of breastfeeding/breastmilk information--I feel a little weak and shaky going on what I know and can find in written references (which I will admit I haven't taken time to search extensively).  Are there "tests" to determine breastmilk content?  Are there tests to assure adequate nutrient levels in the baby?  I look forward to your lively discussion and responses!  PT

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