I was speaking with a mom recently about her petite breastfed
pre-schooler, and I mentioned Lactnet to her.  She gave me permission to
post and would appreciate any feedback anyone might be able to provide,
either from personal or from professional experience.

Her daughter turned 3 years old at the beginning of May and she is very
small (< 3%).  Her family physician has been concerend about her size,
and referred her to a pediatric endocrinologist who feels that in the
absence of underlying medical conditiions that lead to short stature, a
child that is not on the growth curve is *always* the result of lack of
nutrition, inappropriate nutrition of a combination of both.

The endocrinologist informed the mother that she considers her daughter
"definitely undernourished, not malnourished to the point of abuse or
neglect, but definitely undernourished".  She added that she was by no
means telling the mother to stop breastfeeding, that is not at all what
she was telling this mother, however, if she continued to do so it was
at her own risk of jeaordizing her daughter's longterm health.

The mother is herself knowledgeable about breastfeeding (she is an RN
colleague of mine who teaches prenatal, including the breastfeeding
class) and presenting the endocrinologist with research based arguments,
the endocrinologist then added to the mother that she "appears to be
very informed, but surely as a mother she wouldn't do anything to
purposely harm her child".

The endocrinologist feels breastfeeding at age 3 is interfering with her
daughter's appetite, and she should be on solids for all of her
nutritional needs at this point.  She is convinced this mother is not
feeding her daughter at all, other than breastmilk, and when she does
happen to feed her child, she feels the mother feeds her things like
gummies all day long, and other equally inappropriate foods, none of
which is even true.

Bloodwork and bone age x-ray are normal.  The pediatrician on call
corroborated her assesment though, when it comes to a 3 year old
breastfeeding, and filling up on 'empty' calories, interfering with
appetite.  This mother will be meeting with a dietician in July, at the
ednocrinologist's insistance, and she is to return for a follow-up
appointment with the endocrinologist in October.

This mother is very scared her daughter may be removed from her care at
any point breastfeeding is seen as 'abuse and neglect'...

She consulted with an LC who did a pre and post feed weight, and in half
an hour of nursing her daughter took in half an ounce (15 ml).  The LC
doesn't feel the child is nursing for nutritional needs at this point,
but for immune factors, etc.  Her daughter is apparently the healthiest
member of the family; she rarely, if ever gets sick, and when she does
she bounces back very quickly.  The LC doesn't feel the child's nursing
could possibly be interfering with her appetite, which is normal for a
pre-schooler, who does eat a variety of nutitious foods.

Apart from being small (there are very petite women on both parents'
sides of the family), the LC found the daughter to be healthy, active,
developmentally right on track, appropriately verbal, with good skin
colour, muscle tone, hair sheen and sparkly eyes - none of which would
be possible if she were indeed undernouished.  This is the first health
care professional who can see beyond the chart and look at the whole
child, as part of her assesment.  This particular LC has previously
worked in a hospital and has seen undernourished/malnourished pediatric
cases, and she feels the daughter is fine, just a small person, very
similar to the mother's build.

The mother has just today found a new family physician who concurs with
the LC's findings.  This doctor is not prone to unnecessary intervention
and is supportive of normal duration breastfeeding.  Depending on the
second opinions the mother can find locally, she mentioned she being
prepared to bring her daughter to Toronto to see Dr. Newman for a
consult, if need be.

If you have any personal and/or professional experience with petite
breastfed children, this mother would find any feedback most helpful.
It has been a very emotionally trying time for her.

Thanks. Kathleen

Kathleen Bruce RN IBCLC
Independent consultant: Breastfeeding Clinic of Vermont, Lactation
Resources of Vermont, Medela, Inc.
Listowner Lactnet listserv
[log in to unmask]
Archives: http://peach.ease.lsoft.com/archives/lactnet.html

             ***********************************************

To temporarily stop your subscription: set lactnet nomail
To start it again: set lactnet mail (or digest)
To unsubscribe: unsubscribe lactnet
All commands go to [log in to unmask]

The LACTNET mailing list is powered by L-Soft's renowned
LISTSERV(R) list management software together with L-Soft's LSMTP(R)
mailer for lightning fast mail delivery. For more information, go to:
http://www.lsoft.com/LISTSERV-powered.html