Unfortunately, many HCP are not aware of any methods to assist with breastfeeding management. They tend to view breastfeeding as a yes/no sort of thing. If baby is breastfed and not gaining, the answer must be to add formula, while of course those of us with any breastfeeding knowledge know there are many things that can be done to optimize the breastfeeding, if this is needed. My partner is an older pediatrician with no good breastfeeding knowledge base. I'm slowly encouraging her to send her "poorly gaining" breastfed babies to me. I find that many of them are simply constitutionally small babies (often with matching small parents and siblings.) These babies often look great -- developmentally appropriate, happy, excellent output. Often, if I break down the weight gain on these babies I find that they have been consistently gaining, with some plateaus when becoming mobile, or during illnesses, or other not unexpected times. I talk to these parents about genetics, and point out all the positive signs that make me not worry about their baby. I encourage them to continue right on doing what they're doing. Some babies truly are not gaining well. For these babies, I explain to mom that my first goal is to feed the baby, and my second goal is to preserve breastfeeding since it is so important to the baby's health. Then we come up with a care plan to help the baby gain weight (sometimes including supplementation.) Often, telling the parents that maintaining breastfeeding is an important "medical" goal helps them keep going if baby is not able to get all their calories from mom. Interestingly, I've seen two babies lately that were weaned because my partner felt "mom's breastmilk was insufficient." One continues to be a very petite, but active and healthy infant. In the last 2 mos on formula, her weight gain continues to be just barely at the low end of normal, the same as it was on the breast. The other baby clearly has something else going on. He has gained only 15 oz in the last 2 mos (despite formula and high calorie solids), but also at 10 1/2 mos is not crawling or pulling up. I referred him to neurology for what looks like right arm weakness, and early intervention for occupational and physical therapy. I think neither one of these babies "problem" had anything at all to do with breastfeeding. If you have no breastfeeding knowledge, then you have no idea that there are things you can do to improve it. While I can make a difference in my partner, I'm not sure what to do about other HCPs. I do think sending a care plan to physicians is very helpful. If baby is gaining acceptably despite a worried MD, perhaps siting a source for acceptable weight gain in the breastfed infant is helpful. For the baby who is truly not gaining well, listing detailed instructions on what will be done to help the dyad, and what the follow-up will be may make peds more likely to wait and see wha happens. Jennifer Tieman Family Physician Mom to 4, including nursling Caroline Rose born 5/31/03 *********************************************** 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