Dear Wise Ones, I haven't posted in a long time, but I've been reading intermittently, just too busy to keep up. Of course now I'm back because I'm hoping someone will know more than I do about a particular child. I have permission to post. I've mentioned this baby before on Lactnet. He will be 1 year old on Oct. 30. He was born after a serious placental abruption and has anoxic brain injury. He has been G-tube fed since 1 month of age. His mother has pumped for him this entire year. Until about 2 mos ago, breastmilk was almost his exclusive diet. He has been very slow to grow. At almost 1 year, he weighs just 15 lbs, and is also below standard growth charts 3rd percentile for height and head circumference. He has been relatively physically healthy, though. We have tried repeatedly to increase the volume that he eats, but have been unable to as he just vomits more if the volume is increased. On the advice of a developmental ped, mom tried adding powdered formula to fortify breastmilk, but he doesn't tolerate this and just vomits more. In the last 2 weeks, he has suddenly started to have more intake by mouth. He is now taking breastmilk by bottle, about a total of 600-700 ml per day (21-25 oz) and also some pureed foods, mostly vegetables to which mom adds some additional coconut oil and infant cereal made with breastmilk. He is difficult to feed by any method, and this mom is very dedicated and spends much of her day pumping, feeding and caring for this little guy. She has been on domperidone since baby was about 3 mos old and continues to produce his current intake, plus a little extra. Here's the questions after all this background. Mom recently took him to the developmental pediatrician and he also had a repeat swallow study. I have not seen the report, but mom says they told her he had no aspiration with any consistencies, but that he had delayed swallowing with thin liquids and they are worried he may aspirate because of that. The developmental ped recommends thickening all thin liquids. Also, the ped was very unhappy about his weight, and told mom that she had "long out-lived her usefulness" pumping milk for this baby and that it was inappropriate for him to still be getting breastmilk. She recommended putting the baby on pediasure instead. This mom is very reluctant to switch to pediasure, especially since this baby has not tolerated any formula when she's tried it for fortification or supplementation. She wants to continue to pump for him through the winter at least, but she is feeling pretty discouraged after being told she had "outlived her usefulness." Is there any advantage to switching to a formula like pediasure (which is 30 kcal/oz)? Is there a way perhaps instead to fortify breastmilk to increase calories since we can't seem to increase his volume? Now that he is eating by mouth, is thickening breastmilk vital, knowing that he has never shown aspiration on a swallow study, just the delayed swallowing? I have told the mom that I'm out of my league here and that the developmental ped sees more of these babies than I do, but on the other hand, breastmilk is an important part of the diet of many healthy children of this age, so I don't see how it could be bad for this little guy, who certainly needs the immunologic protection. I am also friends with this mom, though, and feel I'm a little too close to the situation sometimes to be objective. (The dev. ped. told her "friends make bad doctors") Thanks for any insight! Jennifer Tieman Family Physician Mom to 4, including my nursling Caroline Rose (now 29 mos!) *********************************************** 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