I had a little run-in with our renal attending physician last week. A baby was admitted from the Middle East with extreme malnutrition and congenital kidney disease for a genetic and metabolic work-up. She was 6 months old, breastfeeding and bottle feeding formula and weighed less than her birth weight. The speech pathologist was consulted to assess feeding skills and she suggested that they contact me to evaluate effective breastfeeding. The renal dietitian also suggested a lactation consult. When I went to see the mother and baby, I noticed a note in the medical chart from the attending physician stating that the mother badly wants to nurse the baby, but that this should not be allowed. So I approached him and asked why he didn't want the mother to nurse the baby. He replied "Well, of course there's no milk there or else the baby wouldn't be so malnourished." Then he said, "It's the need of the mother to breastfeed the baby. The baby does not need to nurse." I couldn't believe he said that! First of all, it IS the need of the mother to be close to her baby and what's wrong with that anyway!! This mother has every right to breastfeed her baby. And besides, how does he know that the baby doesn't benefit from the comfort of breastfeeding as well as the immunologic properties of the breastmilk. In any case, the mother (who doesn't speak much English) with support from the nurses (who somehow missed the orders against breastfeeding) continued to breastfeed her baby several times a day while hospitalized. The baby gained some weight on 16-20 ounces of concentrated formula a day, and a test weight on one breast showed that the baby received an ounce of breastmilk in less than five minutes, so I know she's getting some of her mother's milk. I told the mother to continue breastfeeding as long as she and the baby want to (which is exactly what she planned to do) with formula supplementation. I don't think this physician likes me very much. My job can be extremely frustrating. Rachelle Lessen, RD, IBCLC Children's Hospital of Philadelphia