I believe I left this saga at the point where the baby was 5 months old and by the mother's report, the primary MD was unhappy with wt. gain pattern and unwilling to consider the possibility of hereditary factors or weighing errors in earlier weights charted. The second opinion MD told her that in fact some mothers DO have too few calories in their milk - she KNEW because it happened to HER. The mother had no real choice in health care except to use this facility. The mom (with mild CP) had been forced to sign a contract not to breastfeed at all (not even for comfort) for 2 weeks, with all feedings to be of ABM, to which the mother decided to add 1 tsp. cereal to each bottle. (This stopped the reflux.) The MD approved her decision. After the MD's warning (read "threatening"?) the mom that the baby might have to be hospitalized if not at least 13# by the next visit, she continued pumping but fed ABM, 6-7 bottles daily, round the clock. Her freezer was so full of pumped milk that she discarded the older milk in order to freeze what she kept pumping. Several tests to rule out UTI and other infections were done at the next appointment. When the baby did reach 13.5 # on the enforced ABM feedings, the MD began "permitting" her to nurse for comfort from 7 p.m. to 7 a.m. That of course placed the ABM feedings during the hours when she had sole responsibility for the toddler as well as the baby, without her husband home to help with the manual dexterity that might be needed in giving the bottle. > > The mother is currently gone for 10 days on vacation to relatives she feels are unsupportive. Perhaps her enforced regimen may turn out to be a blessing in disguise, as she can bottlefeed in the daytime when and where they can see her, and breastfeed in privacy during the night. This family is so dependent on this health care system, with which the WIC program has no direct influence, that to prevent increased stress on the family, we felt it was best to validate her courage and devotion, provide her accurate information and support, but let them manage the interaction with the physicians. There were some (no doubt younger and less battlescarred than I) who were so incensed by this case that they wanted one of us at WIC to sort of charge in on a white LC steed and try to rescue the situation. In my experience, that would have made the physicians defensive about their obvious ignorance regarding certain aspects of breastfeeding, and perhaps become more punitive to the mother. It would have further soured relationships between that facility and WIC that would be harmful to future patients. We may ultimately decide to provide the mom with a printout of all the responses received, and the name of a breastfeeding-friendly local lawyer, and let the family decide what to do or not do in relation to the physicians. Thanks to all who responded. K. Jean Cotterman RNC, IBCLC Dayton, Ohio ___________________________________________________________________ You don't need to buy Internet access to use free Internet e-mail. Get completely free e-mail from Juno at http://www.juno.com/getjuno.html or call Juno at (800) 654-JUNO [654-5866]