Hello,
I need some help with a situation that is only marginally about
breastfeeding.  I've been contacted by a mom of a 28-month-old girl
who is quite small in height and weight.  I don't have exact numbers
right now (will get them soon - I only know her weight is around
22-23 lbs), but she is off the low end of the growth charts.  She was
exclusively breastfed as a baby and continues to nurse regularly,
several times a day.  She has always been small.  She has also always
been in excellent health, has reached all developmental milestones,
and seems to be a perfectly normal though tiny little girl.  She is
the younger sibling in a family, and the older sibs are small too
(though big enough to be on the charts).  Mom is petite and
small-framed, and dad is of average height but slender.  The parents'
infant growth records are not available.

The family has just switched health insurance due to a job change and
the new insurance company has refused to cover this child due to her
small size.

The mom is looking for any information to help her argue that her
daughter's size is not a medical problem.  The growth charts for
breastfed babies on the Promom site only go to 12 months, so they
don't help.  The CDC/NCHS growth charts are essentially the same as
the ones her doctor uses, which show the little girl being below the
3rd percentile (off the charts).  I have scoured Lawrence and Riordan
& Auerbach but all the information on slow growth is for much younger
babies.

A PubMed search turned up some abstracts that are interesting but I'm
still looking for a "silver bullet".  One study (Rohn RD, Am J Dis
Child 1990 Sep;144(9):995-7) concludes that genetically
short-statured children are more likely to have a very short mother
than children who are short for other reasons.  The father's height
was not related to the diagnosis for the child's short stature.

I wonder if anyone out there (peds or ped. nurses?) can point me in
the direction of sources that can help this mom establish that her
daughter's small size is not pathologic.   Also, any suggestions on
questions to ask the mom at this point?  Are there things that would
indicate fairly conclusively that the child's small stature is
genetic and not endocrine-related, for example?

Warmly,
Margaret
Longmont, Colorado

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