>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.

>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.

What will they think of next? On what basis are they refusing coverage?
Does small size count as a pre-existing condition? The charts are
averages. Averages only apply to large populations, not individuals.

Someone has to be on the low end of the chart, or even off the chars.
If not, the charts would look different!

Two of my kids were born at 2 kilo, 4.5 lb. One was term but small (SGA),
the other was preemie. They are both still on the small side. My now 12
year
old (the SGA) is still on the very bottom of the chart, but he is healthy,
athletic, and growing. I feel very fortunate to have a pediatrician with
some perspective (he himself is abou 5'2", so he certainly has perspective
on this issue.) His criterion is not where the kids are on the chart, but
that they are following the growth curve wherever they are on the chart.
Is this little peanut following her own curve?

Can this family get their pediatrician to back them up? Does the insurance
company have to answer to anyone questions like on what basis are you
refusing
coverage? What is the mechanism for appeal?

>Are there things that would
>indicate fairly conclusively that the child's small stature is
>genetic and not endocrine-related, for example?

Can she set up a consult with an endocrinologist? There are tests they
can do, not fool proof tests, but they might help convince the insurance
company.

I hope others on lactnet with professional expertise, not just personal
experience in this area will weigh in on this one.

Naomi Bar-Yam

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