Karleen asks:

Why would this be the case? I know that mothers are often told to wean in
order to get their child to gain weight but I've yet to see any evidence
that this is helpful??
Karleen Gribble
Australia

> Very rarely I have seen a mom have to wean completely in order for her
child
> to start to eat enough.  Sad, I know.  Complex and sensitive issue.  
> But
am
> reminded of Coach Smith's Rule No. One - Feed The Baby.

Ruth Lawrence has good input on this issue pp442-3 in Breastfeeding, a guide
for the med profession, 6th edition, where she discusses nonorganic failure
to thrive.  

I work in a very large clinic and am the last resort referral for a
physician who has tried everything, tested everything and baby severely
undernourished.  Given the volume of families that come to me it's
inevitable I'm going to see some cases that are most unusual.  Let me
emphasize again that is is very rare for me to meet a baby who would rather
underfeed at breast than fill up with solids appropriately offered.  But,
just as a very few women have insufficient glandular tissue, a very few
babies love love love the breast to the point they are content to underfeed
beyond a reasonable point.

This situation is totally totally different from the benign underfeeding at
breast in early months, usually easy to remedy by correcting breastfeeding
management, and from that drop to lower weight percentiles in 2nd year that
may make a few physicians queasy - but in fact there's no problem.  The ones
I'm talking about have reached point where head circ %ile is dropping,
length %ile is down significantly, and weight is far below the curve.

Sometimes the mothers are most concerned.  Strikingly, some are not (Ruth
Lawrence has good explanation for this talking about "parental
misconception").  She also mentions "vulnerable child syndrome" (ref
O'Connor and Szekely) - children gain fine for 5-6 months and by 8 months
weight/height score has decreased dramatically.  Intake of solid foods
minimal.  Bfdg pattern is frequent day and night. "Further investigation
revealed numerous household stressors and usually the mother's need to
maintain control by breastfeeding." 

Please don't send me flaming emails - these are Dr. Lawrence's words, not
mine!!

Lawrence does not give any solutions, but the cases cited make it clear that
there may be extremely unique and very unusual situations where bfdg isn't
working.  I do what I can to repair the breastfeeding but have noticed (this
would be a choice made by the baby's hcp and the mom) an extraordinarily
rapid recovery of length/weight when bfdg is minimized or eliminated (tho
mom may pump what milk she has).

Not a happy situation.
Joanna Koch  

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