Lisa Paul asked about improving the weight of a baby who is six months old.  Possibly because I have an interest in the weight gain of infants older than three months, I tend to see all those babies who start to fail in their growth after the three month mark.  

To date, I have never ever seen a single baby who is not growing well because there isn't enough fat in the milk.  In fact, Cathy Genna posted references to about 5 studies that show that it is the VOLUME NOT THE FAT that counts.  What Lisa did not report was the baby's intake from the breast.  The notion of stuffing slow growing babies with fat to make them grow is a notion that my teenage son might call "so last century". This may be one of many potential causes of the U-shaped curve of those who grow poorly early on having greater risk of obesity later on.  So, I'm going to paraphrase Nancy Wright about what they found when they were stuffing premies with extra fat "All we did was create fat babies, not healthier babies". 

The majority of the causes of slow gain are:
* infrequent feeding
* aggressive sleep training
* block feeding (which I find is a very common cause of faltering at three months)
* undetected suck swallow problems including restrictions of the tongue and lips

In this case -- the first two can be ruled out.  The third can only be evaluated with a current pre and postfeeding weight check. What happened at two weeks is likely to change.  I cannot even tell you how many mothers I've seen with a copious supply whose babies are actually drinking a good amount of milk with single sided feeding whose babies actually need the second breast around 3 months of age.  How much can this baby actually drink at a feed?  

So, even if the mother has a good capacity to make milk -- if she is not pumping at all she is only making as much milk as this baby is asking for and this baby is clearly not asking for enough unless there is an undetected nutrient deficiency.   In all likelihood, this baby needs more milk period.  Between drinking more milk to grow enough to compensate for growth related developmental delays and having green stools, the choice should be clear.  Developmental delays are far more risky than green schools. So I'm going paraphrase Jack Newman on this one and saying "wear sunglasses".  And also suggest that the baby be fully evaluated for suck swallow problems including a very thorough examination of possible restrictions of the tongue that may not be visually evident.

Less commonly the causes of slow gain can include:
* nutrient deficiencies in vitamin D, zinc, and iron
* undetected metabolic disorders

So, in terms of offering foods, yes it is important to have sources of fat but it should not be pushed in exclusion of the two nutrients that are most needed around six months of age -- which are iron and zinc and the "hormone" that we should get from the sun but have to balance with the risk of skin cancer -- which is "vitamin" D.  And solids should not be pushed to the point that the frequent intake of breast milk is suppressed either.   Since the baby is ONLY six months old, I seriously doubt that not offering solids with fat is the cause and I would recommend against a teaspoon of oil at every feed.  

Sincerely, 
Susan E. Burger, MHS, PhD, IBCLC, RLC

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