Hi, Mary!

I am a registered dietitian who worked with children with failure to thrive for many years. Here are my thoughts:

1. "The child did not gain any weight in a month and has been slowly dropping in her weight percentile from 50% when she was 9 months old to 5% now.  Her height has remained in 50%. " This is unusual, but not unheard of. During the first two years after birth children typically adjust to their genetic potential for size from their size at birth, which is related to their prenatal nutritional environment. I would want to know: a. her weight for length percentile and b. her parent's growth patterns at a similar age.

2. "The doctor feels that the night nursing is interfering with the child consuming calories from solid foods during the day." I basically agree with the others who have said that it's easy to blame what you don't understand. However, this could be true if the child weren't eating during the day, which it seems is not the case. Bottom line for weight gain is calories (combined with genetics and "love" - oxytocin, physical contact and a loving environment).

3. "Ped wants child to consume protein rich foods during day time. Mother reports that she eats 3 small meals a day plus a few snacks." I would encourage the mom to document (as accurately as possible - measure prior to serving and after finished eating) what the child eats for a few days. This would help the pediatrician and pediatric dietitian to see what the child is actually eating and estimate the child's calorie intake. If the calorie intake is good, it may support the need for a referral to a pediatric endocrinologist or other growth specialist.

4. "Can anyone explain what might be this doctor and dietitian’s rationale?" Obviously, not knowing what they know or have evaluated, I can't know their rationale and it may be perfectly valid. It may be helpful to reach out to them to garner more information (with her permission, of course!). I would want you to do this if it were me - it's always possible that the mother misinterpreted what they were saying or why they said it and there may be more to the story than what she is sharing. Also, any time a parent questions a professional's recommendations I encourage them to get a second opinion from a similar professional or an expert in the field of concern - in this case growth.

I hope you find this helpful and I wish you the best outcome for this situation!

Nancy Gray, MS, RD, LDN, CLC

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