>Got a call from a mom who wanted information to support her continued breastfeeding of her 14mo daughter.  Although her daughter is only 15 pounds<

 From the way you have reported this, it is a classic of how not to use 
weight -- of course I realise that this case comes to us third hand, so this 
may not be an entirely fair judgement! 

'Stunted' refers to height, 'malnurished' to weight.  You say you don't know 
the length, or the history of the length, but this would be the measurement 
of interest for a diagnosis of stunting.  If height and weight are in 
proportion, maybe this is a small baby.  Height (length) and head 
circumference measurements over time will help to give a better picture of 
the liklihood of a problem. 

I converted this weight to kilos and looked it up on our UK90 growth chart 
(in standard use for all UK babies) at the appropriate age (of course this 
chart may not be fully applicable to US babies).  This weight is below the 
0.4 centile, so this baby falls into the set of children at higher risk of 
disorder.  This means that further investigations are worthwhile 
*statistically*.  It does not mean that there is a definite problem.  You 
say tests have been done, and so far have not discovered any organic cause. 

It seems to me -- from my reading of the literature -- that there is a 
difference between a baby who started out with a birth weight in (say) the 
lower quartile of the chart (or less) and whose weight maybe drifted down 
over time to settle on a centile -- even one below the 0.4th -- and then 
tracked roughly along the trajectory of that centile, and one who was on a 
higher trajectory, who has suddenly plummeted.  What is the history of the 
weight gain, has it been regularly taken and charted?  One weight in 
isolation really doesn't tell enough! Did the weight suddenly begin to 
falter at any point -- and if so, what was happening then (eg illness)? 

Also, if this baby is on a nutritionally adequate diet of complimentary 
foods (as you say) what is the point of removing breast milk from her diet?  
Is the idea that somehow the breast milk is so lacking in nourishment that 
it is somehow negating the calories the child is otherwise taking?  What are 
they suggesting the mother give the child instead of breast milk?  Is it 
better to pile on the pounds with something like a steady diet of burgers 
and chips or to continue to offer nutritionally balanced diet with the 
inclusion of the optimal nutrition of breast milk and keep a watching eye on 
this little girl's health?  Bearing in mind rapid weight gain in infancy 
appears to be linked to later health problems such as obesity and problems  
(e.g. Early nutrition and long-term cardiovascular health.  Nutr Rev. 2006 
May;64(5 Pt 2):S44-9). 

These are my thoughts, coming from the perspective of not ruling out the 
possibility that this child is perfectly normal, with normal -- for her -- 
growth. 

Magda Sachs, PhD 

ps, on the question of rapid growth in infancy predicting higher risk of 
later health problems, I have not seen a study which separates out breastfed 
and replacement-fed babies and compares their health in later life.  I do 
live in fear that the current concern about obesity is going to negatively 
impact women whose babies perform that huge breastfed boost in the early 
months....  This would not be a new phenomenon: “Many a young mother worries 
if her child has taken 10 or 15 grm more than she was told to give it, 
whilst another grieves because the figure demanded cannot be attained.  And 
so the weighing machine becomes an instrument of torture as much to the 
mother with plenty of milk as to the one whose lactation is poor” (p1659). 
Cran DHD (1913). Breast feeding. The Lancet 2, 1659-1660.  So, here we go 
again. 

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