I would like some ideas for this client. Infant is 6 months old. Weight
has been 5th percentile at birth, 10th at 2 weeks, below the range at 3
months and had a gain but stayed the same level below range at 6 months.
Length has been between the 20th and 10th percentile consistently. Head
circumference has been birth 10th%, 2 weeks 20th% and 3 moths just above the
5th%. Infant was 6 lbs 6 oz at birth, he is now 6 months old and weighs
12lbs 7.4 oz. He has started table foods but his weight gain is still slow.
He is very active. He crawls, he pulls up to standing, he walks along
holding on to furniture. He is smiley faced and happy. The pediatrician
tells mom that he is not getting enough nursing and she should add formula
to his diet. Mom was not really pleased with this, ( this is the second
pediatrician mom has seen, she was not happy with the first for the same
reasons, even when baby was not below on the growth charts the first ped,
was recommending supplementing since the baby was not gaining fast enough)
Until the 5th month he gained 16 - 20 ounces each month. On the 6 month
check he had gained only 11 ounces. He also has been spitting up frequently
at around 4 months, this slowed down around 5 months and cereal was
introduced at 4 months to help him gain weight ( per pediatricians advise)
He takes fruits and vegetables as well. On Friday I saw mom and baby for a
feeding assessment. Baby nursed very well when he was at the breast, it had
only been one hour since a full feeding prior to my visit. He took in
approximately 3 ounces at the observed feeding. He was a typical 6 month
old, he did not pull off frequently, but did stop to laugh or pull off to
check out any source of noise. He spit up several times after that assessed
feeding, but mom states he does not usually do that and he did not spit up
all weekend. Over the weekend to increase calories mom added safflower oil
to some of his fruits and vegetables. She also increased the amount of
foods he received. He nursed about the same as always. His extra calories
per day ( above breast milk) were approximately 225-500 calories, he nurses
on demand and usually nurses 7 times during the day/evening and then sleeps
with mom "on the breast" off and on throughout the night. He did not gain
any weight from Friday until today. His weight is 12# 7.4 ounces. The
pediatrician has recommended formula and has scheduled the baby for a sweat
test to rule out cystic fibrosis ( based on slow weight gain alone, stools
are normal and no other symptoms)
The baby had an allergic reaction to food last week and was on prelone
benadryl and had an ointment for diaper rash. He does not have thrush and
mom does not have any signs of a yeast infection. Based on the intake here
in the office and the amounts of added foods mom is giving it seems to me
like he is getting plenty of calories. Any ideas as to why this baby has
slowed down with weight? Should mom be concerned? Mom feels that she
should not be concerned she feels that as long as he gains steadily, and has
no diseasesor illnesses it is alright if he is small, and the baby does
really look good, he is really happy and his color is good. He is never sick
(with viruses or colds). Any suggestions would be appreciated. Thanks
Pam Price IBCLC, CBE
Lactation Services Coordinator
Women's Health
Trident Health System
9330 Medical Plaza Drive
Charleston, S.C. 29406
(843) 824-5013 office
(843) 728-9640 pager
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