Darlene -

First of all, what good would it do for the physician to know the exact
kcaloric content of the milk?  What's so magical about the figure 28 kcals?
Why not 28.7?  Or 26.15?  I suspect 28 is just a convienent number, and may
actually be *about* right (or may not -- who knows?)  Besides -- if hmf is
being added to Mom's milk, and we don't know the *exact* kcaloric content of
that, how does he figure that the final product is 28 kcals/oz???

As an RD with experience assessing energy intake and expenditure, I know that
nutrition is NOT an exact science!  It's all an educated guess, and the "proof
in the pudding" is the clinical outcome (baby gaining weight on unknown
kcals/oz, who's to say he would gain more or less on 28 kcal/oz??)  I'm not a
pediatric nutritionist, and don't know exactly what outcome you're looking for
with this Down's Syndrome baby, but if the desired outcome is being achieved,
I'd say there's not a problem.  It sounds like one of those "control" issues
to me ...

Second, who has responsibility for the child?  As long as the baby is fed,
cared for, and not abused, the parents have the final say in what to feed him.
(Parents opt for ABM all the time, and most of *them* don't have to defend
their inferior or downright hazardous choice of nourishment!!)  If the
physician has a problem with this, he will have to either get over it or refer
the care of the child to another physician (which might not be all bad.)

-Sandra McMillan, RD
Saint Eugene Medical Center
Dillon SC