Jan asks the question about slow gainers and developmental milestones.  I have just gone through lots of growth charts and 3 to 4 ounces a week over many weeks leads to substantially different growth patterns than the healthy breastfed infants that comprised the current WHO charts. 

Typically within a month or two they slip down more than 2 z-scores which is well beyond what you would expected from individual genetic variation or regression to the mean.  A week of 3 to 4 ounces is no big deal.  When I see a baby gaining that slowly over weeks and months, however, about 99.9% of the time I discover that there is a real problem that went undetected.  

The problem with allowing a slow gain to continue without a thorough investigation is that it inevitably leads to stunting.  When a child is shorter than they should have been, this means that their skeletal growth has been impacted and there are a variety of ways in which this is NOT healthy.  My doctoral dissertation research showed that the 3-6 month interval appeared to be particularly important for length at 2 years of age.  

What I see with self-limiting feeders is that they actually would be happy to feed more frequently, but often parental and pediatric expectations are such that they allow the baby to eat smaller amounts on the same routine as a baby who can handle a larger volume of milk.  Babies can rapidly be trained to ignore their hunger cues and eat less.  These babies perk right up when they are encouraged to eat a little more frequently.  

Sincerely, Susan Burger

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