Brenda -

Re: these older babies "falling off" their growth curves: I do agree with
you that there is for many (most?) babies a "window of opportunity" for
introduction of solids, and that missing this opportunity, for any of a
number of reasons, can cause eating problems, and logically speaking, growth
problems.

But I do wonder if perhaps that isn't also something of a natural growth
pattern for human BF babies, or at least for *some* of these babies. How do
these "failure to thrive" babies look & act? Are they healthy in other ways?
Lively, doing the things babies that age usually do? responsive & reactive
with their surroundings & people? I know we've said it dozens of times on
this list, but we need to LOOK AT THE BABY rather than the chart.

I certainly can't comment on your WIC iffice, Brenda, but I know that at the
WIC program where I worked (coming in as an RN, not a nutritionist -
although I did play one at work) I sometimes felt that within WIC there's a
tendency to pay more attention to the growth charts than to the baby. Partly
this may be a factor of the nature of the WIC program itself: babies are
seen more frequently than in the doctors' offices (every month or every
other month), and of course as a nutrition program the emphasis is on food
and growth rather than on other paramaters of appropriate development, and
because of the way WIC requirements and "risk factors" work there is a lot
of focus on growth percentiles regardless of how a given baby is doing. A
program runs on its "numbers" and various easily-quantified measures; it's
much easier to document that a baby's growth has dropped by X percentile
points than to note that the baby is on the small side but feisty, smart,
and super-active and has had no colds, ear infections, spitting up, or other
health problems.

I always used to find this kind of alarming when I was at WIC - also, its
converse: babies that "plotted out" on their growth curves perfectly, but
that just didn't have that nice juicy good-baby look, or had that dull look
in their face that speaks to me of trouble. Almost always, those babies that
"just didn't look right" to my eye would turn out, a couple of years down
the road, to have problems, while most of the ones that "fell off the curve"
were just fine. (Unless, of course, the off-the-curve ones *also* had that
dull puny look - in which case everybody knew there was trouble much earlier
in the game.)

Cathy Bargar RN IBCLC Ithaca NY

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