Ginger is right, why wouldn't the 7.5 mo old be referred to a peds RD
(registered dietician)?
My understanding is that HMF is used because it provides added protein and
minerals which are needed in higher quantities in the preterm infant (more
than even preterm milk provides). Although this can and has been debated,
this is the current rationale, as far as I understand it. So, HMF is not
appropriate for the term or older infant.
One statement that struck me was that the infant in question was in daycare
for 8-9 hrs (hope this is accurate). In addition to other suggestions, I was
wondering: Possibly could the breastmilk be diluted for some reason, or the
baby actually taking less than what is being reported? I hope not, but
sometimes daycare is of very poor quality. Did the poor growth start after
daycare started? Would it be possible for mom to take a vacation or leave
and see if baby's growth improves? Possibly could the baby be depressed due
to the extended separations from his mother?

Laurie Wheeler, IBCLC, MN, RN
New Orleans Louisiana, s.e. USA

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