There are several ways to fortify this little guy's maternal milk to
increase caloric density. Whether or not he actually needs more calories is
tough to tell from the outside. If he has always been at the 3rd percentile,
like the smart ladies of Lactnet have pointed out, that may be where he is
going to stay, and he doesn't need anything else. However, it is very common
for kids with neurological problems to get calorically enhanced liquid
nutrition, so that they don't need to take in as much fluid to meet caloric
needs. This can help some kids wean from their G-Tubes sooner. Anyway, mom's
milk can be fortified with formula powder, as has been tried already. Trying
a hypoallergenic formula would be a potential place to start, something like
Alimentum, Pregestamil. Single component fortification is also possible,
with oils like Microlipid, MCT oil, or even just a vegetable oil. This would
be risky in a baby with aspiration risk, as oils are easily aspirated due to
slipperiness. There are also carbohydrate supplements like Polycose.  Is
there an RD in the area mom could meet with? Good luck to your friend and
her little guy, and shame on the developmental ped.

Tarah Colaizy, MD, MPH
Neonatologist, University of Iowa

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