I agree with Heather that the creamatocrit would be of limited use.  The amount of fat 
will vary widely according to when the sample was taken and studies have shown that 
this varies breast to breast and feed to feed within the same woman.  It is better used for 
research purposes than diagnosis.  

Moreover, Cathy Genna previously gave some excellent references on the whole foremilk 
hindmilk imbalance theories that suggested it is NOT the fat content it is simply the 
volume of milk.  It was perhaps four or five studies she cited that really showed very 
clearly that the more an infant takes in, the more the infant gains and the fat content was 
irrelevant.  I would look more towards feeding patterns.  

Furthermore, maternal fat ingestion has nothing to do with the overall fat content of the 
milk.  All it does is merely shift the ratios of different types of fat.  Increasing fat may 
actually, if care is not taken, increase some of the more unhealthy types of fat in the 
milk if mom starts to down milkshakes in the mistaken belief that this will increase her 
baby's weight gain.  If she is taking in an appropriate amount of fat in her diet, I would 
not encourage her to take in more that may result in undesirable health problems for her.

The only other nutritional items I would investigate are zinc because it affects appetite 
and is closely related to maternal diet and sun exposure which doesn't usually kick in 
until later.  There have been several infants that one wise pediatrician in Manhattan has 
spotted with failure to thrive due to "sunlight deficiency" as I now prefer to call it.

In terms of zebras, the one and only zebra case I had was a metabolic disorder and I 
think this would be highly highly unlikely.  The baby in question took in huge quantities of 
milk, but was losing weight.  It turned out this baby had a problem with aldosterone 
which was corrected by the endocrinologist who actually really listened to the mother and 
read my reports of how much this baby was drinking.  This was solved by short-term 
sodium supplements.  

Good luck on this one.

Best, Susan Burger

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