Anne, 

I write as a pediatrician and lactation consultant who has had a fulltime 
breastfeeding-only specialty practice for the past eleven years. I don't do any 
regular pediatrics, I only see mothers and babies with various 
breastfeeding/lactation challenges. So I see a lot of babies with slow weight 
gain. I'm also a fellow of the Academy of Breastfeeding medicine. 

Just a couple days ago I wrote on lactnet about a similar situation. Please see 
my reply to Rayann about a younger baby who was also growing slowly. 

> Subject: Re: weak suck, poor milk transfer...solutions? 
> Date: Thu, 20 Sep 2007 23:07:18 -0400 

I will not repeat the above letter here which you can easily find. Instead, I'll 
just briefly summarize the basic point of the above note, and also point out 
where the baby Anne describes is different from the baby Rayann describes.

In my experience, as long as a baby is significantly underweight, just being 
underweight itself creates a vicious cycle--they are very poor feeders, they
conserve energy by only drinking when the fast flow (lower fat milk) reminds
them to drink, but they fall asleep and quit drinking when the flow slows
down (creamier milk left behind). Thus also slowing mother's rate of milk 
production, further worsening the vicious cycle of slow growth, and keeping 
mother very busy trying to push up her production, which of course, really 
should be the baby's job if the baby were growing well enough to do his job.

This baby Anne has described is older than the baby Rayann described, but 
the situation is similar. 

However, the one thing that is very important about this older baby described 
here is that the baby's growth in length also has been slow. Most of the time 
the babies I see in this vicious cycle situation keep growing well in length, 
which actually makes them look thinner and thinner, because they are growing 
longer faster than they are putting on weight. The fact that this baby is 
growing slowly in length, too, and so looking proportional, makes me wonder if 
he has perhaps some genetic or constitutional predisposition to being small.

The issue here is not breastfeeding, but (1) determining whether this baby has 
a normal growth potential that has been transiently thwarted by the vicious 
cycle that can occur when the breastfed baby's natual ability to self-regulate 
his intake is thrown off by being underweight--and then the issue is not the 
breastmilk itself, but the baby's response of leaving behind the slower flowing 
richer milk, and the vicious cycle that ensues (see my letter to Rayann); as 
well as (2) investigating whether or not there is also a primary growth issue, 
unrelated to breastfeeding (in which case formula feeding wouldn't "cure" the 
problem anyway). Such a "primary growth issue" could be as simple as 
determining that he's a healthy baby who is simply destined to be small, with 
no other health problems, but, importantly, it could also well be that the 
growth problems are an early warning of some other health or medical problem 
that needs to be investigated and treated, in which case, depending on what 
the problem is, appropriate treatment for that problem might or might not 
improve the baby's growth, but the treatment might be very important to the 
baby's future health. 

When a mother is worried, she knows something is not right. She needs help 
from someone whose opinion she can trust, who can investigate the issue 
thoroughly. 

Tina Smillie MD IBCLC FABM


 

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