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Lactation Information and Discussion <[log in to unmask]>
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Fri, 26 Oct 2012 07:01:47 +0100
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Pat, it strikes me as a very difficult situation for you to work with 
if the mother is not willing to be as accurate and forthcoming as you 
need her to be, re. precise weight gain and history of weight gain. 
After all, a baby who has only ever gained 2 oz a week is a different 
category than a baby of 6 mths who's weight gain has only recently 
slowed and  who looks ok (apart from appearing slender, as you say - 
unusual in a baby of 6 mths but not necessarily worrisome, and you 
cannot make a proper assessment in a baby of this age with just your 
eyeballs).

Dropping centiles is physiologically normal for some babies - but IMO 
you do need to know at this stage which chart is being used as the 
WHO chart starts to differ from about 5 mths on. There is no 'first 
centile' on the WHO charts (though of course there is a notional one 
- I mean there's no first centile line, at least not in the ones we 
use here) so if a mother said this I'd be wondering about the quality 
of info she was giving me. Guidance is that a baby who drops two or 
beyond two centiles over a period and sustains the drop does need 
checking out. What precisely is the drop with this baby?

I'd be asking *why* the mother is not interested in increasing the 
baby's access to more breastmilk , and finding out more about how 
often this baby is feeding.  Anyone involved with helping the mother 
and baby needs to know if there is something going on here - rigid 
scheduling, deliberate withholding of the breast, whatever. I'd be 
worried about *why* the mother is not being communicative about any 
of this.

Heather Welford Neil
NCT bfc, tutor, UK


>I have a mom who started showing up last month at my support group 
>just to weigh her 3rd daughter who now has just turned 6 mos. Older 
>girls are 3+ & 6 and were breastfed also. Baby looks quite 
>bright-eyed, but slender small. Mom was not very interested in 
>talking about increasing feedings to get more weight on (I think she 
>was only seeing gains of 2 or so oz/week, again not very willing to 
>say what the gain was). Indicated that daughter wouldn't take more 
>milk. Today she called & daughter had just been in for 6 mos check & 
>is in the 1st %tile on weight charts. Don't know if WHO chart was 
>used. She has dropped %tiles since 2 mos check. Doc said to push 
>solids. Mom called me for suggestions. She has a quantity of frozen 
>breastmilk & I suggested thawing & spooning off the fat that rises 
>to the top and adding it to foods, avocado, & anything calorie 
>dense. I don't know how many breastmilk feedings mom is doing. What 
>would be your suggestions for calorie dense foods for this mom to 
>offer? Warmly,Pat Bucknell IBCLCprivate practice & facilitator of a 
>weekly hospital-sponsored BF moms' support groupAvon Lake OH 
>(western Cleveland suburb)

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