Hi, 
As a recovering anorexic (20+ years), I can speak to the defensive state of 
mind this mom must be in. In many anorexics, the need to be "perfect" is 
almost overwhelming. Now, she has a baby who isn't gaining--one more thing 
she must somehow get control over. But, this involves eating--the most 
meticulously controlled thing in her life. I met a mom while I was a nursing 
mother's counselor whose baby wasn't gaining, and the LC who had seen her 
couldn't figure out why. Mom was saying she was doing all the right things--
feeding on demand, letting the baby decide when to finish a feed, etc. Latch 
and positioning looked spot on, and the baby was healthy, just gaining very, 
very slowly.  What I found when I went to drop off the scale the LC and mom 
requested (to monitor baby's weight gain daily), was a mom obsessed with 
getting the right amount of weight gain for a healthy baby, but a deep-seated 
worry that the baby would be "too fat". I explained to her how breastfed 
babies gain what they are supposed to because the physiology of the process 
and the composition of the milk was perfect--and that a chubby breastfed 
baby will grow into a lean and strong toddler. She wasn't quite buying it, but 
when I confessed to her about my own struggles with eating disorders she 
opened right up. She was terrified that she was going to "mess up her baby
' but unable to see a way out.   I patiently explained about the need for 
frequent feeds, etc. Mom reluctantly agreed to let her son control the 
frequency and duration of feedings (luckily I could  encourage her with  "boys 
eat like pigs" and "ever notice how guys just burn it off" ). After that 
conversation I reported back to the LC and suggested that in the follow up 
visit the scale be removed--let them work out another way to get baby 
weight checked since a scale in the home was WAY too much. I saw this mom 
and baby several months later, socially at a neighborhood gathering, when her 
toddler was eating solid foods. She seemed stressed about how much he was 
eating--little finger foods and goldfish crackers--but did not restrict how much 
he was given access to. Mom was still talking endlessly about how 
she "couldn't eat all that", but she seemed to be coping.  Good luck getting to 
the bottom of this mom's issue as it relates to milk supply and feeding her 
baby. Also, if you have a question list or screening tool for PPD, ask those 
questions, too. I have been treated most recently with celexa (citalopram), 
which is listed as L2 in Hale's and saw a huge improvement in myself with 
regard to my eating disorded thinking and anxieties. I hope I have provided 
some insight into why when it seems she may be doing everything right the 
baby may still not be gaining. I hope I haven't crossed the TMI line here, and 
apologize if I have. I am in Mechanicsburg if you need to contact me privately. 
Very kindly,
Leslie

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