>
> A client contacted me as her pediatrician has suggested she bring in an
> expressed breastmilk sample to spin for a crematocrit as he suspects her
> milk is not "fat enough".  Her 4mo old is in the 5% range in the wgt area=
>  on
> the growth chart. She says her milk looks thin.

The fact that her child is in the 5% range does not mean there is a problem!
Somebody has to be in the 5% range and that may be exactly where this baby
is supposed to be. Occasional - or even frequent - spitting up of milk is
also common and not necessarily indicative of a problem if the baby does not
seem to be in pain or distress. And many mothers think their milk looks thin
because it doesn't look like the homogenized cow's milk they are used to
seeing.

I think that before the mother worries about fat content, she needs much
more information about whether or not there is a real problem. The baby may
well be just fine.

This reminds me of a conversation I had with a mother last week. I had seen
her when her baby was a newborn and again when he was four months old. He
was born weighing 9 lbs. 9 oz. - a big, healthy baby. But from that point
on, his weight gain was slow. He dropped down in percentiles on the chart,
and her doctor became very concerned. However, many other things were good -
he was developing as expected, he was alert, very cheerful and happy,
energetic and active, and seemed content after feeding. She even tried using
Domperidone and found that her milk supply increased, but the baby then
nursed for a shorter time at each feeding. The doctor continued to be very
concerned, put a lot of pressure on her and finally she weaned the baby to
formula.

He's ten months old now, on formula and solid foods, and guess what? He is
still very slow gaining. Now, though, the doctor isn't concerned and points
to the same good development and behaviour that we had pointed out six
months ago. I did talk to her about relactation but she feels it will be too
much work - but is frustrated that the doctor pressured her so hard.

There is new research out there suggesting that promoting rapid weight gain
in babies is likely to contribute to health problems later in life. Some
babies are meant to be smaller than others and that's okay!

Teresa Pitman
Guelph, Ontario

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