Got a call from a mom who wanted information to support her continued
breastfeeding of her 14mo daughter.  Although her daughter is only 15 pounds,
she is healthy and reaching appropriate developmental milestones.  The daughter
does eat nutritious foods, but also snack breastfeeds (as the nutritionist told
the mom).  Daughter has received some medical tests and there is nothing
apparently wrong, but the mom has to return to a Children's Hospital in another
state for a follow-up visit.  I guess the only thing they could pick on in the
previous visit was the breastfeeding and the mom is afraid they will tell her
when she returns (if there is not sufficient weight gain)  to wean and since
she is in the "system", mom is afraid of what will happen if she does not wean.
   I'm not sure what the daughter's length is, but they are throwing the
"stunted" word at the mom and the mom has no idea of how that is diagnosed.
   
  Need help!
  Terriann Shell
  Big Lake, AK


I had a similar experience with my 4th child.  (out of six).  
The first thing I would do is to get a growth history.  What was the 
baby's birth weight, how did she gain from then until the present? Has she
always been a slow gainer?  Has she been ill? 

When my 4th daughter Athina was born, she was actually my biggest baby by a few
ounces,  7#8 oz.  She gained less then my three older kids, who were fantastic
gainers,(they gained 8 to 16 ounces a week, Athina was a 4 to 6 ounce gainer)
but by 6 months of age had reached 16 #.  Then between 6 months and one year,
she only gained 4 ounces.  

She was a happy baby, reaching all her developmental milestones.  Our family
practice dr. was not concerned. I was worried, and pressed to see a specialist.
 I was also concerned about the fact that she ate very little solid foods, which
I figured affected her weight gain.

We ended up with the first Pediatric Endocrinologist, who after a long history
of family growth patterns, instructed me to keep a food diary.  He also wanted
me to supplement her with soy formula.  (as she was dairy sensitive).  She
wanted nothing to do with the formula, and not much to do with the foods.

Long story shorter,  he misdiagnosed her, but eventually several years later we
finally had an answer.  She was diagnosed with Insufficient Growth Hormone.  
Her body was not producing much at all.  She was in first grade, age 6 1/2 when
we finally had our answer.   

She breastfed until she was nearly five, and had a very small appetite.  Getting
food into her was difficult, and she was very picky to boot.  Until we had her
correctly diagnosed, we did not know that lack of growth hormone translates to
small/nonexistant! at times appetite.  

Since she has started treatment, she is now at age 9 at the 5th% on the charts
for height!!  That is after 2 years of growth hormone treatment!!

I went through the oversight of specialists, who always want to blame
breastfeeding first.  There should be nothing at all wrong with the
breastfeeding, but getting complimentary, (hopefully high calorie foods into
her as well) was the challenge.  
I refused to even consider weaning, but made a concerted effort to get food into
her, and appear to be compliant with the DRs.  I made it clear that breastmilk
was a compliment to her foods to them, and worked hard to get anything else
into her that I could.  I brought up the fact that my breastmilk also played an
important role in protecting her from illness, as being tiny, she didn't have a
weight cushion if she were to get sick.  (besides her growth hormone problem,
she was rarely sick with flu or colds etc!)   

But I wanted to mention my daughter's case, as the lack of appetite is common in
growth hormone deficiency, and the diagnosis is not often made until the child
is older then a toddler, after consistently falling off the charts for their
age, both weight and height.    

We often put Athina's size off, thinking she was just following the pattern of
some very tiny women in my husband's family.  There were other symptoms that
were present, we thought she was very quiet, but she didn't have the energy to
go out running and playing.  We thought she didn't like the outdoors.  It was
subtle enough that we didn't attribute it to health.  (her heart had been
checked by this point, and found ok).  

Since starting on growth hormone therapy, she has caught up to her age level in
school, she now runs and bikes and rollerblades etc, and now eats normally.

Insufficient growth hormone is one of the most common growth related problems in
young children.  ( I am not talking about kids that are given this hormone just
to be bigger, I am referring to children that have bodies that do not produce
enough of their own, and are not growing normally).

At first when we got the diagnosis, my husband and I thought that we would not
treat her and she would just be small.  We made the decision to start
treatment,
after our research showed that she could have serious health complications and
very possibly be infertile as an adult.

The growth hormone has been a miracle drug for our daughter, and the signs of
this medical disorder started out very small, and I was pooh-poohed by other
breastfeeding counselors and doctors alike that thought I was overreacting to
her small size.

It helped my case though, that she was my 4th child, and that her older three
siblings had all breastfed for a long time but all had eagerly taken to solid
foods and gradually decreased nursing.  They were not huge kids, 50% in size,
but normal for their age.  

Athina just kept going down the chart and eventually fell off it completely.  

I don't know what doctors this child is being seen by, I am assuming a pediatric
endocrinologist, but the main issue is that breastfeeding is not the problem
here, and to make sure that there is nothing else going on.

I would just ask this mother if the child is very interested in solids at all,
or how active the child is.  In our case, there was very little interest in
food, and she wasn't by any means a very active child that would be burning off
a lot of calories.   We also have a strong history of food allergies, so we
attributed much of her avoidance of foods to that for a time as well.  

But the first red flag was the 4 oz weight gain from 6 to 12 months.  Any steep
decrease in weight gain is more worrisome then a gradual decrease.

Good luck!!

Lisa Papas
retired LLL Leader and mom to 6 breastfed kids and nursing #6 Elena now 19
months!

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