I wanted to comment on the posts regarding slow weight gain/ FTT. I
really appreciated K.Dettwyler's comments on wt in relation to good health.
Over the years I have seen many babies that were slow at gaining and the
situation  was simply allowed to continue indefinately. This is a real
concern to me when the mother simply talks to a counselor /health care
provider  who does not take a complete history or see the interaction between
mother and baby. In some cases I have seem practices that were directly
impacting the weight IMHO (such as pacifiers, Parent Directed Feeding plans,
overuse of infant swings) which the physician or breastfeeding counselor
never knew about because they were accepting of a slow but steady gain. In
these cases the baby is really not reaching his potential.  I had one mother
call my office last week who said her physician was now concerned with her
baby's weight at 7 months, but it had initially slowed down after 4 months.
During our conversation, she shared that she was only nursing three times a
day  and offering three meals plus four 8 oz bottles of juice a day. The
meals consisted of cereal and fruit/vegatable. Her physician thought it could
be a problem with breastfeeding but never asked how often she was nursing OR
WHAT ELSE WAS GOING INTO THE BABY!
       In my own family , my first baby was a scheduled feeder with a
pacifier and gained at low average levels until 6 months where his growth
slowed even more. My other three children gained well above average for the
first year. Only my oldest son has problems with his weight. He is now
overweight and seems unable to eat when he's hungry and stop when he is full
 like my other three.  I do not feel he turned out "just fine".
       My concern is that we could sometimes be "patting the mother on the
head"  and not gathering enough information or suggesting ways to help with
the situation. It does seem that many of these babies turn out "just fine"
but I feel that K.D. covered alot of very important reasons to put some
effort into evaluating these cases where children are "smaller than they are
supposed to be".
       Can I get some ideas on where to go with a "stalled" case? Infant was
born at 36 wks. gest on 12/1,vac extraction due to infant distress but was
stable at birth, only bulb suction following delivery-no difficulty with
respiration, temperature, etc. Birth weight was 5-4 and dropped to 4-8 by 48
hr discharge. Mother has no unusual history, no hormone inbalance known, no
breast surgery, no infertility, no complications in preg until elevation in
BP encouraged physician to induce at 36 wks.Mag sulfate /epidural were used
during labor. Labor was 25 hr total w/ 2 hr 2nd stage. No hx of retained
placenta or hemmorage. Infant was not separated from mother, nursed
frequently (10+times per day). I saw the family on day three and at that time
recommended expressing with electric pump and supplementing in addition to
feeding at the breast. Infant had not stooled and had 3 dark urine diapers on
day 3. Infant fed for an extended period (relaxed but roused with little
stim.) at our visit with good corrected attachment. Mother reported the bay
was nuring all night. Oral anatomy appears normal as does tongue motion. The
pediatrician ran a bili and it was 18. It continued to rise to 21 and then
dropped to 16 on day5. No phototherapy was started because the parents had
turned off their phone and the pediatric office was unable to arrange on day
3. Then the lab did not rush the results on day 4 so by the time they
submitted the third sample, the level was dropping. After ABM was started
stooling/urine hit normal levels. The mother has continued expressing for 9
days and has never gotten more than 10 cc.  Usually she gets 4-6cc total. She
has never felt fuller or engorged but had some spontaneous leaking today. The
baby still enjoys nursing at the breast,but swallows infrequently. I'd like
some feed back on what else to evaluate or recommend?
          Debby Kearney IBCLC- in chilly Orlando! I know there's snow where
alot of you are, this is the time I really enjoy it here! Good hiking
weather!