could I get some help processing this GI appointment and its conclusions?

[CassnBeth]

I just took DD to her first gastroenterology appointment today and...I don't know how I feel about it. I would love to get some other opinions? Sorry for the novel I know this is going to be...

A little backstory -- DD was born at 7 pounds 6 ounces and 19 inches long. Since then she has wandered around between the 60th-70th percentile for height (though she suddenly stopped getting taller these last three months). Her weight has always been an issue and has fallen from the 45th percentile down to the 14th and has been as low as the 9th. DD wouldn't ever latch and I spent the first three months of her life coaxing her to take breastmilk in a bottle before she finally decided she liked bottle-nursing. Introducing solids however went very, very well and, in fact, is what slowed her initial plummeting weight percentiles down to a lackadaisical amble. Right now DD gets three huge meals a day to eat, drinks about four ounces of water and takes two three ounce bottles of breastmilk before naps and a four ounce bottle of breastmilk at bedtime. A typical meal for DD would be two scrambled eggs and 3/4 of a cup of peas or half an almond butter sandwich and a whole banana. She is chronically constipated and, without miralax, can easily go four or five days between poops even if she eats nothing but prunes and breastmilk (not kidding -- it was our ped's suggestion). She is in other ways healthy (though she has a suspected dairy issue which we need to do a new tolerance test on) and can walk and talk and is cheerful and free of rashes but sleeps like crap and is a carrier for CF.

Which brings us to today's appointment. I told this whole story to the gastro and was very surprised by his answer; he thinks DD doesn't eat enough. He came right out and said that a toddler absolutely must have between 16 and 20 ounces of milk a day on top of their solid food in order to grow. He seems okay with that milk being breastmilk though I can tell he thinks it's a little weird and would like me to try cow's milk. Truthfully, I had never really intended to give DD much cow's milk anyway so I am torn about that. And I am not sure the doc was right that everyone else's toddlers needs that much milk on top of food in order to maintain a weight curve. Am I wrong? Are other people's kids drinking way more milk than I think they are?

The gastro doc wants me to get 16 to 20 ounces of milk into my daughter daily and keep a food diary and come back in to see him and a nutritionist in two weeks. And I think it might work if I obsessively push milk and switch out a lot of DD's fruit and veggies for meat but I am not sure that is such a balanced diet. And I am not sure how it would prove DD is "normal" if she has to eat such a weird diet (in comparison to the kids I know and have nannied for) in order to keep growing

As to the constipation, the doc is doing a bunch of preliminary tests the only ones of which I managed to catch were for celiacs, longstanding inflammation and electrolyte imbalances though I am sure there were more. Does anyone have any clue what I should be pushing for or watching for on that front?

Bah. My head is totally spinning from all this new input. Could I get some help synthesising this? And maybe some other data points on this nutritional thing?

[2boyzmama]

I have always found gastro to be very frustrating, so I feel you there!

First of all...if there are signs of a dairy intolerance, why in the world would the dr want you to give her cow's milk? Did he mention any other milk alternatives? Almond milk, coconut milk perhaps? Can you pump more breastmilk, or is the 10 or so ounces a day she's getting all you can pump?

I think that many kids drink a lot of milk between 1-2 years old, but I don't think it's healthy for them. There are healthier fats, and better sources of calcium.

You might want to call and find out exactly what tests were run. I find it easier to bring a notebook with me to appts and ask the dr to tell me exactly what he is testing for, what the test is, and to spell it all out. That way I can take as much time as I want researching it on my own after the appt. Because, like you found, it all gets confusing when you're sitting in the office and getting lost in medical jargon that's unfamiliar!!

There was just recently an article about a new form of CF being diagnosed more often...adult-onset even. I don't remember where I read it, maybe on msn's health section? CF can cause growth and digestive issues. Even though she is only a carrier, there have been symptomatic carriers, so it might be worth researching that.

[momtoalexsarah]

I would up the milk - BM if possible or an alternate milk if BM is not posible. All three of my kids where drinking far more then that at 1 year, plus lots of solids. My older two where on a hypoallergenic formula from 1 year until over 2 (my milk dried up with the next pregancy- although I tandumed when I had enough) and my son at 1 year was drinking 35-40oz a day and older DD 30-35 oz and they where both great eaters too. Neither of them is large either DS at 6 is at the 50% for both ht and wt DD is about 90% for hight and 50% for wt. My youngest was excusivly nursing at 1 year and I'm not sure what she was takeing but the couple days that I had to pump I was easily pumping 45oz a day and not getting it all (so she was likely takeing more then that).

Drinking is less energy consuming the eating and 1ounce of BM would have more calories then the cup of peas. Really for the first 2 years BM (or an alterante of similar quality - almond, coconut, formula) should be the main source of nutrution. Solids are for practice eating.

When her wt started plummeting how many ounces of BM was she getting a day?