Dr. Gwenn Schurgin O'Keeffe, MD, FAAP

Dear Dr. Gwenn,

I was wondering if you can tell me if I should be concerned about the health of my daughter. She is currently 15 months old. At 13 and a half months she weighed in at 8.42 kg and she was at the 50 percentile for height. She is also really paled skin and it was suggested she was anemic. They didn't do any tests and I am inclined not to believe that she is as she is really active and was that skin colour since birth.

I am still breastfeeding but she has a really good appetite on her and eat small meals throughout the day. They suggest I feed her more each time (but she will only eat a certain amount) and that I have to put her on formula.

I would just love to hear another opinion on this. We recently moved countries from South Africa to New Zealand and her previous pediatrician said she is normal for a breastfed baby but that she can't go on a nursing or food strike as she doesn't have reserves to fall back on and that will be the only time I should get concerned about it.

Thanks again for your opinion.

Signed,
Shirena

Dear Shirena:

First, I applaud your ability to breast feed for so long - that is an amazing accomplishment. Let's look at the facts so far. Based on a standard growth chart, your daughter is very, very underweight especially given her height is 50th percentile. I am not familiar with the pediatric practices in South Africa or New Zealand but can tell you that by US standards, we consider this "failure to thrive". More times than not, this is a calorie issue and I suspect that is at play here to a degree.

Keep in mind that breast milk is really designed for infants. Toddlers have different needs. Milk is really just a small part of the overall nutrition plan for toddlers. For most toddlers, breast feeding becomes more of a security blanket than a nutritional supplement. At the same time, the milk your toddler is getting is likely suppressing her hunger enough that she is not taking in enough calories with her meals.

I'd enlist the help of your new pediatrician to connect you with a nutritionist who can guide you to creating a diet for your daughter that will help make up for losses and keep up with what she needs to grow.

Finally, the pallor could be due to anemia. A simple blood test will give you that answer and your pediatrician can guide you to further treatment with iron if needed.

Best,
Dr. Gwenn

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About the Author
Pediatrician, Dr. Gwenn Schurgin O'Keeffe, MD, is a board-certified pediatrician and Fellow of the American Academy of Pediatrics. Dr. Gwenn is an experienced columnist, educator, and practicing pediatrician. Dr. Gwenn strives to write as if she were talking to a parent. As a parent herself, she knows how important it is to obtain information but also understand how precious little time parents have to find that information on the internet. Pediatrics Now was developed to fill that gap and provide a bridge between the parenting and pediatrics worlds.

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