Failure to thrive during breast-feeding is a dilemma that has plagued mankind for centuries. It is not a common occurrence, and only scattered reports of a few cases have been published, while millions of infants worldwide are successfully breast-fed each year. An increasing number of mothers are breast-feeding their infants, however. Although there are abundant resources in the nonmedical literature for interested parents who want to learn about the normal course of breast-feeding, the medical literature has not kept pace with this subject. Medical counseling for successful breast-feeding is often unavailable. Recently, case reports of failure to thrive during breast-feeding have appeared.1 Most of these reports reveal management regimens that begin with the discontinuance of the breast-feeding, whereas ideally the management should include the early identification of the problem and early intervention to support nursing.
The article by Roddey et al (see p 597) describes four children who appear