A breast-fed 4-month-old infant girl observed since birth had gained only 1230 g (2 lb 11 oz). The mother had three older children with birth weights of 3440 g (7 lb 9 oz), 4000 g (8 lb 13 oz), and 4895 g (10 lb 13 oz). All were exclusively breast-fed and thrived, eventually growing between the 25th and 50th percentiles on the National Center for Health Statistics growth charts. The mother also had five miscarriages during these 7 years. She had gastric bypass surgery for morbid obesity between her third and fourth children. She had lost 49 kg (109 lb) (114 kg to 65 kg) [254 lb to 145 lb]) in the first 12 months after surgery and had been stable at her new weight for 4 months prior to becoming pregnant with this baby.

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