Pediatric Allergy – Oral Food Challenge Consult

Ella is a 4 month old who was accompanied by her mother to the clinic on 2026-02-02.

Ella was last seen by me 2026-02-02 for:
 1) Concerns about feeding and inadequate weight gain: Ella is exclusively breastfed. Her mother reports uncertainty regarding the volume of milk Ella receives during direct nursing, as Ella sometimes falls asleep during feeds and it is difficult to assess satiety. The mother notes a perceived lack of weight gain over the past month. Review of Ella's growth chart reveals appropriate weight gain until approximately two months of age, followed by a plateau in weight from three to four months. The mother previously used a breast pump and bottle-fed at times, but has been exclusively nursing directly for the past month. She reports variable milk output with pumping, especially after nursing. Ella sometimes goes 5–6 hours between feeds without crying. There are no reports of forceful vomiting, but the mother is advised to monitor for this and to track wet diapers and stool frequency.

Problems:  
1.  Abnormal weight gain (R63.5):
- Pump and bottle-feed Ella for one week to accurately measure daily intake.
- Target intake of at least 700–800 mL per day; if intake is less than 700 mL, supplement with formula or stored breast milk.
- Feed every 3–4 hours during the day, regardless of hunger cues or crying.
- Monitor for at least 5 wet diapers per day and track stool frequency to assess hydration.
- Record daily intake volumes using a phone or chart.
- Return for a weight check in one week; goal is a weight gain of at least 200 grams.
- Contact the clinic if Ella has forceful vomiting or appears uncomfortable.

Thank you kindly for your referral.