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Man this is a tough situation, just based on this information, it sounds like you aren't super close (only seeing 1x a year) I would leave it be. I know as a parent most are in constant communication with their pediatrician about weight issues. I had issues with my child getting her to gain weight and doctors keep a close eye on it. From personal experience I would get super annoyed when people offered their opinions when they weren't completely informed. It's easy to judge, but you have no idea what is going on. My child spit up everything (BM and formula when we switched) and it was because of a later diagnosed medical condition, so it could be a bigger issue than you know.

Unless the child was neglected I would leave her be.
I had a baby that was on the bigger side (8+lbs) and he struggled to get back to birth weight until he was over a month old. The doctor did ask to supplement at that point but I was ashamed and really depressed about it. I followed his advice and we did continue breastfeeding until he was 11 months old but I was pretty devastated and it wasn't something I really wanted to talk about.

ETA: FWIW My son continued to grow on a good curve but is still a lightweight for his age, he's going to be 4 in less than a month and is around 30lbs. My husband and I are pretty small people, looks like DS is following right along.

I'll disagree. I would say something. She needs to take that baby to a pediatrician. If no one else closer to her will say something I would feel like I had to try. Someone needs to advocate for the baby.

OMG I would totally say something even if I was perceived to be "that" annoying mom or whatever - even if she disliked me forever I would say something. I knew a few people who were like that - totally dedicated to EBF and suspicious of the medical establishment and wanted natural methods for everything - which is totally fine, but their kids ended up having developmental delays from being undernourished for a long period of time and they would just cry and cry and cry.

My son had colic and reflux and who lost a lot of weight when we were trying to EBF and we chose to supplement bc he wasn't getting enough to flush out his jaundice. We ended up combo feeding and medicating him for GERD bc my husband and pediatrician urged me to and every time I see a situation like this I am SOOOOO glad I listened to them.

Yeah you need to say something considering she isn't taking the baby to a pediatrician. Do you know who the chiro is? Perhaps you could call him and ask he mention it to her? Some chiros act in more of a primary care function...quite frankly if she didn't do something to address it I would not hesitate to call CpS.

I'm no doctor but is a 3 month old weighing 10 pounds really that uncommon? My EBF baby cried all the time! And she spit up too. I took her to the dr regularly, she had all her shots, etc... I was a fairly typical, overly paranoid and protective FTM.

I think its a tough call considering you haven't actually seen this baby on a regular basis or for any extended period of time. You'd think a chiro would raise some kind of alarm if he thought there was a serious problem, no?

@jh524: Also, I might totally be paranoid, but if the baby was that big at 3 weeks early, I would also wonder if she had gestational diabetes, in which case he might have blood sugar issues that should be monitored closely. Those babies, if they have low blood sugar, have a hard time feeding, vomit a lot, might have wheezing or breathing problems, etc.

Again, I would totally be the a**hole in this situation, because its like I WANT you to prove me wrong. I WANT milk supply to be great, I WANT your kid to be perfectly healthy and getting enough to eat, I WANT your kid to just be on the lower end of the growth curve. Prove me wrong - go to the doctor!

When I was in the nicu, in order to gain enough calories, my NICU said I should BF them upto 3 times a day. I can pump and give them BM, but we fortified the BM with fortifiers or formula. This increased the BM from 20 calories to 24 calories. We stayed on that 24 calories for a month after they were born. My babies are 3 months old and they are now on regular preemie formula that is 22 calories. If I was giving them BM, I would add some formula to increase the calories. I know I was told that for my premie babies that if they were on breast or bottle for longer than 30 minutes that they actually start burning more calories. So longer nursing sessions were not benefitting my babies. They also wanted my babies to gain weight so that why I was fortifying my breast milk with HMF (human milk fortifier) or formula.
My babies were tiny at 3#11 and 4#3 and at 2 months they were 6#15 and 7#15.
I'm not sure for a 9 lb premature baby. I'm not a dr but I would think gaining weight over time is better than losing weight. Not sure what Drs think about a baby that maintains their weight. I do know there was one week where DD didn't gain an ounce a day, but the dr wasn't worried because she was gaining so well weeks before.

I would say in your friends situation that she isn't seeing or listening to her dr. Is she against formula supplementation? I think with preemies they need the extra calories to catch up.
ETA: she's against vaccines, too? Yeah, I'm not sure if there is anything you can do that will change her mind if she is against listening to medical professionals. I would tell her what I told you here and I guess that's all you can do. If the baby starts looking thin and starving, I would be more alarmed. If you don't want to rock the boat, could you ask if she is seeing a pediatrician regularly for weight and wellness checks? I would hope the pediatrician would report her if they thought the baby was being starved. My babies saw the dr every week for weight checks until they were 10 weeks and then got their vaccines at their 2 month appt. We are having a 3 month weight check then a wellness check at 4 months. We also had to follow up with the feeding specialist at 2 months and will see them again at 5 months to make sure my preemies are developing normally.

@jh524: what do you think is at play?

@yoursilverlining: I agree with you that anything the OP says will likely fall on deaf ears.

But, if it is weighing on you (and I can imagine it has to be!) I think it is totally fine to say something with kindness and alleviate your conscience.

Poor sweet baby.

Something needs to be done. My best friend is a foster momma to a girl who was taken away from her bio mom at 4 months due to lack of growth due to spitting up all the time and mom not figuring out a solution. She had to be hospitalized and the hospital doctors called CPS. The mother didn't have the knowledge, skills, or deep concern enough to figure out how to feed her daughter. The baby was starving. The stats are very similar in the case you described. I wish I had suggestions for what to say or how to say it.... But I don't. The suggestions above sound good. All I know, is that if it keeps going like this for even another month or 2, that baby could need to be hospitalized and the mother could lose custody.

Are there any super-granola doctors in her area you could suggest? In this case any doctor is better than none. How about suggesting the local human milk for human babies facebook groups for supplementing? Maybe call the chiropractor she sees for pediatrician or family medicine recommendations.

@Autumnmama79: the baby gained 1lb since being born 3 months ago. That's the concern.

I'm not a doctor, but I feel like this raises so many red flags. I bet she's afraid to bring the baby back to the doctor because she's worried that they will call Child Protective Services on her - and frankly, if she's skipping doctors visits, failing to treat a newborn's cough, eye infection and severe spitting up issues, and withholding nutrition to the point where the baby has gained one pound in three months, someone probably should call CPS.

@KatieBklyn: agree 100%

@bluestriped bee: I'm sure she does think it's normal, but well-intentioned neglect is still neglect. Clearly I'm not there and I don't know the whole story but this sounds like one of those news stories you read where a baby winds up seriously ill, or worse, and everyone's like "how could no one notice? Why didn't anyone call CPS?"
I mean, in comparison, my son was born at 9 lbs, 9 oz also three weeks early (didn't have GD, I promise - they tested me twice) and at three months he was 17 lbs. It's perfectly fine to be a peanut and grow on your own curve and look at the WHO guidelines for growth instead of the AAP ones but this kid must be free-falling through the percentiles.