Had a horrible, horrible day - need some tiktok and hunkerisms please. (Huuuuge post)

[verylittlecarrot]

I've had a wretched day following receipt of a letter from the paediatrician. Distilled down, it basically reduces dd down to two things; "failing to thrive" and "inadequate calorie intake". It also claims she has some delay in her motor development - ascribed to the failure to thrive - which he hopes would "pick up once her nutrition improves". I am surprised to hear this and don't agree with it.

Other possible causes have been ruled out (thyroid, heart, absorption problems)

The formerly supportive bfc who referred me (at my request) apparently felt a little miffed that I had not followed one particular piece of her advice, namely to express several times a day in addition to feeding on demand. (I attempted this for a while but abandoned it for several reasons, both practical and theoretical, in favour of just putting the baby to the breast at very frequent intervals.) This rejection of her advice has been noted in the letter. I rang the bfc to find out what this was about and challenged her, as she has previously told me I have "gallons of milk" and that supply isn't a problem. She seems less certain about my supply now, apparently.

The letter has a lot more to it and doesn't present me in a great light either. The paed wants to refer us on to a dietician.

There's so much I want to dispute in the letter - the diagnosis, the apparent motor delays, the conclusion that it is my bf to blame, the advice to wean her earlier rather than later (on baby rice!), the assumptions that I take random advice off the internet and lack the necessary intelligence and discretion to research properly info salient to dd's specific circumstances.

But actually, I've had enough. Spent the whole day in tears. I think I've run out of fight.

It's almost worse having gained the knowledge I have, from MN, because in RL you just sound like a non-compliant nutter with odd ideas and bizarre principles. And there isn't a tiktok or hunker in my neck of the woods to back me up, sadly.

So here are my questions

If I were to introduce a high cal formula at this stage, after 6 months of excl bf, perhaps a bottle a day, what effect might it have on my supply? (I already know what it will do to my psyche) Assuming that the hcps are correct, and for some reason I have an inadequate or fragile supply.

Is this likely to damage my long term plans to continue bf until she self weans?

Are there any risks to dd in doing this, vs carrying on bf (and weaning obv)

Is there a formal, diagnostic procedure to confirm that I have low supply? No-one has examined me ever in all of this, it's just a conclusion that has been reached through elimination of other causes.

Taking into account a steady and consistent weight GAIN from day 2 of her wee life, starting at 3 oz a week and now slowing to about 1 oz a week, does this sort of growth pattern seem consistent with low supply? She gained better in the beginning than she does now - might my supply be worse than it was?

If so, is it too late to fix things now?

I still feed every two hours roughly, sometimes more, both sides, and take domperidone (although I stopped for a few days last week as I honestly didn't feel it was making any difference, but have started again in desperation)

Does it make any difference that I still get engorged if she goes 4 hours between feeds at night occasionally? Does this mean anything?

I'm grasping at straws, anything to avoid admitting that my body has provided "inadequate calorie intake", which has caused motor development delays. The very real fear that I might have harmed my baby has been writen down in black and white today. It is sickening to read it.

I'm rambling and incoherent because I'm so upset. But I'm losing my nerve against the pressure. I need to consider formula, if it will help dd catch up some of the weight she needs so badly. I can't forgive myself for causing her problems. I feel like a defective failure. I tried to do everything I was supposed to do and it just hasn't worked.

oh vlc, I've just seen this and feel for you. I can fully appreciate your scepticism at the letter and am shocked that you weren't included on the distribution list.

I would ask for a second opinion though, if that's possible

Wish I could say something constructive and helpful

hi vlc, just wanted to say, don't give up, you are doing so well, im sure when your dd starts getting more food inside her shes going to put on more weight, id also probably give mashed up food like creamy potatoes etc if she was my dd.

also sounds like a load of shit, thm trying to make out your dd has develpoment problems, mine is 7 months and doesnt sit or even make any attempt to sit, also doesnt like going on her tummy much either

ps ive lookd at your profile and baby carrot is absoultey gorgeous, but then you know that already.

present for you to go with the brandy etc

Verylittlecarrot - please do not beat yourself up about this. The fact that you are so concerned and fed up with all of this proves that you've done the very best you can. Think of how many people just give up at the first hurdle. You have done amazingly. BF is hard work!

Look at your baby and you will see whether you feel she is developing ok. You know her the best. You have the holeistic view on the situation. No one else does.

My first baby stayed the same weight for six weeks (!). I saw a lovely HV who said if i thought he was well, able and feeding ok, we shouldn't worry to much. What a rarity! He grew longways rather than outwards. At his review another HV said she would have referred him at that stage - made me feel quite bad - but in my heart of hearts i knew he was a well and contented baby - she didn't. To see him as a happy toddler now proves to me that i was right to know my own child.

I think you have done a stirling job; sticking to BF throughout all of the worry. You should be proud of yourself. Keep strong. Use Mumsnet for support - it's brilliant. Don't be brow beaten.

Thanks girls

My HV is complete bobbins so I dumped her ages ago. It just seems that no healthcare professional dares to go out on a limb and say "this child is normal". I've had a jolly good whinge tonight and feel a bit better after reading the lovely messages of support (look heinous tho' with red swollen eyes and nose).

babycarrot is slowly getting to grips with the concept of food, and some might have even made it down her throat tonight, so maybe things will improve, provided she doesn't cut back on her milk to compensate.

And she made a concerted effort to drag her foot into her mouth whilst breastfeeding tonight. Like my nipple needed the company or something.

Delayed motor development my bottom.

I just feel a bit stomped on. Need a good night's sleep.

(Like that'll happen!)

(((( Big Hugs ))))

I've just been rereading the research on exclusive breastfeeding and the evidence is starting to pile up that this is a Very Important Thing. I think the time will come when you'll be vindicated for your determination to keep it going, and the health professionals will have to eat humble pie (high calorie, of course).

I see no motor delay in what you describe.

I think you should get a second opinion from a paediatrician with an interest in child development - these are often community paediatricians - your GP would know who to ask.

If her development is normal and her blood tests are normal and she has free access to milk and solids and is happy in herself, her weight is totally irrelevant and you can safely ignore anything anyone says from that moment on IMO.

Hi VLC, sorry that you have been put through the wringer again.

I can't speak from experience and you have already had great advice. I do have a good friend who was pressured into giving up bf at 4 months because her dd was tall but skinny. She put her on formula and her dd remained skinny. Just because you change what you give them doesn't mean that they will take more of it. To give a high calorie formula (if she will touch the stuff at this stage) will probably mean that she will ask less often for breastfeeds. I knwo that even ebm, my daughter didn't glug away the way I ahve seen some babies glug formula. she just sipped at it and waited for me to feed her.

the indicators state, by their own admission, to not indicate malnutrition. I guess what they want is an acquiescient mother.

have you seen the unicef website with the baby friendly hospitals in the UK? could you then push for a referral to a paed who work in one of those near you?

vlc - you ask about high cal formula. I don't know the answer to this. Clearly, now the carrottette is over 6 mths, the exclusive breastfeeding thing no longer applies, but if all they are worried about is getting more calories into her (and the reasons for this seem unconvincing on what you say here), you need to remember this is a processed product - would be very hard to argue that it would be 'better' for her than anything else. The advantage of high cal formula, as I understand it, is that it does get calories into a baby quickly and easily - and if quickness and ease are an issue, then there's an argument in its favour.

Some babies do need a quick nutritional and growth fix - the question would be does this apply to dd, and do you trust the people who say it does?

It's horrible to be thought of by the professionals as a nutter who gets her info off a talkboard, when you know you are very careful and throughtful about dd's needs. Your experience of HCPs is by no means universally good, and you are not going to accept what they say just because of who they are, and you are equally cautious, I know, about judging info from all other sources, too.

I think you'd be helped by seeing a bf-friendly paed. Can you ask around locally? Breastfeeding counsellors in your area might know the best people.

vlc, I haven't followed your previous threads but this sounds horrific and you must feel (quite undeservedly) awful. I don't have any feeding advice, but just wanted to post about the "motor delay" - my ds was enormous and was far less advanced at 6 months than babycarrot sounds! He didn't push his head up when prone for ages and didn't make any attempt at crawling until 13 months. Sat unaided (for a few seconds) at 8.5 months. I really don't understand how what sounds like very normal development can be interpreted as failure to thrive - I'm sure there are heavier babies than yours with slower development (ds for one!).

Of course you shouldn't feel guilty, you have been feeding your baby in the best possible way for 6 months, which is brilliant. I hope you manage to get a second opinion. Best of luck.

vlc I just want to add my sympathy and support really. I "folded" under a bit of pressure from HV when my dd was 4.5 months old and introduced 1 formula feed per day. I felt absolutely shitty about it, and still do (even though lovely dh made me laugh by sticking a sign on the box saying "Weight Gain 3000")

when I started topping up, dd put on weight a bit faster, but stayed small for her age. Amazingly HV left me alone after that - it was as if her whole aim had been to get me to give formula and she had succeeded [paranoid emoticon]

Dd was almost off the charts - 0.4th centile for a while - and I gave up when HV said the next step was doing tests for malabsorption. So I really admire you for sticking with it and going through with the tests etc.

This quote from you struck a chord with me "She's been weightbearing since 8 weeks, babbling for ever, great head control since 3 months, sits with support, can raise herself on forearms when prone."

This sounds exactly like my dd at 6 months. She was so lively and chirpy and very physical in her own way, but she was a bit late to sit, hated being on her tummy, and didn't crawl till 10 months. Now, aged 3, she is still a little bit cautious with running and jumping etc - it is just the way she is. It's easy for me to say that with the benefit of hindsight.

Apols for long ramble. the thing is, your dd (imho) should not be under all this scutiny at all. I bet a lot of 6mo babies would get similar judgements re motor skills if a paed was looking for something negative to say - it sounds like a horrible hatchet job and I am so for you.

Just checked your profile - babycarrot is gorgeous!

vlc - so sorry to hear about this. please get another appt and get a second opinion. go armed to this appt with a pre prepared list of questions so that you can get their opinions, fully understand why they are saying what they are and come to your own decisions. medical people are not right all the time, but neither are they wrong all the time. getting a second opinion will let you know how misguided the letter you have received is,

hang in there, you sound like a wonderfully caring mother.

Oh, lovely VLC, I'm so sorry you have been undermined so dramatically by the people who are meant to be providing you with support.

I am uneasy about the apparent fixation with "feeding 'em up" that so many HCPs seem to have - it would seem that decades of this way of thinking - well, look around you at society today. And then when children get to four or five and start school, the same parents are told (sometimes by the same HCPs) that their children are overweight and should go on a diet.

It's bonkers.

However, this doesn't help you right now. I think you should talk to a different bfc (you have the numbers, I'm sure, but they're all on my blog for reference.

It is so hard when HCPs are telling you you're doing the wrong thing or suggesting you're damaging your child because of your insistence to bf.

The minimal head lag is pretty common, surely, in 6mo babies? Motor skills develop at different times in different babies - she's weight bearing, she has found her feet, you say she's alert, producing wet and dirty nappies.

It's important to remember that I'm not a bfc. I am considering hiring myself out as bfing mum advocate though and attending appointments with HCPs to say, "Really, that's not quite what the research says, is it?" to them in a smiling and comforting and quite scary fashion.

It may be she loses the tongue thrust reflex over the next fortnight or so. I'd be tempted to do a mix of spoon feeding and finger food with her though. Then you know you're giving her wholefood and not a more processed substance like formula - would that be something you were happy doing?

well, here's the rub

It's a baby friendly hospital, milk bank and all, and the paed is supposed to be bf friendly too...he set up a tongue tie clinic, and was recommended by the bfc.

He was pleasant, and polite, I'd even say kindly. The things in his letter were not intended for my eyes - clearly thought he was sparing me his real opinion.

He's probably as good as I'll get. And I'm grateful for the fact that he has ruled out any meical problems, and trust him on this.

I just think, in the absence of medical causes, he 'needs' to ascribe this baby's skinniness to something. He said in the appt that she had probably just got accustomed to only wanting a small amount, 'like being on a long term diet'. He has been careful not to blame my supply overtly, but I'm pretty sure that's his conclusion.

I asked him if, in his opinion, there was a remote possibility that whilst unusual, babycarrot's weight gain was physiologically normal 'for her'. He said he doubted it.

I don't think anyone in RL is equipped to deal with this. I'm considering telling them that we are going private so that we can get out of this constant scrutiny and unwanted advice. I'm just scared that they can "force me" to take her to the appointments and follow their protocols. I live in permanent fear of them reporting me to Social services or something, especially now he's officially used failure to thrive.

I think it boils down to this.
BF is demand and supply.
in our case one or both sides of the equation are not working as 'normal'
Either

1. DD has a small appetite, resulting in low demand, therefore corresponding low supply

or

1. I have low supply, which ought to result in dd's demand being conspicuously greater than my supply. Which doesn't seem to be the case. Unless of course she's become accustomed to being starved and doesn't mind at all.

I think it's 1.
And as I have no idea how to make her want more I'm buggered really.
She never refuses the breast - ever. She is the original bush baby of the kalahari as once described. Takes little and often.

Just a suggestion - not an expert myself.
You just said she takes little and often. I thought that they need to have a good long feed in order to get to the really rich milk. If they just have a tiny bit really often, it doesn't fill them up.
Have you considered her routine if there is any? Does she sleep thru the night? How long can she go between feeds?
I am only getting my thoughts from the baby whisperer book. I am a big fan.
You would know if she was hungry, she would be really unsettled and crying alot.
Sorry, if you've been all through this before - these questions I mean, just trying to help.
Finally, if you are bf exclusively, are you gettting enough to eat and plenty of rest?
last of all, congratulations for keeping up the bf!
Ohh and very last, are they measuring her growth on a growth chart for BF babies - not the one in the red book. My dd was really low on the chart in the red book but when i found the bf growth chart she was actually fine.

oh wow, took too long to post there!

hunker - you're hired. seriously.

I am doing a bit of spoon feeding as well, although not much is going down yet. she loves grabbing stuff, hand to mouth is spot on, chewing great, just swallowing...

she'll get there.

I do feel happier about feeding her calorie dense foods rather than formula, but not sure if that's logical.

I've made the poor girl do dozens of sit ups. I just can't see any head lag. Actually, when the paed was doing this with her, he had her on a medical bed covered with paper. Every time he tried to drag her to sitting, she slid along the bed like a cuddly toy on the generation game conveyer belt. He tried it several times until I offered to brace the paper to stop her sliding. No wonder the poor girl lagged her head then. She must have been bemused.

ca7439, I have to correct you on this, sorry. Babies do not need a big long feed to get to the 'really rich milk' - this is such a myth and it is based on a misinterpretation of the research...'tiny bits really often' are the physiological way to feed, and add up to an impressive, calorie-rich, high-volume intake. For more on how this works, and the way HCPs and books and mothers have misunderstood the research in exactly the way you have, see www;kellymom.com. The Baby Whisperer book is truly terrible on breastfeeding - riddled with errors. Not your fault

VLC does not need to eat enough and rest more to make more milk - again, while good in themselves, they do not impact on breastfeeding 'performance'.

VLC - more info about the paed makes me think a second opinion may actually be an appropriate way to go....if he is a kindly man and already bf friendly, he will know you need to hear another voice on this. Would it help if you explored ways to get more calories into dd which were not high cal formula? This might address the understandable concerns you have about formula (basically, you don't want dd to have it!) and the issues raised by the HCPs....

bad link

www.kellymom.com

VLC, you are totally logical about preferring calorie dense foods rather than formula.

The clue is in the name

"Foods' are, um, foods. 'Formula' is a processed, industrially-manufacturered product - necessary in some instances, of course, but processed, all the same. Many people feel more comfortable themselves, knowing they are eating 'real food' , and it's perfectly undertandable to feel the same way about feeding their babies.

VLC I had this 13 yrs ago with my dd and am about to be referred again. I got out all the hosp letters re my 13yr old and her developement was behind so they said.....
I don't live far from you if you wanted to meet up you can email me

soremummy at hotmail dot co dot uk

VLC, have only just seen this. I'm so sorry you are having to go through this. I think you are right to be sceptical. Don't really have anything of great wisdom to add, just wanted you to know that you are not a Nutjob Or if you are, you're in great company!

children do reach milestones at different rates and your reasons for her not rolling all the time make perfect sense. Children do what they are interested in and enjoy. little carrot prefers not be laid on the ground (don't blame her). She will probably be one of those children who skips a step and just goes onto the next one.

The one answer I see constantly on this board is, if you didn't see any health professionals/get her weighed, would you be worried? In her pics she looks like a happy little thing. I think the problem is that she doesn't fit the 'norm' but that doesn't mean she isn't healthy! At least your paediatrician has ruled out all major illnesses and if she isn't malnourished then I don't really understand why they think there is such a problem, I'm not an expert obviously but so far my dealings with the 'experts' have made me very sceptical that they are any good at anything other than to diagnose major illness.

The high calorie milk thing is difficult. I would probably be tempted to try it just to see if you can get a bit of extra padding on her. If my lo would take a bottle then I would be tempted to substitute one feed (express off the equivalent) with the high calorie just to see if it helps.

Please try not to get too upset, I know it is not easy.

xx

oh, scratch what I said about the high cal milk, forgot you were on the weaning stage already...I would also go with the cheese and avocados any day

I read this quote in an American paeds text book yesterday and thought of you:

"Physicians are trained with a purely medical model of disease but little attention is paid to child development or parents concerns. Many paediatricians unconsciously blame parents for everything that is wrong with a child. This may be the result of their concern about the child and their inability to solve all the problems. They may fall back on their own past experiences."

I'm sure you are right that the paed just felt he needed to give some explanation rather than admit that no-one knows why babycarrot is small. The upside is that you know there is no serious medical problem. You do have an option of just declining further appointments if you feel they are not helpful but I can quite understand that it is hard to have confidence n your own judgement after such a knock.

I have not had anywhere near as much to deal with as you but do know how it feels to have hcps implying I starve my baby when she wobbled off her 0.4th centile. It was heartbreaking and a massive blow to a 1st time mums self esteem. Always remember-you are a great mum!

VLC feel for you. I saw this thread in the Weaning section and thought you might find it useful too? (hope I've done the link ok). www.mumsnet.com/Talk/2400/465005

basically it's a few ideas on how to introduce a high amount of calories if you need to when weaning your DC.