What can a paediatrician make me do and do they understand about breastfeeding?

[AlisonJB]

My lovely 16 wk old DS has been exclusively breast fed since birth. From about six weeks, he started sleeping through the night and demanding less food less frequently. HV told me this was fine and as a first time mum I believed her.

At wk 8 I saw another HV as DS had dropped 1.5 ozs. She encouraged me to feed more often particularly at night. DS gained 4oz the following week, 1oz the week after that and then only 0.5 ozs over the next three weeks. Meantime, I'd noticed that he was feeding much less longer (only about ten mins) and only on one side. We were then referred to GP who felt DS checked out fine and was meeting all his developmental milestones except weight gain, but referred us to the paeds as a precaution.

Two days later one of the older GPs called me to say the appt with the paeds had been brought forward and that in the meantime, I should stop breastfeeding and feed formula instead. I got very upset about this, but decided to ignore him and speak to a BF counsellor instead who advised switch feeding.

In the two weeks that we've been doing this, DS has been feeding more regularly and for much longer (sometimes as much as an hour) and he's gained 10 oz in those two weeks which I thought was great. But we went to see paeds today and registrar advised topping up. I asked why I couldn't offer another breast feed instead - he then conceded that I could top up with EBM. But I'm feeding every three hours as it is, usually for 45 mins to an hour and am worried I won't be able to express that much in the meantime. We have to go back to see the paeds in three weeks. Apart from slow weight gain, DS smiles, giggles and is fiendishly active and alert. He's very tall, just not so fat.

Paed told me DS will be fundamentally weakened for life if we don't get his weight up in the next three weeks and that I should be looking for a weight gain of 7oz per week. I'm now even more worried and stressed about it and have spent most of the evening crying. Would be grateful for any advice - sorry for long post!

daftbat see top of page for usefull stuff: acronyms

and don't be afraid to start your own thread if you are after some info, you get more answers that way.

InMyHumbleOpinion btw (by the way)

Cheers Madmouse

littlelamb - it's called "standard deviation towards the mean".

It means babaies on those top centiles float down towards average - and that's normal.

And babies on the bottom centiles float up towards average - and that's normal.

Keep calm. Hopefully docs will take that on board if you end up seeing one.

Christ,these people need to be hung, drawn and quartered for their stupidity, ignorance and insensitivity.

I just wanted to add that a normal weight gain for babies is around a pound per month. One pound = 16 oz so about 4 oz per week. My paeds also said that the range of normal is anywhere from 1 oz to 4 oz per week. It depends on the baby and if they are otherwise healthy, there is no need for formula top-ups.

Alison, so sad for you that you have been made to worry. Here's my take on the situation

• I think, like you, bf was not going as well as it might have done, probably since the beginning or at least the first weeks. This does happen occasionally - laid back babies don't always ask for what they need to really thrive, for some reason - these babies (in my experience - no research on this!) are often babies in busy households maybe the second or third child, and they ask for enough food to jog along and the rest of the time sorta just fit in!
• the turn around you have seen in his weight after deliberately increasing supply and access to the breast shows there is nothing to be concerned about except calorie intake - good! Nothing metabolic, no heart defect, no cystic fibrosis....nothing but calorie intake, and you are addressing that beautifully
• the paed might not actually believe you will keep up the extra bf - he is watching his back, in case you slip up!

I wonder if this paed trained elsewhere than in the UK? Some countries have very bossy paeds and are used to their word being Gospel, and 'norms' elsewhere may actually be 7 oz a week - I can assure you that the range is much wider than that in reality, but this is what mothers are told by their docs.

Keep up the extra bf, inc the switch nursing, and find an HCP, like the more recent HV, who can support you in this.

Thank you so much everyone for your support and wise words. I'd got to a point where I couldn't see the wood for the trees but am now starting to feel like I can fight these people again. I'd got so motivated before and so excited about DS's weight gain - but after my experience yesterday afternoon, was beginning to feel like I was the crazy one again.

I hate the way HCPs make you feel - they make a remark or suggestion which they probably forget the minute they've said it, but I've spent all this time getting angry, stressed and upset. I really wish I'd posted earlier as I might have got the help we'd needed earlier .

I'm seeing the BF counsellor again next week and in the meantime I shall crack on with the feeding and encourage DS to feed even more if I can.

Has anyone got thoughts or experiences of frequency vs quantity - ie is it better to feed for 45 mins every three hours or 20 - 30 mins every two say?

AlisonJB -you should be excited about your DS's weight gain - 10oz in 2 weeks is great! Please don't let them get you down. I can't see what their prob is if he is gaining weight - I think the average for a bf baby is 5-7oz/week. Glad you're going to see the bfc - keep your support network up - you are doing a great job and someone in RL needs to give you some recognition for that!

Frequency is the driver of milk supply, Alison - two hourly shorter feeds are more stimulating than three hourly longer ones.....absolutelty no doubt about that. Read info on www.kellymom.com for the science, and anyone who says rubbish like 'make her go longer to stop her snacking' or 'shorter feeds are no good as she wont get the hindmilk' is merely exposing their own misunderstandings.

Hope this helps.

AlisonJB - Have been thru the same myself with 1st DS. Tho HVs didn't really seem too bothered. Probably cos I ended up giving him bottle of formula a day. Didn't know any better then. He still gained slowly and he ended up fussing at boob and eventually he gave up BF at 8 mo.

Do look at that kellymom website. Particularly this page about weight gain. I found it really fab.

Also I've seen a site somewhere that has an article titled something like "treat the baby not the chart". Maybe you could take it with you. Says to look for signs of healthy, happy baby etc rather than just using a chart. I'll look and try and find it for you.

Oh and a weight gain of 10 oz is fab. Congrats! My 5 mo DD is a totally different story exclusively BF and gaining weight fine at a consistent rate of 4 to 5 oz a week. Babies are just differnt.

We got sent to see the paeds when DS was 8weeks, the HV had come round with a breastpump and a referral. It was gutting as he'd put on 6oz in just over a week and had got back to his huge birthweight the week before. We saw a junior doctor who said he was fine, that we should think about top-ups and I should express to check my yield.
When it became clear they wanted me to express right there I kicked off at a snooty nurse and they sent the registrar who listened to me going on about there being nothing wrong and said I needed pampering, come back in a week.
So, I ignored the pump, ate lots of flapjacks and fed, fed, fed and he'd put 7oz on when we went back. He stayed on the 9th centile till 5 months, but was clearly ok.
Read up as much as you can, I found loads on Kellymom and on the 'little acorns' thread.

Best of luck.

My ds floats around the 0.4th centile and sometimes just below. He was 9th centile when born and has only ever lost weight once, he gained fine for the first 8 weeks then slowed down and has gained slowly ever since.

He is now 14 and a half months old and fit and healthy. He has been refered to the paediatrician ages ago and he keeps saying ds is fine but we go back for regular check up's to check how he's getting on. He was also refered to the dietician for ideas on how to up his calorie intake.

I bf him for 5 weeks, gave up for a week, started again but still had problems so he was mix fed till 5 months (all the time I was pressure to give more formula than I was giving by the hv, I kept insisting I didn't want to lower my milk suppply by doing this, eventually ds got more used to bottles and wouldn't bf . I have since found out he has an undiagnosed slight tongue tie which may have affecting him latching on). Just for the record, his weight gain was no different on formula than it was when he was bf at all! Oh, and breast milk has more calories than formula anyway.

By the time we saw the dietician he was ff so she prescribed slightly higher calorie formula which helped a little bit. As he wasn't moving up the centiles on that she prescribed an even higher one at 1yr old and thins helped a bit more but also had the efect of making him sick once a day and putting him off solids completely . He is now on a mixture of the old high calorie and the new high calorie.

He's doing well but I have to say, this is just how he's made, he has always had a small appetite when bf ff and fed food.

As a lot of people on this thread have said, someone has to be on the lower centiles, it's just as normal as being on any other centile, adults aren't all the same size are they?!

I, like the others am worried about the comment made by your paed about him being weakend for life . I have to say my paed has been very good, we actually asked him that very question 'will ds be affected in any way by this slow weight gain later in life' and he answered 'no, not at all'. I believe that the baby would have to be severly malnourished and particularily in the forst 8 weeks of it's life for it to have any affect later on. This is clearly not the case with your lo!

It sounds like the switch feeding is doing an excellent job. You are doing so well, it takes a lot of time and effort to do what you are doing.

Our paediatrician did blood tests and took stoll samples from ds 'just to rule anything out' but atated he didn't expect anything back from the tests as he could see that ds was happy and healthy even if he was on the small side. Of course nothing came back from the tests and that put our minds at rest that nothing else was causing it. For that reason it might be worth getting these tests done if you haven't had them done already?

I'm sure everything will be fine, check out my ds on my profile, he's small but perfectly formed and full of energy, I can't keep up with him!

can I add the other side? Ds 1 was 9lb 1oz and was b/f till 6 weeks I then changed to formula and at 12 weeks his weight levelled out and then he dropped from the 91st downwards for some weeks and ended up on the 9th. The HV encouraged more feeds -he ate less at the more frequent feeds but THE SAME over a 24 hr period. As it was formula I could accurately measure. We were told he was thin and made to feel very uncomfortable about his weight gain. The hv said she was giving me till her next visit for ds to put weight on and then she was referring us to the paed. I was petrified. The next visit came and a lovely lady (HV went on long term sick) whoc asked whether he was active? Met milestones all of which yes. She looked at me -5'2 and size 8 and said that I grew a large baby but he maybe he's not meant to be a big chap. She said she was happy and that was the end of that.
Ds 1 is now 4.9 and still a skinny minny. He never stops from the minute he wakes up in the mroning till his last sigh at night.

Ds 2 was 9lb 15 1/2 and b/f till 14 weeks and his weight didn;t drop at all but he's has a completely different body type and shape. He is enormous, large shoulders and large head and tall. He takes after dh (dh doesn't have a lrge head though!) so we think he'll be broad.

hi dal!
x

Hey muppet x

Just a thought - there's seems to be so many tiny, healthy babies coming out on here shouldn't the tiny acorns thread be resurrected?

I posted on that thread a few times, found it useful . It's still there but has kinda slowed right down.

Here's the link if any of you fancy trying to get it going again!

Just to show te bias or thought processes-

ladies in a lift in Asda today

'Ooh look at that baby and how well he sits! doesn't he look happy? And so healthy and bright.... how old is he love?'

'9 months, and he is doing well yes- took his first step 2 days ago'

'9 months? at that size? poor kid, is he ill?'

FFS! LOL. He's fine- catching up in fact!

How rude of them, I used to get comments like that all the time!

peacy I get that from old dears re my non walking (not even crawling?????????) ds 2. It was other people that made me worried...

peachy

I thought it was funny tbh, but after 4 I am hard.

OTOH 2 of my other 3 are disabled so it's going to take a lot to bother me as long as he making progress IYSWIM.