Cereal at 3 months? Don't like the Doctor's order.

[kafine]

DD has just gone 3 months and went in for a weigh in at her paediatrician (we've just moved to the States so no more MW or HV). She came in at 9lbs 7oz. She was 6/11 at birth and according to the charts has dropped from the 20th percentile to the 5th. She is BF only btw.

Nevertheless she is happy, has many long moments of alert attention, eats lots and poos and pees plenty (4-6 #2s a day, plenty), can hold her head steady and at 45degrees during tummy time and sleeps 6 solid hours a night.

Well, doctor told us to start giving her rice cereal mixed with expressed milk in order to get her weight up. I hate this idea. I think it's too early for food and have always understood rice cereal to be processed non nutritive mush anyway. I'm worried if I supplement her food it will lead to bad eating habits, to allergies or constipation, and to a decrease in my milk supply.

On the other hand, the worry is that she's gaining slowly because she's not getting enough calories and this could affect or be affecting her neurological development. Scary thought and though I see no sign of this but she is dropping percentiles and rice is doctor's order.

I really don't know what to do. Does this scenario sound familiar to anyone?

Which charts are they using? The out of date charts based on ff babies typical weight gains are not particularly relevant to bf babies.

Personally I would never give a baby rice cereal. Of be looking to increase feeds if the weight is really a problem... Or perhaps it's that you have a petite baby?

My 4 dds were all small and dropped in the percentile charts as ebf babies. A pead told me (in the uk), that it was just how my children were. When it happened to my first dd, I topped up with formula on hv orders.

With dd2 at 2 weeks old she was hospitalised for being underweight. I was distraught, had to top up with breast milk every 2 hours. After a weekend of this (just recovered from mastitis, baby with jaundice and a slow feeder) I saw the cons rather than just the dr on the ward, who explained that they had wasted my time following protocol rather than listening to me. Told me to trust my instincts...

Dds3 and 4 follow the same pattern. Dd4 especially quite small. I kind of missed the radar of the mw/hv. At 3 months, I was always v confident that they were alerts, smiling, meeting developmental milestones etc.

Dh is a very strapping rugby player psychique. Last three dds have definately inherited it! They eat like horses, they are unstoppable. I was told at 4 months to wean dd1, she was just to young, couldn't eat...

You have my unsympathies, the easiest solution would be to feed her to get her weight up, but kind of a 'lazy' option from a dr who just wants to tick boxes....

My dd dropped from the 91st percentile (at birth) to the 25th (at around 8 weeks). Cue much panic from HVs who all said I would need to switch to formula. I gave it another 2 weeks of ebf and her weight did not drop off any more and as she was otherwise healthy I stuck with ebf. She is just naturally small I think. She still is, as a 3-year-old, but is perfectly bright with no physical problems. Of course, I can't comment on your dc, but cereal at 3 months does sound wrong. Can you seek a second opinion?

Forgetting the percentiles is she her weight going up?

I am sure you know but the down sides to introducing anything at this age are huge, especially as you say for leading to allergies etc

Could you not try altering your breast feeding first? You hind milk is fattier. What I did was block feed off one side as much as possible so that DS was getting the fattier milk. Or on days where I was uncomfortable (due to too much milk) I pumped off the foremilk first and let DS have the hind milk.

Doctors don't always know best. I agree with above about them going for a quick fix. My DS's consultant paed is great and told me not to wean early and not to supplement with formula. If necessary he felt supplementation with breast milk through cup feeding could be an option but only if weight fell or plateaued. He even felt that tube feeding would be better than early weaning due to the negative long term effects. As long as weight (not percentile) is going up not to worry.

So I'd say there are several other options before considering early weaning.

Is plenty coming out (wet and dirty nappies)?
I thought milk was more calorie dense & easier to digest than cereals, hence why people use cereals to try to make babies sleep longer.
So the solution to low weight gain is more milk not using cereals to displace milk.
Or at least that's what all the breastfeeding Afiocionados say.

Do your research.

Missbluebird's advice of block feeding is potentially problematic. Block feeding is used to reduce milk supply for women with abundant over supply. I wouldn't suggest that in your case. More frequent feeding, with switch feeding, is going to increase your milk supply and hopefully your baby's weight gain.

You could also try breast compressions whilst your baby is feeding. Have a look at the Kellymom website - there's lots of helpful info on there about increasing weight gain.

Make sure you offer both sides at every meal, but if the baby is happy and hitting milestones, just trust your instinct...

And not do gie rice cereal, why reduce the calories the baby is getting by bulkiing up with shite?

How long does she go between feeds during the day OP?

Op there are less calories in baby rice (and way way less nutrients if any at all) than breastmilk.
Ignore.
You know your baby and as long as you're happy carry on as you are.

Kellymom is a great website. I know traditionally block feeding is used to reduce supply but I worked to get my baby's weight up and fortunately did not affect mine but that was probably because I also regularly pumped off the side I wasn't using for those few hours.

Thank you for your help and stories. I think I'll hold off on cereal awhile longer. I might just try supplementing with plain expressed milk this month to see if we can climb back up the chart. I do not like the chart.

Good luck with it. I think I called the nct breastfeeding helpline when I was trying to continue with the ebf and they recommend, as a pp has said, trying to get as much hind milk as possible. So don't keep switching breasts, and even massage the breast when you think it's nearly empty to get as much hind milk into your baby as you can! Hope that works.

Like lljkk, I thought milk is more calorific by volume than the cereal anyway? so this kind of advice makes me

I don't know if I'd call it block feeding, but I do think keeping her at the same breast for a period, and making sure she has had a good feed from that let down, is a good idea. If she's easy to get on and off the latch, try hand expressing a few drops to look at during a feed - you can see the difference between foremilk and hindmilk, former is blueish and rather clear, latter is yellowish and thicker.

Volume of milk is the most important thing in increasing weight, not trying to engineer babies getting "hindmilk" - so, feeding frequently, offering both breasts and switch feeding, and also topping up with ebm if you wish.

I certainly wouldn't give anything but milk to a baby under 17 weeks old.