Topic: Baby's losing wieght (medical and breastfeeding advice?)
Boon
unregistered
posted
Thomas is 4 months old now. At birth, he weighed 8 lbs 4 oz. September 17th, he weighed 11 lbs 8 oz. Now he weighs 11 lbs 3 oz.
I've been breastfeeding on-demand since birth, and he also gets 2 oz of juice every day (he's had problems with constipation) and about 1/3 cup of baby cereal about every other day. He has about 10 wet daipers every day, but only has about 2 scanty BMs a week (just enough to stain the daiper).
His doctor said to start giving him cereal twice a day, mixed with formula, and fruit once a day. She also said I need to start giving him a bottle of formula before bed because that's when my milk would "be less effective".
I'm frustrated. I don't have a problem with giving him cereal and fruit (obviously) but should I really be giving him formula? Is it possible that he's just not getting enough nutrition and calories from me? Why?
The doctor said that if he doesn't gain some weight by the end of the week, she's going to put him in the hospital and run a bunch of tests. Is she for real or is this a scare tactic to get me to feed him formula? It seems to me that he just got a lot taller recently (growth spurt) and maybe I just haven't caught back up to his appetite yet.
posted
Thomas probably wasn't ready for cereal as a major source of nutrition. The cereal takes longer to digest and can be a caust for constipation. Very few babies fed only on breast milk ever get constipated.
Because the cereal takes longer to digest, your baby stays full for longer and may not be getting as many calories as he would be getting if you breastfed him instead of giving him cereal.
I'm suprised your doctor recommended that you start it so early. 4 months is the absolute earliest. My babies were eating two or three spoonfuls of cereal more for the experience than for nutrition at that point. How long have you been feeding him cereal?
Your milk is less effective in the evening??? I have never in my life heard that, unless your doctor is trying to "put the baby on a schedule". Formula also takes longer to digest, and as a result formula fed babies often sleep longer, and usually sleep through the night before breastfed babies do. This, again, will lead to less calories getting into baby.
Your doctor sounds somewhat hostile towards breastfeeding. Are there any other indications of that? What is your doctor's 'schedule' as to when to wean? If it were me, I would be switching doctors. Talk to a lactation consultant too.
AMA says babies should be breastfed for at least a year. WHO says two years. All the literature I've read states that when the mother is healthy, breastmilk is always better than formula.
posted
I would agree with Amka about the "less effective" comment. That is just absurd that your milk would be less effective during the evening.
I would say that the constipation is probably cause for concern and I would be asking more questions about that. I find the juice suggestion pretty odd as well (apple juice?) and the formula suggestion to be way off base. Babies don't need any supplemental nutrition until at least 4-6 months and I would think the formula would be more constipating.
Is he eating at least every 2-3 hours? More or less often recently? How many weeks has he been "constipated"? What were his bms like before?
I would have him weighed again in a few days to be sure the weight loss isn't continuing and if it isn't I'd wonder if the doctor weren't overreacting. Thomas seems to be at a pretty healthy weight for his age. I'd talk to a lactation consultant as well.
Poor dear! My coworker's daughter's doctor just did this to her, making her quit nursing cold turkey because the baby 9 month old has had continual problems throwing up from birth even though she is gaining weight well. The doctor was surprised she was still nursing and said that a bottle of formula would be better for the baby. I was so mad to hear this!
Posts: 1777 | Registered: Jan 2003
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quote: The doctor was surprised she was still nursing and said that a bottle of formula would be better for the baby. I was so mad to hear this!
*shakes head sadly*
What in the world is wrong with doctors today?
Amka & Christy offer some excellent incite.
I know that I waited forever (it's been so long since I've nursed that I can't remember) before I gave my children anything except breast milk. They were healthy, rather on the chubby side, babies with normal bm's, wayyyy to normal if you ask me.
Boon - Being a mother of three children, ages 11, 13 and 16, I've learned from experience that not all doctors wake up in the morning with their heads screwed on straight. They're human and they make bad judgment calls just like everyone else. They absolutely have their personal prejudices, how can they not? I've listened politely to every doctor I've gone to, followed the advice of some and completely ignored others. You have to go with your gut instinct on these matters. If you think something is wrong and the doctor’s advice sounds screwy to you or to others, seek additional opinions.
posted
First, I would call an LC. Set up an appointment. Second, the WHO does not reccomend starting any nutrition but breast milk until 5-6 months. The extra "food" may actually be interfering with his appetite for his pefect food. If you are using almost any commercial baby cereal, it is all empty calories anyway. I would cut out the cereal and fruit juice, feed him only breastmilk for a week (under an LC's care) and see if he doesn't gain that weight back! Consider cutting out or back dairy in your diet, that may constipate him. Lastly, if formula supplementation does become neccesary, you do NOT have to give him a bottle. Ask for LC for a supplemental nursing system- a nifty device that allows the baby to drink the supplement at the breast. The bottle can interfere with his latch, which would not be helpful right now! Good luck!!!
posted
I wonder if your doctor has been recieving gifts from a formula company. Maybe he went to an education seminar about the benefits of formula- on a cruise ship. You'd be amazed how much of that nonsense directs care.
The effectiveness of your milk is exactly what the baby needs when he needs it. Unless you have some other problem, in which case the baby wouldn't have gained the weight he has so far.
When did you start juice and cereal? I've always read 4 months is the earliest you should start. Cereal and juice are straight carbs anyhow, I don't see how those would make him grow. Gain weight, sure. But not grow.
We are looking at a 5 oz. differential. That loss could easily be the difference in feeding and a bowel movement. Was he even naked when they weighed him? They usually just weigh them in the diaper.
For your milk overall make sure you are getting adequate nutrition, especially protein, and water. Why were you going back to the doctor after 2 weeks, out of curiousity? If he told you to start these foods and check back in 2 weeks, I'd find that very very fishy.
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posted
My mom tried the supplemental nursing system with my sister who was adopted in an attempt to stimulate her breasts to produce milk. Those are kind of cool, but my mom was a bit older and there were too many distractions so it didn't work very well. It might have helped if we had expected the adoption. As it was, her arrival was fairly spontaneous.
I think the doctors get a lot of literature from the formula companies. There is a lot of profit in these companies to indoctrinate the doctors. But since there is little to no profit to be had with the nursing mom, there is not as much unsolicited literature coming from breast milk producers.
I was a little upset when I got a gift bag at my first prenatal visit, upon which was printed "Infamil with Lipil supports brain and eye development" There was also, of course, a sample of powdered formula and a "third trimester gift" diaper change pad with the Infamil logo and literature about "your baby's formula", and a gift certificate for a diaper bag.
There was nothing similar in the bag promoting breastfeeding, and I think it is telling that in one place they advertised "now even closer to breast milk". However, to the young mother uneducated about such, there is no message that breastmilk would support baby's brain and eyes better than formula ever would.
This coming from a hospital and clinic that 'loves their breastfeeding moms'. But the printed paper bag comes in handy for all the other stuff they give the mom, and how can they not resist giving out the formula company freebies?
posted
Boon, are you working with a board-certified pediatrician, or is this someone who also sees adult patients?
quote:The American Academy of Pediatrics (AAP) recommends that breast milk be the only nutrient fed to infants until 4 to 6 months of age. (36) For mothers who cannot breastfeed or choose not to breastfeed, a prepared infant formula can be used and is a complete source of nutrition. No additional nutrients are needed. There is no nutritional indication to feed juice to infants younger than 6 months. Offering juice before solid foods are introduced into the diet could risk having juice replace breast milk or infant formula in the diet. This can result in reduced intake of protein, fat, vitamins, and minerals such as iron, calcium, and zinc. (37) Malnutrition and short stature in children have been associated with excessive consumption of juice. (4,38) [bold added for emphasis]
I'm serious -- is this a board-certified pediatrician, or is it someone who sees kids and adults?
quote:[Footnotes:] (4) Dennison BA, Rockwell HL, Baker SL Excess fruit juice consumption by preschool-aged children is associated with short stature and obesity. Pediatrics 1997; 99:15-22
(36) American Academy of Pediatrics, Committee on Nutrition. Supplemental foods for infants. In: Kleinman RE, ed. Pediatric Nutrition Handbook. 4th ed. Elk Grove Village, IL: American Academy of Pediatrics; 1998:43-53
(37) Gibson SA Non-milk extrinsic sugars in the diets of pre-school children: association with intakes of micronutrients, energy, fat and NSP. Br J Nutr 1997; 78:367-378
(38) Smith MM, Lifshitz F Excess fruit juice consumption as a contributing factor in nonorganic failure to thrive. Pediatrics 1994; 93:438-443 [bold added for emphasis]
[ October 04, 2004, 02:56 PM: Message edited by: Sara Sasse ]
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quote:6.3 Facilities of health care systems should not be used for the display of products within the scope of this Code, for placards or posters concerning such products, or for the distribution of material provided by a manufacturer or distributor other than that specified in Article 4.
posted
Sadly, many doctors seem to push for solid foods early. Right now my 6 month old niece is eating all sorts of things, including 2nd foods and baby food meats. This is with the dr.'s blessing. Strangely enough, she's been crying a lot and having problems sleeping. Wonder why.
Boon, you're getting great advice here. Don't let a formula-crazy dr. talk you into supplementing and therefore threatening your milk supply.
posted
I still want to know if this is advice from a pediatrician.
I've seen excellent care given to children by Family Practice specialists, but all of the clean-up messes we took care of in residency (what-the-heck-was-he-thinking?!) and all of the just plain crappy advice that I've seen has come from non-pediatricians. I'm actually keeping record.
Kids aren't small adults.
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posted
((Sara)) sadly we only bring our scary stories about pediatricians to this board lately. I was just thinking the other day of an incident where I was so glad to have western medical care. I can't remember what it was anymore, but I don't think you are all crooks. Posts: 11017 | Registered: Apr 2003
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No, no, it's okay! And I know a lot of pediatricians aren't as breast-positive as they should be for infants. I fault them for it, but I do see appropriate formulas as a non-dangerous (even if non-optimal) source of nutrition and hydration for babies. You aren't going to end up with your baby in the hospital because you gave them an appropriately-prepared infant formula.
But juice? It isn't electrolyte-balanced for infants! I've had to deal with infants who were given too much juice or tea (an illness therapy from the Latino tradition) and ended up with whacked-out electrolytes.
That's just crappy pediatric care.
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posted
Long live breastmilk! My brother nursed till he was three! But that was a comfort thing, since he was going through alot of surgery on his arm due to a birth defect. I think I breast fed till I was one or two...
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posted
Oh, yeah the electrolyte imbalance could be causing both the constipation and dehydration, which could explain the weight loss. I was trying to figure out how juice could cause constipation. It seemed counterintuitive. But now it makes sense.
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posted
BTW, the places I work do not give out formula "starter kits" or anything of the sort. Meriter Hospital in Madison is one of less than 50 designated "baby friendly" hospitals in the US!
quote:In 1992, the World Health Organization (WHO) and the United Nations International Children's Emergency Fund (UNICEF) launched the BFHI {Baby Friendly Hospital Initiative] in an effort to transform practices in maternity hospitals worldwide. It facilitates breastfeeding and ensures that women in maternity care have full information and support to breastfeed their infants in an environment free of commercial influences. Baby Friendly Hospital Initiative
Yay for breast-feeding! And yay for good medical care!
[ October 04, 2004, 04:00 PM: Message edited by: Sara Sasse ]
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posted
I'd like to echo the previous comments about not being afraid to use breast milk as the sole nutrition source for Thomas. As I related in PSIs thread we're having sort of the opposite "problem" to you now in that our baby isn't taking to solid food very well at 14 months. However, she is a testament to the fact that breast milk can keep a baby chubby!
((Boon)) Good luck. I'll bow out to the experts.
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posted
The first thing that I thought was that Boon's doctor should be telling her to cut out the juice, not breastmilk. I've read a lot of articles about the dangers of juice and they were all from credible sources and offered a lot of solid research. Not only does it contribute to childhood obesity, but it also leads to cavities and gum disease. I used to read the backs of the kids' juice boxes at the Y and it is full of sugar and carbs and much fewer vitamins that they claim.
The articles I've read recommend holding off everything but skim milk and water until school age. That's what I plan to do. I also plan to nurse for at least a year and if my pediatrician were to tell me to switch to formula before 5 months, I would look for another one.
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posted
Boon, you've already gotten a lot of good information.
I just want to reiterate that a 4 month old does not need more cereal, juice, and fruit to gain weight, but more frequent breastfeeding. I agree with romany's suggestion that you meet with a Lactation Consultant - she can help you with a program of more frequent nursing to increase the baby's caloric intake.
Breastfeeding is the baby's main source of nutrition in the first year of life.
From the American Academy of Pediatrics website:
quote:Exclusive breastfeeding is ideal nutrition and sufficient to support optimal growth and development for approximately the first 6 months after birth. Infants weaned before 12 months of age should not receive cow's milk feedings but should receive iron-fortified infant formula. Gradual introduction of iron-enriched solid foods in the second half of the first year should complement the breast milk diet. It is recommended that breastfeeding continue for at least 12 months, and thereafter for as long as mutually desired.
In the first 6 months, water, juice, and other foods are generally unnecessary for breastfed infants.
Just for the record, I am quoting from this reference: POLICY STATEMENT PEDIATRICS Vol. 100 No. 6 December 1997, pp. 1035-1039 AMERICAN ACADEMY OF PEDIATRICS:Breastfeeding and the Use of Human Milk, which can be found at the AAP website.
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posted
Well, actually once we have the switch to milk, I would give young children until the age of 6 either whole milk or 2%. Young children need more fats in their diet than older children or adults. They are still growing the myelin(sp?) sheathing around the neural connections in their brain, and this requires fats. The fats in whole milk, other dairy products, and fish are healthy fats. These are far more desirable than say, the fats they would get with fried foods.
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posted
I would look at the child...my kids are skinny, so we feed them whole milk ( the boys that is, Olivia hasd to have soy and it's mostly low-fat) But if my child was overweight I would do skim.
posted
Boon, everyone here has offered you excellent information and support. I second them, and would like to offer some hope as well -
Nathan was critically ill for much of his first year of life (and then periodic bouts throughout the next six years.) He was completely breastfed for the first year (including through alternative feeding methods such as tubes) when he was on life support. He was never underweight, and he does not suffer from any of those complications that juice, formula, and early feeding of solids can bring on.
Follow your instincts - and truly, it is your right to find the pediatrician or family doctor that you trust and that will treat you as a partner in your health care.
Hang in there.
(P.S. Breastmilk is actually at its' richest in the evening.)
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posted
Christy, they haven't updated the list -- I know Meriter is designated, as I was at the ceremony.
Unless it was all a trick! But then again, I am a degenerate. A lyin', cheatin', sleepin' degenerate!
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My kids had whole milk till they were about 4 or 5, IIRC, at which time we transitioned to 2% and then skim.
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Boon
unregistered
posted
Thank you all SO much! More than anything, I think I just needed some reassurance that I was right.
Our doctor has a family practice. She's not just a pediatrician. Up 'til now, I've thought she's absolutely wonderful. And I thought she'd know about, and be very supportive of breastfeeding, since she breastfed her own boys.
I'm glad I didn't just take her word for it on the formula/cereal/fruit thing. I'm so very relieved that, once again, the Hatrack Expert Squad has come to my aid.
Here's what I did instead of following her advice immediately: First, I posted here, waited for a response or two (thanks!) and then I bought a nice bathroom scale that measures ounces as well as pounds. Then I cut out ALL supplemental feedings.
I discovered that I've been too busy to be as attentive as I should've been. Instead of making sure he was nursing for an adequate length of time every time, sometimes I'd nurse him until he fell asleep (and not wake him up to finish) and put him down so I could do some of the million other things a busy mom needs to do. Like cook meals for the other two kids. And dishes. And laundry.
I've been suffering from SuperMom Syndrome. And you know what? I can't do it all.
Breastfeeding my infant is the most important thing I can do for him at this stage of his life. My other two kids...well...the routine of the last two days may just become the norm.
They got themselves dressed. SuperMom did not even brush Jen's hair, she just made sure Jen brushed it herself. They rode the bus to school. SuperMom did not get dressed, get the baby dressed, load us all up in the car and run them to school.
Instead of SuperMom's usual routine of morning laundry, she sat on the floor playing with her baby, with a couple of long (had to wake him up twice to hit 20 minutes total!) nursing sessions. Instead of loading Thomas up to go eat lunch at school with the kiddos, followed by 3 hours of volunteering in the kids' classrooms, she ate a sandwich at home and told the teachers she's taking this week off. Next week, she'll start the new routine: 1 hour, twice a week. (And, since she wasn't already at the school, the kids rode the bus home, too!) Guess who took a nap!
When the kids got home, SuperMom didn't go to the grocery store, opting instead to call SuperHusband and telling him to pick up milk and fruit on his way home. Kids got their own snacks instead of getting served. Then, SuperMeanMom made them do the laundry she neglected that morning, while she had another nice, long nursing session.
To cap it off, SuperMom hasn't even made supper in two days, nor done dishes. SuperHubby made grilled-cheese-and-tomato-soup-sandwiches (family joke) Monday night and Banquet cooked frozen dinners last night.
Just call me SuperDelegatingMom. Or SuperLazyMom. Or maybe SuperBoobies. He's gained 3 ounces in two days (average).
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posted
Wow, no wonder! You were trying to do wayyyyy too much. I am so glad you're cutting back, only so much is humanly possible. Go Supermom!
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posted
My nurse practitioner said that babies should be breastfed exclusively until they are 6 months OR 4 months AND more than 14 lbs. My advice: stop solids and juice, revert to exclusive breastfeeding. It's higher in fat and protein, and absolutely the best thing for a baby who's not gaining weight. Make sure he's positioned correctly; sometimes as babies grow, they like to wiggle, and it gets harder for them to latch on properly without supervision. If your baby is still losing weight after switching to exclusive breastfeeding, it might be time to think about supplementing, but I'd change pediatricians if I were you. When you say your son was constipated, does that mean hard pellets? If not, it's not constipation. Few stools are common in babies, especially when they're growing fast. Even so, the first thing to try for constipation is more frequent breastfeeding, not juice. Juice being given to a baby that young, besides immediate risks of electrolyte imbalance and inadequate nutrition, increases the risk of diabetes. To sum up: go back to exclusive breastfeeding, try doing it more frequently, make sure he's positioned right, and change doctors.
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quote:Breastfeeding my infant is the most important thing I can do for him at this stage of his life. My other two kids...well...the routine of the last two days may just become the norm.
Awesome!
And you will produce less milk if you are stressed out, so relaxation and naps for you are important for your baby.
quote:Our doctor has a family practice. She's not just a pediatrician.
FWIW, she's probably not a pediatrician at all.
Most family practice physicians are not trained as pediatricians, although they do take care of kids. Pediatrics is a separate specialty, and to be a pediatrician, you have to have gone through a pediatric residency and passed the board exam for pediatrics in particular.
Family practice residency takes 3 years on average, just the same as a pediatric residency. The difference is that pediatricians focus on learning about kids for all three years. FPs are spending much of their time learning about adults. Some have more pediatric experience than others, but it is not in the same ballpark as completing a pediatric residency -- and some only have a few months' worth of time spent specifically on kids.
Because we see kids and kids alone (except for some university student time), errors in basic kid management are (I am convinced) fewer, and it is easier to keep up-to-date on the literature.
Mind you, some FPs are excellent caretakers of kids. It's just that many are not. (*she says, snootily )
[ October 06, 2004, 05:17 PM: Message edited by: Sara Sasse ]
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posted
My dad's a FP, and he's good with kids, but he admits that's mostly because he has some of his own. Posts: 21182 | Registered: Sep 2004
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posted
I think you have hit the key to the possible problem. Breastfeeding long enough to get to the "good stuff" (the breast milk with the fat and nutrients necessary - sorry, can't remember the correct termonology ). The "good stuff" does not immediately come when a breastfeeding session is first started but after a few minutes of feeding.
So often doctors don't really know what to do so they guess. I've heard many different things from in-laws (from their doctors) and from my wife's doctors over the years.
My sister-in-law and others sometimes start on solids early (such as rice) just so they can get more sleep at night. To me that is a selfish reason that doesn't have the infants best interest in mind. I apologize for any offense taken by those who may do this.
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Boon
unregistered
posted
I think Hindmilk is the word you're looking for.
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posted
"good stuff" = "hind milk" (full of fatty goodness!)
ketchupqueen, I would hate to be taken to imply that FPs as a whole can't take good care of children. I'm sure your dad is great! I just think it's easier to get the certification without being really good at or well-versed in kids' issues when you go the FP route. You can't slide by in pediatric residency, because it's 24/7 kids kids kids. No getting away from it.
(And trust me, I am wayyyy out of my league when it comes to adult stuff, so my perspective is probably quite biased. I couldn't even do a crappy job as an FP. Don't have it in me. )
And anyway, yay for Boon again!
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We've been well read with our kids and have at rare times not taken our pediatrician's advice because it contradicts what we have read from numerous sources. We do that cautiously, however.
posted
Congratulations, Boon! Way to go! Yeah!!!! You are a wonderful Mom and wife! I love the report back to us, including the humor! Humor helps keep you relaxed which is good for production. (Popcorn and beer helped me . . . )
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posted
Yaay for Superboobies *grin* We knew they could do it. Yaay for Boon and yaay for the Boon family for stepping up to the task so that she can nurse! I'm so happy for you all.
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Yeah for Meriter! And Sara!! took my Five years ago, I think there were less than 10 Baby Freindly Hospitals. I am thrilled they are growing!![[Eek!]](eek.gif)
A lyin', cheatin', sleepin' degenerate!
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More than anything, I think I just needed some reassurance that I was right.![[Big Grin]](biggrin.gif)
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