being sent to failure to thrive clinic...

I just found out today that my boys have not gained any weight this week. The pedi is sending us to a failure to thrive clinic. I am worried sick and so confused and just heartbroken...

My boys have been slow gainers from the get go, and have supplemented with ebm and recently I began supplementing with formula . The first week the formula helped some and the boys gained, but this week G gained nothing at all and E gained 4 ounces. I have been nursing all the time and supplementing. The nurse today suggested there could be something wrong with my breastmilk.

I take fenugrrek and do not seem to have any supply issues.

I don't understand why this is happening or how. I have talked to local lcs, my doula, etc. Some people said not to worry,but my pedi sees it otherwise.

The boys seem very healthy, are very alert, etc. But they have only gained a little less than two lbs since birth (three if you count it from what they weighed after losing some after birth) and they are a little over two months old.

I am so sad.

 

:hug: I'm sorry. I know I have healthy kids and good drinkers (nursers) but my last baby went from about 80% at birth down to about the 30% at a year. 2 lbs gain at 2 months doesn't sound bad to me. :hug: How big are you and your dh? Perhaps your babies are just petite. Hang in there.. know that all this breastmilk that you are giving them is protecting them and helping their brains grow!

 

How old are they?

Try your best not to worry. One cool thing they can do is weigh the babies before and after a feeding, and see how much they are getting.

Keep us updated. :hug:

 

wow are you me? The only thing different about our situations is that my ped seems to be on the opposite end of the spectrum as yours--not worried about the slow gaining. Hang in there, these early months are so hard, I went through this w/my daughter as well who stayed between the 3rd and 10th percentile until 2 y.o. and she is now in the 50%! So things do change. Just remember the benefits of breastfeeding still are there even if you supplement. Hugs!!!!

 

Thanks for the support ladies. I am having a hard time feeling okay about continuing to breastfeed, even though in my gut I know it's the right thing to do. I am so afraid there is a larger problem, yet I also suspect they may just be small. I am only 5'3 and fairly thin. My husband is very tall and thin. He was that way as a baby. The twins are long and lean.

Chicago mom---I have read your posts and thought before how similar are our problems. I feel for you. I feel crazy sometimes trying to figure it all out. It's wonderful that you are getting support for continued breastfeeding!!
I live in area where there is very little support for breastfeeding.I think if it was up to the pedi, and certainly if it were up to her nurses, I would just give it up. But I have tried so hard, you know? I can't quit now. And bf is important to me--for my kids mostly, but also for me. Breast cancer runs in my family and I understand that nursing can possibly help prevent breast cancer, especially extended nursing.

The pedi wants me to start supplement after every feeding, even if they don't seem to want them. I know this will decrease my supply, but I don't know what else to do. I suppose I will pump after each feeding as well to try and keep supply up? Not sure how I will do that when my dh is not home. I am afraid I will wind up weaning early even though I don't want to. I gave them a bottle after their last feeding, and while they did take it, it took forever for them to eat it. Now I imagine they are super full and will not want to bf for a while.

When I tried to talk to my pedi in the past about formula hurting supply, she said she did not think it was a problem and not to worry about it. Where I live most people, if they do bf, quit by 6 months, so I don't think there is much knowledge about supply/demand issues.

Yet at the same time I feel I need to supplement more because if there IS something wrong with them I certainly don't want them to go malnourished. It's so confusing and scary. argggg.

And I talked with the clinic again, and it looks like they can't get me in to the failure to thrive clinic for a few weeks. whew. Going to be a hard few weeks trying not to worry.

Thanks for listening ladies.

 

I would be wary of advice from the pedi to "supplement after every feeding". If the pedi really thinks you have a supply problem or that the babies are having trouble transferring milk rather than suggesting formula they should suggest you work intensely with a good lactation consultant.
Breastfeeding is a lot of work and it takes a LOT OF SUPPORT to make it work. You're doing a great job. Don't get discouraged! If you can see your lactation consultant again (as many times as you need too) and think about seeking out your local la leche league. lots of leaders will do home visits and come be the support and extra set of eyes and opinion.

:youcandoit:

 

Many many many pediatricians don't know much about BF and can hinder the success for some moms. I'm not saying yours is doing that at all, I just know how confusing it can be hearing different things from different professionals.

I hop you start to feel better soon. I think the FTT name is so scary. My kids have all been small and two of them very low in the percentile range. That term was thrown around here and there and freaked me out every time. Please try not to worry too much. Knowledge is power. Meeting with that clinic will give you more knowledge.

Hang in there. Please let us know how it goes.

 

You know it is kind of funny you should write about this, because my daughter was and is a very distracted nurser and gains very slowly. My pediatrician was always wanting to supplemnt with formula and I went along with it for about a week but had to decide what I wanted to do. I decided to BF. I still am not happy with that man(pedi)for trying to get me to quit BF. I felt like it was a bother to him to try and help with my choice. Well we pushed through and she is still BF and she is still a slow gainer. She is 6 months and is only 13 lbs., but she will be tall like her mamma! Her brother is already 18 lbs, and they both weighed 6.4 lbs at birth! He's built like daddy!!Good luck and find a new pediatrician that will help you and support your BF, they are out there!

 

Since it will take a few weeks to get into the clinic anyway, I'd suggest that you buy an infant scale (I've seen them at Babies R Us and Target for $50) and keep a log for a week or so of the weight of each child before and after each feeding. That way you'll have numbers to show exactly how much breast milk they are drinking, and if supplements are needed they can give you an exact amount so you can continue to BF for the remainder.

I'd also look for a BF support group and ask the members to recommend a BF-friendly pediatrician for a second opinion.

 

I agree that supplementing after every feed will definitely impact your supply. It is a tough schedule to keep up also. As you don't think there is a problem with your supply, then I agree with getting a scale and weighing before and after each feed. If that's not a possibility, I would replace a feeding or two with a bottle (ebm or formula) and make sure to pump when you give the bottles. This way, you know they are getting a certain amount at those feeds but you won't be affecting your supply by supplmenting after each feed.

I also had a very slow gainer...she will be two at the end of the week and is only about 21 lbs. She has numerous food allergies, which was a reason early on that she didn't gain well. Once we got that under control and thought everything would change she continued to gain slowly...it's just her. I am not particularly small but was very thin and long as a baby and my pedi convinced my mother I needed an appetite stimulant! I wish they'd never done that!! Anyway, I tried not to panic with my DD and just watched her milestones, all of which she is meeting wonderfully. She was always alert and active as a baby, and as a toddler she is all over the place and her language is incredible. So this slow weight gain has not affected her development at all!

Stick to your guns. It's hard without support but come here whenever you need encouragement, and even facts to back up your beliefs. The women on here are great for providing both! The benefits of bf'ing for both you and the babies are so huge...you are obviously committed to making it work so don't let anyone around you make you feel that it's not important!!

Good luck and hang in!

 

I hope you can find a great LC and a local support group such as La Leche League.

Here's another source of great information until you do have a chance to get with someone in person. http://www.kellymom.com/babyconcerns/growth/index.html

As I was reading your posts, I wondered how you could go about actually getting your milk analyzed. I was alwasy curious, but since I never had any baby weight issues I didn't pursue it. I wonder if this is something that can be done at a local lab and under insurance ? seem reasonable.

anyway, I would suggest the scale at home. I have one and did weigh ours before/after for several weeks & months.

So, in all your posts I didn't see that the babies are still fussy and hungry? I don't know what that means, but I'm just curious. I hope that you are able to push through this and that the babies continue to grow and thrive.

 

one thing that the kellymom website mentions and others here have mentioned too is that the "degree of emptiness of the breast is what research has shown to drive breastmilk fat content, and thus calorie content.

The fuller the breast, the lower the fat content of the milk;

The emptier the breast, the higher the fat content of the milk (Daly 1993)"

here's the exact link to that information:
http://www.kellymom.com/nutrition/milk/change-milkfat.html

I didn't totally understand this and if I had, I think I would have kept up feedings every 2-3 hours. I am in awe of breastmilk and production! and I really hope that you are able to get some good help and figure out your babies needs. As the others said, any bf'ing you can do is wonderful and you are giving your babies such great antibodies.

 

I am so sorry that your are not getting the support you need. I agree with pp that you should get a scale. I have one with my girls and used one with my eldest DD. It really helps me know how much they are getting and making sure they get enough.

Currently I pump after every feeding, and there are times when they get only a bottle (EBM). At least one bottle a day helps me know how they are eating and if I need to work on increasing my supply. Maybe if you can get a small stash of EBM, you can supplement with that. I will say that I believe because I am pumping after every feeding, I am emptying the breast fully - therefore, when the girls get a bottle, it is more likely to have some hind milk in it and not just foremilk. Maybe your supply is so good that they are only getting the foremilk?

Good luck - keep up the good work. It will get better.

Niki

 

Pps have lots of good ideas. Just tossing out some ideas here.

Yes, supplementing after every feeding is going to hurt your supply. Either breast or bottle, not both, so the babies won't get lazy and just hold out for the bottle instead. Your pedi's heart is probably in the right place, but pedis are woefully underinformed about how BFing works. (Did you know that in the entire course of their education, they get maybe one lecture about BFing? Seriously, you could fill a book with all the crazy pedi stories I've heard in here.)

One thing you can ask your pedi about: it's possible to fortify formula or EBM to increase the calorie content. All it takes is just adding a little extra formula powder. You can look up what am't to add to bring it up to 24 or even 27 cal/oz. If you do this, then whenever the babies do get a bottle, it will really be worth it.

I seriously doubt that there's anything wrong with your milk. It's almost unheard of. And you're feeding frequently enough that I don't think they're missing out on hindmilk. If you're really concerned, you can have a lab analyze your milk, but TBH I think that would be a wild goose chase.

What you wrote about your & your DH's build and the babies' build is VERY reassuring. It really sounds like they're just the shape and size they're going to be.

I think it's great that you have a failure to thrive clinic available! The label sounds totally scary, but hopefully they'll get to the bottom of this. I'd be surprised if the babies aren't getting enough to eat, given what you're doing - it may just be their metabolism.

I actually wouldn't recommend getting your own scale to do pre/post-feed weighs all the time. You'll just drive yourself crazy counting ounces. With BFing, the amount they take at each feed may vary quite a bit, and that is perfectly normal - babies, ESPECIALLY BF babies who nurse on demand, are absolute masters of self-regulation, and they will take what they need over the course of a day. You'll just drive yourself crazy checking oz per feeding - oh no! they only took 2 oz, and last time they took 4, they're not getting enough!

It would still be a great idea to see a LC and do one pre/post-feed weigh - she can evaluate it in context of that particular feeding - what she observes (with trained and experienced eyes) about how the babies are nursing.


I'm really sorry you're having such a hard time. :hug: I know you're full of doubts and fears right now, but you are doing a WONDERFUL job. Please keep us posted on how things are going.

 

to add to the last post about not recommending getting a scale... I almost said that too... you can make yourself a little neurotic to keep weighing before & after etc.... I did this for a while... and I didn't really DO anything with the information... so basically it was wasted time. I did find it good to do once in a while and especially to do with a trained professional that way they can give you their professional advice based on what they see the babies transfer.

hopefully you get to the bottom of this soon.

 

GOOD NEWS!!!

Yesterday I went to see a lactation consultant at a large medical center about an hour and a half away. It was SO worth the drive. She was a huge help!!!

She talked to me about all the problems I was having, and then watched the boys nurse and then weighed them after nursing. Here is what we discovered and how we are going to address the problems.

Turns out, although they are spending A LOT of time at the breast they are not doing much effective sucking and therefore not removing all the milk at each feeding. When she weighed them after breastfeeding they had really not taken in that much even though they stayed at the breast for quite a while. So it's sort of like they are snacking all day long. They are getting enough to fill themselves up for just a short period of time--hence why they nurse all the time without a lot of weight gain. They are getting enough to grow, but not enough to really pack on pounds or stay full for longer than a few minutes at a time. A lot of their sucking was more comfort sucking then actual milk removal. This is also probably why I keep having plugged ducts and mastitis over and over. They are just not removing all the milk and not getting much hindmilk. In turn this is probably decreasing my supply because they often don't fully empty the breasts thus telling my body to make less milk.

You can't imagine what a relief it was to hear this. I have just been nursing non stop for two months and was going crazy trying to figure out why in the world they were not gaining and why they always wanted to nurse as soon as I put them down. I was starting to really feel crazy.

So, here is the plan we came up with. It involves supplementing for a while longer, but she says she thinks I can get rid of the supplements in the future if I am diligent. I am very, very dedicated to getting back to exclusive breastfeeding if at all possible, so I am up for the challenge. And I really think this plan will work.

The plan:

Rather than nurse them at the same time like I was in the past, I nurse one while bottle feeding the other. This allows me to really focus on how well they are feeding at the breast and make sure they don't snooze while eating. While one is nursing I bottle feed the other in a boppy with emb whenever possible or formula if I am out of emb.

After the baby that is nursing nurses for for 30 mins or so, I remove them from the breast and offer a supplement (emb or formula). To keep my supply up and remove more milk and thus encourage more production, I then pump for twenty mins. I then, of course, save this milk for the bottles. It's hard to find the time to pump, but I discovered that If the babies are fussy when I need to pump, and I am home alone (which I usually am during the day), I put them in my twin slings and pump while swaying back and forth with them in the slings. Not the most comfortable thing in the world, but it does work.

I try and pump at least 6 times a day. As my supply goes up I can use more and more ebm and less formula in their bottles. Right now a little over half of my supplement is with emb, but that should greatly increase as my supply goes up.

As they get bigger and stronger she thinks they will began to extract the milk much better and I can began to decrease the supplements after feeding. She said she sees this problem a lot in babies who are born on the small side. By three months or so when they are bigger they began to nurse much more efficiently. The trick is to make sure that until that time I am giving them adequate time at the breast while also making sure they are gaining.
She said typically supplementing after bfing is a supply killer, BUT if your babies are not removing milk well then the supply is already low. Pumping can fix this.

I am not sure at what point I can get back to tandem feeding...one step at a time. But I do think it will be possible.

After one day of following the plan I already feel so hopeful. It is hard to do all that pumping and cleaning up bottles...but it sure beats sitting and nursing for hours on end and never being able to leave the couch, AND never seeing a whole lot of weight gain.

Now they want to eat every two hours or so, which is totally doable. Before it was every hour or every forty five minutes, sometimes even every thirty mins. But that's because they were just snacking, so to speak.

The sweetest thing is that one of the boys always wants to nurse after he has the bottle...he's basically comforting nursing at that point, but I think this is so promising because it tells me he would rather have the breast, and as soon as he becomes a better sucker he will begin to fill up his belly there.
And I always let them comfort suck or nurse whenever they want to. Anytime they want to be at the breast I let them!! I want to encourage it as much as I can.

I am still going to go to the Growth and Development Clinic (this is it's actual name---sounds much better than the "failure to thrive clinic" which is what my pedi's nurse called it) as soon as they can get me in just to make sure there is not something else going on. The LC said they might could do something called "suck therapy" there. That sounds really promising.

Anyway, just wanted to update everyone.
Hope maybe this information can also be of use to others!!

 

Yay, that's great news! :yahoo: Well, not great that they're having issues, but great that you're getting to the bottom of it. Sounds like you saw a GREAT LC, and have a great plan for moving forward.

And let me just :bow2: to you for your amazing hard work and dedication! You rock! :clapping:

 

YAY! I'm so glad you got to see someone in person, its so helpful for them to see what is going on etc. I was going to ask if they recommended the sucking therapy, I've heard of several friends who have done that and it really helped. I think my friends had consults w/an occupational therapist for that. hopefully you find out what you need at your clinic tomorrow. and yes, that's a much better name for it than failure to thrive! good luck!

 

Sounds like a great visit! Your LOs sound a lot like mine. Mine were very slow to gain during the first 3 months. After 3 or 4 months, they got stronger and started gaining much more quickly, just like your LC mentioned. Now they are 10 months and are great a nursing. DS weighs 20 lbs and DD weighs 18 pounds. I did supplement some and pumped a lot in the beginning. I saw an LC every week or so during the first 2 months. I also have my own scale, which I used to weigh them weekly. I did not weigh them before or after feeds.

At about 4 months we were EBFing. There is definitely hope! It sounds like you have a good plan in place. You're doing a great job for your babies!

 

amazing!!! very helpful to read as well as my babies are doing the same darn thing re: comfort nursing...

 

That is awesome!! I am so happy for you. Keep us posted on how it works for you!!

 

Thanks everyone!!

I will keep you posted on the progress!

 

That's great. I knew once she measured the amount they were getting that you could get a better sense of what's going on. I did finger suck training with one of my boys who refused to latch and or latch properly, and it worked pretty well. Maybe that's what they will try to do.

I think your doing great!! Your persistence in the face of adversity is awesome.

 

You are so inspiring! Thank you so much for posting here and letting people know how these kinds of problems can play out with good support - not to mention your own determination and commitment to follow through on what feels right to you.

I had one guy who weighed less and didn't nurse very strongly for a while. In addition to a regime similar to yours, I tried this technique called breast compression, described here: www.drjacknewman.com. It basically does an end run around some of the extra pumping, allowing you to get more of your milk into the baby without pumping it out first. Check out the video, too (link on the left of that page) - it's super helpful.

 

Thanks for the video suggestion! I am so glad to hear that similar methods worked for you.
How long did it take for the methods to really start working?
I see that from pervious posts that you are an extended nurser. This really gives me hope!!! Thank you!!


My LC did also suggest breast compression, and I try and do it when my husband is home and I can feed one baby at a time.

I just also wanted to say again thanks also for your kind words everyone. I am glad there is a forum where we can post these kinds of things because I know I have been so inspired by your stories and dedication. On days when things get really hard I am reminded of so many who have been in the same place.

Things are going fairly well with the plan thus far, although we do have some seriously chaotic moments during the feedings from time to time. Trying to bottle feed one and BF the other is actually a lot harder than trying to tandem BF I think. Or at least it is for me.

BUT--I do have one positive thing to report. A few days ago one of the boys bf for 30 mins, and I could tell he was really gulping. After he got done eating I gave him the bottle and he took maybe three drinks and that was all he wanted!!! It has not happened since, but my LC said the growth curve will probably be slow. But that is a good sign!

 

I am so glad everything is going so well for you! and I believe it that bottle feeding & bf'ing is harder... but can you do it at the same time on your EZ2Nurse pillow? if you have one? still seems a little more difficult! you are doing a great job!!