Do these comments make sense?

So I was feeling great yesterday about making it to four months of BF, until we took the babies to
their checkup.

Both babies only gained a little over a pound in the past two months. Maeve dropped to below the 3rd percentile
(she's 9lb 15oz) and Finn is in the 3rd -5th (11lbs 2oz).

Our ped said the babies weren't getting enough calories from my breastmilk and wants me to start them on barley cereal.

She asked how many times a day they were nursing and I told her Finn nurses 8 times a day (average). She said that
at this point, they should only be nursing 6x per day. Is that true????

She also said since he doesn't sleep longer than 4 -5 hours at night, that shows he's hungry and not getting enough from my breastmilk. I agree that he's probably hungry, but I didn't think it was bad for him to be waking up at night.

She also made the comment again that there probably wasn't enough fat in my diet and that it was impacting my breastmilk.
She's knows I run regularly and watch my diet so that's probably where that comment was stemming from.
Is this true????

How worried should I be about the babies weight gain? I feel sick to my stomach thinking that I am not providing them with enough.
Nursing seemed to be going so well....anyone else encounter something like this?

 

:hug99: I EP so I can't relate entirely, but I have one that wasn't eating enough or gaining enough weight. I have to fortify BM for her. That doesn' work well for you since you are breast feeding. The neonatologists in the NICU told me to increase my dairy fat intake to help boost the fat content of the BM. Maybe you could try that. I don't know about the nursing frequency questions, but it seems fine to me. Maybe someone else has more advice. I'd be wary of starting cereal so early.

 

OMG, where to start...

QUOTE
Our ped said the babies weren't getting enough calories from my breastmilk and wants me to start them on barley cereal.


Starting solids before 6 mo does NOT help weight gain problems. All it does is replace breastmilk (full of fat, calories, protein, antibodies, etc) with something the babies can't even digest yet.

QUOTE
Introduction of complementary feedings before 6 months of age generally does not increase total caloric intake or rate of growth and only substitutes foods that lack the protective components of human milk.


source: AAP breastfeeding policy statement

QUOTE
She asked how many times a day they were nursing and I told her Finn nurses 8 times a day (average). She said that
at this point, they should only be nursing 6x per day. Is that true????


Absolutely not. There's no such thing as too much nursing. And why would she tell you to nurse LESS if the babies are having weight gain problems??? That makes no sense.

QUOTE
She also made the comment again that there probably wasn't enough fat in my diet and that it was impacting my breastmilk.
She's knows I run regularly and watch my diet so that's probably where that comment was stemming from.
Is this true????


Wrong again. Mom's diet/exercise does NOT affect the fat/calorie content of breastmilk. (Unless we're talking famine/concentration camp conditions, which is obviously not the case here.) And fat/calorie content of breastmilk does not affect infant weight gain. Total intake is the only thing that affects weight gain. Even if you were making low-fat milk (which is highly unlikely), it wouldn't make any difference. source

QUOTE
She also said since he doesn't sleep longer than 4 -5 hours at night, that shows he's hungry and not getting enough from my breastmilk. I agree that he's probably hungry, but I didn't think it was bad for him to be waking up at night.


I agree that that kind of sleep pattern is perfectly normal for that age.

OK, your pedi is obviously beyond clueless about BFing. Now that that's out of the way - yes, it looks like there is a weight gain problem. :hug99:

Can you tell me a bit about what a typical day is like, feeding wise? Have you been counting diapers? How does a typical nursing session go? (How long do they nurse, how do they act afterward, etc.)

My first recommendation would be to just nurse like crazy. Nurse them as often as they'll take it. Offer every hour during the day. It's possible that your babies don't "signal" to nurse as often as they really need to, and maybe they just need a little reminder.

I'm sorry you had such a freakout! And I'm sorry your pedi is so ignorant. After such terrible advice, I'd seriously consider looking for a new doctor. But take some deep breaths - whatever is going on, we can figure it out, and we can fix it!

 

I have been battling with weight gain from the beginning. At my babies 4 month appointment Brooke was in the 1st percentile and Hailey was not even on the charts. After talking with my ped, and this works for me, since I have returned to work, we have increased the calorie content of the bottles they receive, either by adding powdered formula to my breastmilk, or adding a little extra powdered formula to the formula. I don't think it would be a good idea to start cereal this early. So I don't know if you ever offer bottles, but if you do one a day or something, talk to your ped about increasing the calories for that one bottle. The ladies on this board gave me lots of ideas on how to increase my milk supply and get better at pumping. I've been taking Fenugreek to increase my supply, and you can also do breast compressions while your babies are nursing, this helps them get the fatty hind milk. ( I dont' have the link but it is on the Kellymom site somewhere.) Also how are they doing with milestones, etc. I'm not a doctor, but if your babies are doing great with their milestones, and don't seem to be hungry/sick/upset I think it is alright to not gain tons of weight. Also on the Kellymom site there were some growth charts for breastfed babies. When I plotted my babies on those charts, they actually ended up on the charts! The other thing is have they always been small, or are they not following their growth curve? Anyways, hang in there, now that my babies are 4.5 months, I feel like they have really started to gain weight. In fact, just this week we moved up into some of the 3-6 month clothes! Woo hoo! HTH.

 

Oh, I forgot to add. One other thing you can do is go see a Lactation Consultant. They can weigh your babies before and after you nurse to see how much they are getting. This helped ease my mind so that I could continue to nurse and know my babies were getting plenty of food.

 

Don't forget babies grow in spurts, this has been my biggest struggle since one checkup DD will have gained a lot and the next DS. Our doc tells me over and over that as long as they look healthy and are meeting their developmental milestones what they weigh is not as important. You would know if they were not getting enough. Any seriously when pushed most nursing moms of even one are getting up a couple times a night well beyond 4 months.

It makes me mad. Would a doctor tell a mom with a kid in the top %iles to cut back on food - no they say "what a happy fat little baby". Some babies are just little - I have one and it is hard to get over the feeling that you are doing something wrong. As long as you feed them when they want food that is enough.

I agree with pp about cereal, we started at 5 months and it didn't pack on any pounds.

 

your ped sounds rude. i run too - well only about once a week these days - gone are my marathon days - for now -but i digress- you shouldnt be dieting while breast feeding, but that doesnt mean you should be eating a stick of butter every day. if it makes you feel better my girls were 10 and 11 lbs at 4 months and my ped didnt seem worried at all - as far as how often they nurse - when in a growth spurt they nurse like crazy to inrease your supply and sometimes i would nurse my girls and realize they werent hungry but just wanted to pacify. dont look too deeply into it. as long as your kiddos are on the charts it should be fine. my little one was below 3rd% at 4mos. find a more laid back ped maybe.

 

As long as they are following THEIR growth curve there isnt much need to worry. What % were they at their 2mo appt?

I have got some bad BF advice from the NP, its terribly frustrating!! :hug99:

 

You've gotten great advice here from PPs...hope you'll seriously consider seeing a Lactation Consultant and maybe asking her/him (has anyone ever heard of a male LC?) whether they can recommend a pediatrician who has a clue about breastfeeding.

It really ticks me off when medical professionals say things like, "eat more fat and your milk will be fattier". There is basic and VERY ACCESSIBLE research out there that shows that nutrient content is not affected that way by mothers' diet. (Fat TYPE is affected - but not total fat calories. In other words, those transfatty french fries are getting into your milk, as is the great unsaturated fat in olive oil.) Ugh!!!

 

QUOTE(eewelks @ May 30 2008, 11:40 AM) [snapback]800925[/snapback]
She also made the comment again that there probably wasn't enough fat in my diet and that it was impacting my breastmilk.
She's knows I run regularly and watch my diet so that's probably where that comment was stemming from.
Is this true????


During the first 7 months I was breast feeding I was on an extreme low fat diet because I was waiting for my name to come up on the "elective surgery" list to have my gallbadder out. I had as close to ZERO fat in my diet as I could--but unlike you (I'm assuming) I did have plenty of fat on my hips for my body to burn off (and it did, no exercise necessary). So you can make milk with little fat. I also took a "mommy formula" from Meade Johnson called Enfamom (here in Mexico it's next to the Enfamil in the pharmacy) It makes a tastey milkshake with a banana thrown in.
My girls were also on some formula--we did both, so my breast milk was fine, but all the doctors, pedi, gyn, general surgeon new I was breastfeeding on my diet and no one ever suggested that my milk would be effected by it. (I believe malnurished women are able to produce nutricious breastmilk in developming countries, only when it becomes extreme malnurishment does it affect their milk.)

 

I just wanted to add that a lot of ped's offices still use growth charts that are based on formula fed babies, not BF babies. BF babies tend to have different rates of growth, so it's worth asking what the growth charts are based on-just because they're "off the chart" isn't necessarily an indication that they're too small.

 

At 4 months, I would expect them to take AT LEAST 8 feedings and nursing more makes a heck of a lot more sense than nursing less :huh: I'm pretty sure we were having about 10 sessions at that point. I also think that if your doctor is concerned, scheduling a follow-up appointment to check for weight gain makes more sense than starting cereal or trying to pump and add calories to the milk. FWIW, cereal positively submarined my boys' appetites and their weight gain suffered so I'd be very hesitant about that advice.

OH, and I have to add this... when I took Trent in for his foot injury last week, they weighed him on the baby scale so he wouldn't have to stand. The weight came up 23 pounds and I saw the confused look on the nurse's face and then she looked in his chart and said, "Let's move him more to the center." 3 inches scooted and he was suddenly 28 pounds. 5 pounds of difference by centering the kid on the scale?! I could hardly believe it. This is why going by one weighing on one day makes no sense. A trend of poor gain is different but if it's only once, it could be a number of things including the scale.

edited for typo

 

I understand your worry. The first few weeks were a little scary for us as well since my DD was not gaining any weight and my DS was gaining VERY little. A ped. in my doc's office said the solution was to start nursing every 2 hours and I just broke down. I realized I PERSONALLY could not mentally and physically do it, so we opted for the route of high protein formula addition to my EBM until she started gaining weight. My mom (who was visiting) was ecstatic that she could feed the babies and honestly, I was so tired that I gave in pretty easily. Now that they are almost three months old, they are getting all during the day/night BM except for one bottle a day of 2 oz. of BM and 2 oz. of Similac Advanced right after their nightly bath/"rinse". It is just part of our nightly routine and allows my husband to help out. This is personal choice in our situation.

My point, however, is that the PP is completely correct about the scale measurements. One of the days we were in the ped office (while my DD was not gaining weight), the nurse practitioner decided that she could not have gained 6 ozs in one night and that something was wrong with the scale. So there's one example. The hospital's LC had twins and she has been super kind and supportive to me as a mom of twins. She actually offered (and I took her up on it) to let me "check out" Medela baby scale for about 9 weeks. So, just about every day I would weigh them. It was amazing to see the changes throughout the time I had the scale. I would see a huge jump one day and other days none at all. I also tried to make sure I did it after I fed them, but other times I tried before I fed them and then again after I fed them. Some times (after a huge blow out diaper) I would find their weight go down from earlier in the day. That's my other example.

So...I would totally see if you can find a supportive LC in your area and see what she/he has to say after at least a few consultations (and I would go to more than one). Then I would really think about talking to your ped. or find another one based on a LC's recommendation.

Good luck and I hope you get the support you need in your area. Realize that many people have gone through the same situation. Fortunately, I have gotten some really good support and hope you are able to as well!

 

I just found the following information on kellymom.com:

Does the amount of fat in mom's milk make a difference when it comes to baby's growth?

The research tells us that baby's milk intake (the volume of milk - not the amount of fat in that milk) is the only thing that has been correlated with infant growth in exclusively breastfed babies. As noted earlier, average fat content of human milk is highly variable, but has not proven to be significant when calculating baby's total energy intake or weight gain. (Aksit 2002, Butte 1984, Cregan 1999, Mitoulas 2003, Mitoulas 2002.)

 

Oh for PEDS sake!!! Your milk is perfect for them.

How much do you run? I did have my LC tell me not to run more than about 12-15 miles per week. Not sure why. My Greta is on a very slow and low growth curve (she was my ham at birth BTW) and the ped always tells me it's fine because it's HER curve like Nichole said.

Listen to the PP's and your gut! I'd be VERY careful about adding anything before 6 months.

 

I have not read the other posts.....RUN do not WALK....Get A NEW DR!!!!!

and definately reach out to you local LaLeche group and a lactacion consultant.

Good Luck and keep up the good work Momma

 

You have no idea how much I appreciate your advice and input. Starting cereal this early seemed crazy to me, and I don't understand how the ped could think that a baby nursing more than 6x times a day was a bad thing!! Also, the notion that eating more fat would increase the fat content of my milk seemed ridiculous to me. Why aren't the peds better informed????? Why do so many people try and subvert breastfeeding, especially with twins?? I never encountered such negativity when I nursed my singleton!

Anyhow, here's a little more info....Their stats from six weeks ago compared to today:
Maeve was 9lbs 1oz six weeks ago and 9lbs 15oz on Thursday. Maeve was in the 3rd percentile and has now dipped slightly below it.
Finn was 10lbs 2oz six weeks ago and is now 11 lbs 2oz. He has maintained -- he is still in the 3rd-5th percentile for weight.

I didn't realize the peds use growth charts based on formula fed babies. That puts a few things in perspective for me.

My only other concern is this: both babies have ample wet diapers through the day, but Finn has not been pooping regularly. He went five days in a row without pooping. They had us give him a suppository. Then he went another five days so the ped told us (at this checkup) to give him an ounce of baby apple juice with an ounce of water.
Does the lack of poopy diapers show that he isn't getting enough or are the wet diapers a better indicator?

I think I am going to supplement one night feeding with breastmilk and some formula.
I also am contacting my lactation consultant on Monday.

One last thing...I am running about 15-18 miles a week. As long as I am eating and drinking enough, that shouldn't make a difference right?

Thank you, thank you for your support!
Beth

 

Oh..and one last thing...
Maeve has become much more efficient nursing. It only takes her about 10 minutes max now. She also is quite distracted, pulling on and off to look around. Maybe she isn't getting enough hindmilk and while I think she may be done, she really isn't?

I think Finn would nurse forever if he could. He takes much longer than she does.
Again, thank you.

 

QUOTE
My only other concern is this: both babies have ample wet diapers through the day, but Finn has not been pooping regularly. He went five days in a row without pooping. They had us give him a suppository. Then he went another five days so the ped told us (at this checkup) to give him an ounce of baby apple juice with an ounce of water.


More bad advice. BF babies don't get constipated. Ever. They do very often go days between movements and then poop incredible quantities. That's normal. Giving apple juice and water is common advice for formula fed babies who are constipated but will do NOTHING for your baby. If he seems uncomfortable, you can take his temperature rectally to stimulate a poop but it's not a good idea to do this on a regular basis.

 

I forgot to look at your info, but if you live in the US, then you can go to your WIC office and they can do the weighing for you. They may also be able to help you with breastfeeding info and lactation consultant.

Try eating high fat foods like avocado, whole milk etc. If you cook your own food use the higher fat option when possible - sour cream, cream cheese, etc. The babies will suck all the fat out of you.

My kids didn't have a weight gain problem but they did start cereal on the day they turned 4 months old b/c they were nursing every hour on the hour. They were completely draining me every time. They obviously needed more.
They also had the physique for eating cereal, like head control, etc. if you feel starting cereal at this age is not right, then wait. you will know when it's time.

 

Breastfed babies can poop every day (multiple times - haha) or go many days without pooping. My source is Dr. Terry Brazelton book Touchpoints. I'm sure it's "common knowledge". I do not think it should be a concern that a breastfed baby does not poop very often as long as he is not straining in between times and when they do poop it's not hard and dry.

My EBF twins were/are frequent poopers but my first born (fed pumped BM) only pooped about every 5 days and then OH MY was it a big mess!! We argued over who had to change him.

I hate to beat the dead horse but your docs office has some explaining to do!!!! They are giving pretty bad advice on many fronts.

Good luck. You seem to be more on top of things without your peds advice than with it.
MJ

 

Chiming in with everyone else's response about the pooping thing...
A few weeks ago my DS had not pooped in 4 days. I called the ped. office and they said that it is ok for a BF baby to not poop up to 7 days! If he still hadn't pooped after 7 days, I was supposed to call them to get a suppository prescription. Thankfully, he did poop at the end of the 4th day! Whew it was nasty though!! :blink:

 

My guys poop ever 6-8 days....it is "normal " for them....after a month or so of it....I am used to it..and hey we are saving $$$ on diapers!


I wish you the best, please keep us posted on how you are doing.

 

One of my guys also took his time about pooping when he was EBF (ie. before solids), but I noticed that they would BOTH go several days during a growth spurt. It was as if they were using up every last calorie and there was nothing left to get out.

Mine also got really fast about nursing at that age, though there 's always been a difference in how long each of them is willing to linger at the breast. It's a developmental thing, and your daughter is probably getting just as much as she wants. It was also my littler guy who finished faster - he just eats less. You can try to relatch her a couple of times, but the times I tried to insist on "finishing" were the days I got bitten...nothing like a good nip to let mama know you're really done! (but it was amazing what a slow learner I was