What should I do?

[CJNeeley]

Ok, my DD has had slow weight gain. The ped recommended formula supplementing. Which I resisted for quite awhile and opted to talk with the lactation consultant for help instead. Tried quite a few things, fenugreek and blessed thistle for 3.5 wks (it didn't help and the LC thinks reglan would be a bad idea because it has some bad side effects), different feeding techniques (I can get out my notes later), pumping after feedings (though maybe I should get an electric pump), waking her to nurse at least once sometimes twice btwn 1-4 am, etc. But she still wasn't gaining any better so I finally gave in and tried supplementing, and we give her 4-8 oz a day. But today when we went in for a weight check and the ped wants us to start giving her a minimum of 8 oz of formula a day and to try to give her another 4 oz a day with 1T of baby cereal mixed in (she said just cut a bigger hole in the nipple, etc). :( I don't want to do this but I'm concerned maybe she's not doing well enough. Sure she's growing slower than the boys, even the preemie, but she looks healthy and she's even been starting to fill out a bit in some places despite being so active. I just don't know what to do anymore. I mean it seems a little weird to be so excited that my almost 5 mo old has outgrown her newborn stuff, even more so when she is rolling over, sitting up (well tripoding), learning to crawl, occassionally walks holding her daddy's fingers--even doing push ups, crunches, and downward facing dog, LOL. She so far ahead of what the boys did at their age I can't help but think that her activity is keeping her slim, both the boys started slowing down with their weight gain when they started crawling and cruising they just were older before they were this active.

DD's Progress:
Birth, 12/2 - 8#3 oz and 21"
Dec 6 - weight: 7#11; length: 21.125"
Dec 13 - weight: 8#1
Jan 10 - weight: 9#2; length: 22.5"
Feb 6 - weight: 10#; length: 22.875"
Mar 18 - weight: 11#2
Apr 3 - weight: 11# 8; length: 24.625"
Today, 4/25 - 12#1

We're in the process of moving to Memphis so I'll be getting a new ped, but what do you guys think I need to do? And how bad does this seem as an uninvolved third party?

[Jaz_Trio]

ACK...

OK first off, does your baby seem like shes getting enough, even before the formula??? Was she pee'ing ok? Pooing ok? Seeming VERY happy with life?

IF SO STOP!!! Your doctor sounds like "old school" and is thinking that formula is going to be the answer, ITS NOT...MANY MANY MANY breastfeed babies grow WAY slower than there counter part formula feed babies... Even the WHO is now saying this (look at this) http://advice-for-parenting.blogspot.com/2006/04/finally-world-health-organ_114588712812879431.html there is also some info there on some growth charts for breastfeed babies!

I feel your pain, my son is now 29 1/2 months old, and he is little I MEAN little, only 22 - 23 pounds...his doctors tried to get me to do this to, its soo not needed, he's growing well, hitting all the mild stones (besides talking) and thriving, he's just small!!! Its ok to be small!!!

(((HUGS))) It looks like shes growing well! If you want to talk give me a holler, I am available!!! (((HUGS))) and I would be telling you to RUN to get a new ped, but your moving! *SMILES*

[Lucky Child]

Hi. It doesn't seem that bad to me. My dd is 18 months and aside from length in the pants 6-12 month waist is still big on her. She's small.
If I were you, I'd wait to see the ped. My dd was in newborn stuff until 6 months old... She was less than 14 by 6 months... I never had to supplement formula However around 5 months I switched over to formula altogether for other reasons and her weight gain did not improve at all. It has nothing to do with the milk or formula imo... she is just small, always will be small and comes from a small mother.
Your ped seems like he is overreacting imo. If I were you I would not add cereal until 6 months and I would back off the formula.
My pd always says that if she is gaining there is no need to worry, even if it's only a bit... if your daughter is happy and developmentally at the point she says I'd ignore that ped for now.

[eoster58]

Here is a link to an article about re-doing the growth charts. They are way outdated and based on formula-fed babies.
http://news.bbc.co.uk/1/hi/health/4938234.stm

Good Luck! :)

[bethanyjoy]

I'd say try calling a local LLL leader and talk to them; they should have either more ideas or some support for you! Seems to me like your DD is doing just fine, my mom b/f all eight of her kids, we were ALL skinny but did just fine, kwim? Some babies are just small...as long as growth is consistent, she's developing well in other areas, and you're getting lots of wet/poopy dipes, then I'm sure she's doing great. Definitely call LLL though, they are a great support system!

[Shaineinok]

Gosh thats good steady growth. I don't think I would be worried at all. I have daughter who is on the small side too. It made absolutly no difference when we added in solids at 10m. And I am convinced it wouldn't have made any with her earlier either. They tried to get me to suppliment to but she always showed a good steady rate of growth so I held my ground and nursed her. Get a new pediatrician and check out the breastfeeding growth charts. I would definatly not do cereal till 6m and then only if you want to start with it. Do check out your local LLL they can be such a help!

[CJNeeley]

Ok, I'm feeling much less insecure about it now. But how will I get my supply up enough to make up for the 4 or 8 oz a day she is supplementing now. I'm not making as much when I pump should I try to get or rent a good electric one (that's something the LC brought up, she asked if I knew anyone who had one I could borrow which I didn't)? Shouldn't she be able to get it up herself? How do I do that?

CJ

[i0lanthe]

Try putting her to the breast more often? Frequency of demand is what increases supply, I think.

[deejahd]

Definately rent a pump, it's finally what allowed me to go back to exclusive breastfeeding my DS after he wasn't gaining. He's still small, but tall. But heck so is his dad :).

[Mommameyer00]

She's gaining close to two pounds every two months. I think that is normal to me. From what I understand, they should be at least double their birth weight by 1 year and she will be there at her current weigh gain.

I would get a new ped. Nurse on Demand and you should built your supply up without problems. Pumping will help too.

Your doing a great job IMO.

[Jaz_Trio]

TOTALLY agree with Kristi! You can do it girl, and even if you still suppliment a little, it will be ok, just dont listen that you need to do more! :) Nursing on demand with a few pumpings if you can will REALLY help your supply, I also know that oatmeal is great too! :)

[EasterBun]

I wouldn't supplement unless your baby is LOSING weight. Right now it looks like she's gaining, just slowly.

My DD was 8lb1oz at birth, had reached 8lb8oz by 2 weeks, and I thought we were doing good, then she was 10lbs13.5oz at 2 months, 13lbs at 4 months, then just 14lbs4oz at 6 months, but then she shot up between 6 and 9 months, and she weighed in at what seemed like a whopping 17lbs14.5oz!

So, it sounds like your DD is just a bit smaller... and my ped never suggested I supplement and didn't even push me to start solids (we didn't really start until 7-8 months)

I am hypothyroid though, and it's taken forever to get my meds adjusted, so it's likely that my condition has had some impact on my milk supply (being hypothyroid supposedly lowers milk production but honestly I never noticed much change) but again, no one was ever too worried about it, since DD was growing, and otherwise thriving, she was just little. It was rather funny actually, because even when she dipped down to 15th percentile, she had little fat rolls - she definately wasn't starving! :)

[scatterbrainedmom]

might i suggest domperidone? i took it and it really boosted my supply. i would say if you MUST do the rice cereal mix it with breastmilk instead of formula

[imommy]

We supplemented for a few reasons:
1) It was my first baby, I had alot of complications and I was freaked out so naturally did what the doctor told me to. My son wasn't gaining weight and so she said that I had to start supplementing. If I would have known then what I know now, I would have just nursed more. My son finished nursing at 10 months because my milk dried up but I think it was partly due to supplementing (however mostly due to some other medical conditions).

2) I got really bad mastitis and the antibiotics I was taking for it pretty much cleared out my milk supply for a week and a half. I was literally pumping about 2 oz every two to four hours when a week before I had been pumping about 12 oz every three hours in the hospital :eek: . Huge shift. I'm guessing this contributed to my son not gaining weight but if I would have known what to ask for to boost my supply, I would have done so after my mastitis cleared up.

3) I was so exhausted (had heart problems after pregnancy) that I needed sleep, it was almost imperative that I slept so we would give DS a bottle at night. If I would have known any better (again this is our first child so I had no clue what I was doing) I probably would have had him sleep with me so he could just nurse as needed and I could sleep. We spent most days when DH was at work in bed with him on the boob and me sleeping...duh why didn't I think of that at night? :rolleyes:

Anyway. I hope you come to a conclusion about what you're going to do. Breast milk is the best for baby as you know but you aren't a bad mother if you do give her formula. Don't ever let anyone make you feel that way. I'm not saying that you should or should not give formula...I'm just saying that if you get to the point where you're more comfortable giving it to her, then you shouldn't feel bad about it. You are the mother and can decide what you want to do so don't let the doctor influence you into thinking you have to do something.

Hope some of that makes sense. Good luck! Nursing was the best, most rewarding thing I did with my son and I'm so grateful I did!!

[GrowingUpMad]

Your dd's growth seems to be pretty good. Plus you say she looks and acts healthy. I would question the whole supplementing idea. My dd weighed 6 lbs 15 ozs. at birth and was considered a preemie because she was delivered more than 3 weeks early with in utero complications (resulting in large head, tiny body). When my dd was 3 months old she was FINALLY getting out of preemie clothes and weighed just over 9 lbs. At 6 months old she weighed just under 14 lbs and at 1 yr. old she weighed 17 lbs. The doctors have never questioned her growth as her develpoment was fine. She is now a 45 lb 3 1/2 year old so her slow start has no effect now.

[CJNeeley]

She's a very happy baby, very energetic, she generally still has about a dozen wet diapers a day. Stools aren't so predictable, she can go a few days before having one or have 4 or 5 in one day--but I'm not at all worried about this. We do nurse on demand (plus I wake her to nurse at night) and I pump each side about for about 5-7 min after she's done feeding. The supplement when she gets them are 2-4 oz after nursing both sides if she is still unsatitsfyed, which DH gives her while I pump and she may or may not finish. During the day if she still acts hungry, I just try putting her back to the first breast but if she's not swallowing I try to distract her with play for a few minutes before putting her back (because one of the lactation consulatants said that while putting her to the breast would help increase my supply, if she's not swallowing she's still burning calories from nursing even though she's not getting any--so I try to make sure she at least starts off swallowing).

My supply seems to noticably dwindle in the evening (breasts don't feel as full, etc) and one of the lactation consulatants thinks part of the problem was DD started sleeping the night around 1.5 mo--of course we were so amazed we just let her and enjoyed it--and since she was missing those nocturnal hour feedings she was missing the chance to boost supply when hormones are high, so she suggested making sure she gets at least one feed between 1-4 am even if it means I wake her. Plus she seems less tolerant of hunger in the evenings, which I don't know if it's because she's any more hungry or if she may just be too tired and irritable to settle for less than what she wants.

One of the LC recommended eating the green food source of fenugreek, methi, twice a day since the capsules were not helpful. But I haven't had time to make it over to the indian market yet, so I'd still like to try that before any drugs but thanks for the suggestion I'll look into it.

And thank you guys for being so supportive through this.

[Elphaba71]

I'm a family doc, very very supportive of breastfeeding, and doing so myself. The minimum acceptable weight gain is usually considered a 1/2 ounce per day - on average. Your baby is a just a tiny bit slower than this, but seems to be growing steadily and as you say is ahead of what's expected developmentally. I don't know how long you've been supplementing, but it doesn't seem that she's growing faster now that you are, looking at the numbers you gave. That says something about her "need" for supplementation. Generally, it's recommended that you start solids around 6 months anyway, in another month, right? What's one more month after 5 of slow steady growth? If formula isn't helping much now, it will be interesting to see if she grows faster on solids - or not! Fortunately with the move, you get an "easy" opportunity to switch. When interviewing new docs - I would bring your info, emphasize your strong committment to breastfeeding and ask what they would have done. Very few docs will be anything less than honest with you about what they think (they are very arrogant in general and believe themselves to be right at all times, and are not salesmen trying to snare new customers). Find one that isn't overly concerned and go with that person. It's amazing to me how many docs are terribly unsupportive of breastfeeding, especially now that the American Academy of Pediatrics is sooooo supportive.

All that said, there are some women who geniunely don't make enough milk (it's rare, but it does happen) and do need supplementation. (Gotta give my disclaimer) It doesn't sound to me like you're one of them.

Another disclaimer - of course, I don't have all the info, but I'd cut back on the supplementing if you're not seeing a significant noticable difference until she's six months and start solids then and see what happens.

My :2cents:

[Shaineinok]

A thought on boosting your supply. Don't know if you cosleep or not but I would and make the breast very available. Some extra night nursing say every 2-3 hours will pick your supply up a lot. Might be a little difficult for you to get used less sleep for a bit but its an idea!

[1bigfamily]

Ditto on the suggestions of the other mamas. My daughter was born on Oct. 20 and she only weighs 14 pounds or so. She is 2 pounds lighter than her twin brother! Don't stress. :hugs:

[stephdpn]

Hang in there! Get to Memphis and we'll find you a new doc here!!

[quarli]

I didnt really read all the replies but the WHO announced recently that the growth charts most peds are using are wrong for BF babies. They are based on mainly formula fed babies.

http://www.abc.net.au/worldtoday/content/2006/s1626255.htm

http://www.ctv.ca/servlet/ArticleNews/story/CTVNews/20060424/baby_growth_charts_060424/20060424?hub=TopStories

Your daughters weight gain sounds like my oldest sons. I was always told, as long as hes wetting x amount of diapers a day, dont worry about it. Some children are just slower at gaining weight. And coming from a mom trying to wean her kids off formula supplements.....it can be a long hard raod once you start down it.

[mommypooh]

I just wanted to let you know your DD growth sounds exactly like mine. My Ped also tried to get me to suppliment and add rice cereal and everything. I never added the formula, but did put her on rice cereal, and that was the biggest mistake ever, she would puke and puke and puke from it, it was so bad she would scream all night and day, and then we figured out she had reflux and had to put her on liquid Zantac.

I say go with your gut nurse on demand. I say take away 2 ounces of the bottle everyother day and go from there. Get it out and done with.

[SugarBunsWool&More]

OMG! You're me only you have a girl! :mrgreen:
My son Riley is the king of the smallskies. He's 9 months old and weighs 15 lbs. He's 28 inches long and is doing just perfectly.
We recently switched ped's because our old one sucked, but before we switched, I heard the whole thing about switching to formula or supplementing because it was obvious that Riley had 'outgrown the benefits of my breastmilk' all before 6 months of age! Wow, huh? I resisted and still have. He eats 'real' food now, but he's just not a big eater. We recently went to a bunch of specialists to be *sure* there wasn't something wrong with my angel and there isn't anything wrong with him. He's just small.
He was 5 lbs 4 oz, 19 inches at birth and has continued to gain, but slowly since then. He's got a perfect little growth curve going right under the regular growth curve.
All of the Dr's that I've been to recently about Riley have said the same thing over and over. I'll share it with you and save you the co-pay. LOL As long as your daughter is gaining weight and doing well, even if she's below the curve, that's fine. She's allowed to make her own curve, that's just wonderful if she does that.
I think you know in your heart if she seems *right*, kwim? If there's something else bothering you, have that checked out but if you feel like she's fine....just small, that's ok. She's allowed to be that way. Don't let the Dr's convince you that there's something you're doing wrong. We can't all be in the 90th percentile, right?
Besides, breastmilk has more calories in it than formula, my GI Dr backed me up on this one, so I don't see what switching will do? Does she seem satisfied after she eats? Is she spitting up a lot?
You're doing great mama. PM me if you want to talk. I'm totally there with you in having a small kiddo. :goodvibes: :goodvibes:

[Irishmommy]

I second or third everything that these mammas have said. My ped tried to tell me to supplement when my son was born and it really burned me up; but I would just smile and say, "Oh, okay if it is medically necessary" (but he never said it was, just saw that I was going back to work at four months and assumed I would use formula then), and I never supplemented with formula during those first few months because I knew I needed to build my supply for when I pumped at work. Anyway, you are doing a GREAT job and your little girl sounds like a fiesty little girl with all her activity! You're a great mommy, keep up the good work.

[littleways]

My friend's son is onlu 21 pounds and 18 months - but he is very active and healthy - I wouldn't worry about it. WHO just posted new growth charts:
http://bodyandhealth.canada.com/channel_health_news_details.asp?news_id=9788&news_channel_id=145&channel_id=145&rot=11

[scatterbrainedmom]

I'm a family doc, very very supportive of breastfeeding, and doing so myself.

All that said, there are some women who geniunely don't make enough milk (it's rare, but it does happen) and do need supplementation. (Gotta give my disclaimer) It doesn't sound to me like you're one of them.

Another disclaimer - of course, I don't have all the info, but I'd cut back on the supplementing if you're not seeing a significant noticable difference until she's six months and start solids then and see what happens.

My :2cents:

we need more like you :thumbsup:
my sister just had a doc tell her to PUMP and add rice cereal and if that did't bring the weight up she would HAVE to wean and do soy formula. thankfully she called me and we got in touch with LLL and an LC and ditched the dumbass. (btw, this baby was a chubster too!!)