Help me educate our pediatrition

[Engineering_Mama]

Hi ladies! I need your help here. DH took DD to the ped for a WBV yesterday. She told DH that I should definitely keep waking DD up to feed at night (she'd SSTN if I let her) because DD isn't gaining enough weight and if she doesn't gain more weight then we should supplement. DD gained 1lb 1oz in the previous month and is in the same percentile for weight as she was last month. DD is petite (has been since birth), but obviously she's getting enough to eat.

So how do I go about educating the ped about BF-ing and BF babies? Help me out here. What has worked for you? What resources do you suggest? Any research I should tell her about?

It just irritated me so much. While I know my child is fine and I'll keep BF-ing her as long as DD wants to, how many other mothers have thought "Oh, I'm not making enough milk." And stopped BF-ing. :

TIA

[mags]

Is there another pediatrician in the practice who is more BF friendly? I basically chose my ped based on the one who was the most BF friendly in the practice and didn't have to do any educating, b/c he was pretty aware of BFing and knew when to refer to a LC if needed, etc.. I mention this, b/c from my exp, some peds who are ignorant cannot be educated, for a variety or reasons. They are stuck in their ways (esp the older ones), and some of them are just very pro-formula. From my exp, the peds who are most educated about BF are ones who are younger, ones who are parents themselves or have BF'd.

[mommy2maya]

I don't think there is harm in telling a slow growing 2mo to wake thru the night to nurse. I think it is actually sound advice. If you aren't nursing thru the night, your breasts are not getting enough message to make enough milk. It is very very unusual for a 2m breastfed baby to be sleeping thru the night, they need the nourishment. Perhaps the ped doesn't need an education on breastfeeding, and is trying to keep you from having issues with milk production?

[Emmeline II]

You could try kellymom; that site has a lot of citations. You could also try the LLL site.

Do you co-sleep? Just wondering because a pp said, sleeping through the night is unusual for such a young babe.

[mommy2maya]

But given what the OP has cited the ped as saying, it is all very valid. It is not at all usual for a 2mo to sstn, especially a nursing baby. It is not usual for a baby to only gain 1lb over a month, that is the very low end of 'normal'. If a baby is at the very low end of normal, it is very logical for the dr to suggest that the baby be woken up thru the night to nurse. I am not getting what the doctor needs to be educated on? To be successful nursing, you need to stimulate your breast regularly, which is nursing, or as a back up, pumping. At two months, there is still much regulation that going on, especially a first time mom.

[MCatLvrMom2A&X]

I think the supplementing thing is what she wants to educate her on not the waking her to nurse at night.

[MovingMomma]

How many hours does your baby go w/out nursing at night?

How long exactly was there between visits (weeks plus days)?

As pps say, she is on the very low end of normal weight gain, and waking her at night is an obvious way to get more milk in her belly.

[mommy2maya]

Yeah, but before she goes on 'educating' her ped about not supplementing a bf baby, I'd suggest she educate herself on what is normal weight gain for an infant, and what is normal nursing schedule for a newborn, and what can truly cause 'not enough milk', cause a newborn sleepign thru the night without nursing can EASILY cause all of those things, especially with a 'petite' infant, at which point supplementing would definitely be needed.

As far as the dr recomending supplementing, it seems from the OP it was intended as a last resort of sorts, and as a way to boost weight gain. This is not contradictory. Brain growth is huge in the first few months. If a baby is not intaking enough calories, and growing quickly enough, brain growth may be compromised. The first thing that should be recommended is extra feedings, and feeding thru the night. Especially for a ped to recommend waking a baby thru the night to nurse, it is important, and a ped who sounds fairly educated on nursing, imo. If the ped said, great your baby is sleeping thru the night, awesome, but not gaining enough, so just give bottles, and hey while you are at it, add some rice cereal, that will ensure baby continues sleeping thru, then I'd say WTH, absolutely educate that ped. *This* ped seems to be giving valid recommendations though.

[mommy2maya]

oh, and I agree that recommendations to supplement should not be given glibly. However, as a line of defense, it may not be totally out of line here.

[Engineering_Mama]

OK. Apparently I wasn't very clear. DD is 3 months old and yes while it is unusual for a child that age to sleep through the night its not unheard of. We don't do anything to make her sleep more deeply. We co-sleep. If she so much as stirred I'd nurse her. She doesn't make a peep.

I do wake her to nurse her at night and I have no intention of stopping. She's just so young that even though she seems happy sleeping I figure she needs something. And yes, a lb a month is on the low end, but still normal (I checked on kellymom). In the same month she grew 1.5" taller, which is average. She eats every 2-3 hours throughout the day, more often if she's hungry. I don't think supply is an issue. She has 6-8 wet diapers a day and her poop is normal BF baby poop, yellow mustardy. She's alert and happy during the day. Everything else is very average.

Maybe I over-reacted when DH told me about it this morning. I just hate it that the peds first suggestion was "Supplement with formula" not "Nurse her more".

[MovingMomma]

Originally Posted by Engineering_Mama

I just hate it that the peds first suggestion was "Supplement with formula" not "Nurse her more".

But you said the peds first suggestion was wake her at night to nurse, not supplement w/formula???

[SpiderMum]

My DD started STTN when she was not even 2 months old. She cluster feeds right before bed most nights and then sleeps anywhere from 5 to 8 hours. At first I worried about it...then I just realized that's just how she is. She is gaining well so I don't bug her at night.

[Emmeline II]

Originally Posted by Engineering_Mama

I just hate it that the peds first suggestion was "Supplement with formula" not "Nurse her more".

But the Ped's first suggestion was to nurse her more by waking her more often at night, and then if she did not show more growth then to supplement. Though you could argue that as long as there is growth there is no need to supplement.

Some babes are just "petite", some are just slow growers; it can be hard to tell for peds. My niece is very petite and that is a big contrast to my child of the same age who looks 2yrs older, but her size seems to be primarily due to babes being small on one side of the family. Her peds tried every trick to speed her growth but she did it in her own time.

[Limabean1975]

Tough to know what exactly is right here, but here's what I am seeing, for what it's worth:

-the baby is staying in the same place on the growth charts. There is NOTHING wrong with being on the "low end" of the growth charts as long is there is not a significant drop in position on the chart. The growth charts are made up of healthy, normal, babies. SOMEONE has to be on the low end. Someone NORMAL.

-Mama is happy with her baby's growth. Baby is showing signs of eating enought (wet dipes, etc). Mama's instincts are telling her everything is okay.

I don't think this pediatrician is exactly sabotaging healthy breastfeeding, but nor does it seem that this baby's routine needs any interference.

[elanorh]

Tess,

I have BTDT in terms of weight gain conversations/worries with Ped (with my first dd).

Here are my thoughts --

First, I agree with the other posters who mention that Ped did say to keep waking to nurse at night (as you were doing) and that if "she doesn't gain more weight" that's when supplementing would be suggested. Not entirely great advice (I'd like to see a lactation consultant or LLL referral between the two), but not abysmal. And if your dh is like mine, something may have been lost a little in translation in terms of tone/approach from the Ped.

Second - I can't think of a thing in my life about which I can become more passionate and defensive, than breastfeeding. Everything else (politics, religion, whatever) I can take with a grain of salt. But in terms of questioning about breastfeeding itself (especially as a first-time mom, first-time breastfeeder) I felt personally attacked and inadequate and pretty much like the process of evaluating my supply issues and Ina's weight gain etc., were on some level a bit of judgment of me. Even though I was also very concerned about what was going on with Ina's weight gain. So, bear in mind that if you're reacting that way as well, it may color your interpretation of what you're hearing.

[Because, in the end, my Ped's recognition of Ina's weight gain issues, which were real, and her referral to an LC and their eventual recommendation of supplementing etc. also were accompanied by her 100% support of me rebuilding my supply once we discovered our problem (retained placenta combined with severe infant allergies) -- up to and through a month of exclusive pumping, and supportive of bfing beyond 2 years of age with Ina too].

Give your Ped a chance. Make sure you're well-read up on things and ready to discuss with the Ped at your next appointment (if this is even an issue for your family by then). If Ped is still concerned about weight gain, be knowledgeable about your own family's weight gain history (dh and I were both small babies, dh stayed in 10% 'til high school); and ask for a referral to an IBCLC.

At that point, if Ped is unsupportive, I'd say that's the point to work on re-educating her.

[tanyalynn]

Just from a strictly numbers-standpoint, a small baby staying on their curve means that they'll gain at the low end of normal, right? My big babies, in order to stay on their curve, were gaining at the high end of normal--that's how they stayed on their curve, any less and they would've trended toward the mean.

[AislinCarys]

Originally Posted by mommy2maya

Brain growth is huge in the first few months. If a baby is not intaking enough calories, and growing quickly enough, brain growth may be compromised. The first thing that should be recommended is extra feedings, and feeding thru the night. Especially for a ped to recommend waking a baby thru the night to nurse, it is important, and a ped who sounds fairly educated on nursing, imo. If the ped said, great your baby is sleeping thru the night, awesome, but not gaining enough, so just give bottles, and hey while you are at it, add some rice cereal, that will ensure baby continues sleeping thru, then I'd say WTH, absolutely educate that ped. *This* ped seems to be giving valid recommendations though.

Did the ped measure Head Circumference and chart that? When DD wasn't gaining well the specialist ped we were sent to told us that that is much more important than weight. Also, don't be afraid that your baby will be brain damaged - DD was gaining less than recommended, and the ped who is one of the best in the country) assured us that the brain catches up really quickly, even if it has grown too slowly for a while. Your child will not be brain damaged! Nor will she be "behind" her peers later on due to this. And as long as your baby is gaining, even if it is on the lower end, that should be fine. DD is still on the 3rd percentile, but all the medical people decided she's fine now, she's following her own curve.

Also, I kept my low-supply up, and even increased it (with domperidone, for 4 weeks at 3 1/2 months), despite my DD sleeping 6-8 hours at a stretch between 2 and 4 months. She was happiest that way, she did not feed well at all when we woke her up at night, just wanted to go back to sleep. And I was so grateful for the sleep, as our days were so chaotic!

[Limabean1975]

Originally Posted by TanyaLopez

Just from a strictly numbers-standpoint, a small baby staying on their curve means that they'll gain at the low end of normal, right? My big babies, in order to stay on their curve, were gaining at the high end of normal--that's how they stayed on their curve, any less and they would've trended toward the mean.

Yep.
The charts are made up of normal, healthy babies. Someone has to be the smallest. Someone has to be the biggest. If their stats place on the charts, they are normal, healthy babies. Dropping on the charts is a big warning sign. Maintaining your place on the chart is great.

[PatioGardener]

Originally Posted by TanyaLopez

Just from a strictly numbers-standpoint, a small baby staying on their curve means that they'll gain at the low end of normal, right?

Exactly. The curve is important - as is the growth chart. On average, breastfed babies gain fast at first and then the rate slows. The 'old' charts, built from data on formula fed babies show pretty much a constant growth rate - but when compared to the WHO charts, babies following the 'old' charts are actually 'under growing' at first and then 'over growing' later on.

Here are the WHO charts: http://www.who.int/childgrowth/stand.../en/index.html

[elanorh]

Tess --

For your next appointment, if I were you, I'd chart your dd's weight gain/height/etc. from the Ped onto the WHO charts, and bring the WHO chart with you to show your Ped.

There is a chance that the Ped is using the ff charts (mine doesn't but I think a lot do) -- and this might be a moment for her to learn and access the WHO charts, and also might shed some light on the weight gain issue (especially if your dd's weight gain is demonstrably on 'her' curve on the WHO charts as well as the ff charts).

How are you doing?