Nutritionist says to limit bf to twice a day - Page 2

[Vancouver Mommy]

My son was born at the 50th percentile and within about six months had dropped down to 3rd. He has stayed around the 3rd for the past two years, with a slight dip off the charts. Within the past few months he has moved up to between the 3rd and 10th. He is built exactly like his father. He is perfect. This is not to say that I didn't suffer with anxiety during the first year or so.

In all this time nobody (including the nutritionist) has told me to limit breastfeeding. He still nurses about 12 times a day. The only advice the nutritionist gave me was to nurse after feeding solids rather than before.

What I'm saying is that there are many situations, many practitioners and many sorts of advice given. If you went to another hcp you might be told something quite different. You have to do what feels right for you and your son.

[farmerjess]

wow, what ridiculous advice your nutritionist gave.

Does your lo like meat? I just ask because my LO is very small too (born at 25th and is now down to 5th), but he loves meat. He will eat it over anything else. He especially likes liver and the bits that come off of bones that are boiled a really long time. You may want to try to offer that more if you are not totally opposed.

Also, we nurse on demand, many many times a day and offer solids 4 times a day, pretty much whenever we eat plus a snack.

[DisplacedYooper]

Originally Posted by Vancouver Mommy

My son was born at the 50th percentile and within about six months had dropped down to 3rd. He has stayed around the 3rd for the past two years, with a slight dip off the charts. Within the past few months he has moved up to between the 3rd and 10th. He is built exactly like his father. He is perfect. This is not to say that I didn't suffer with anxiety during the first year or so.

Thank you for posting this - my son is exactly the same, and I admit to having some worrying thoughts sometimes...

To the OP: also, remember that they make the weight charts by first recording the of weights (heights, head size, etc) for all the kids in the study at each age, then sort those weights to find the distribution and make the percentiles. The kids in the study didn't necessarily stay on the same "percentile curve" and you shouldn't expect your DC to either! Kids grow in fits and starts, not smooth mathematical curves!

[averlee]

My daughter is 28 mos, and we have met with 3 different nutritionists already! Like at WIC and other crap, not because of anything wrong with her weight or diet or anything.
Every single one of them has said, continue breastfeeding as long as possible, as often as possible. When I mentioned we are vegetarians and she doesn't like cow's milk, the nutritionist responded, "Those are excellent reasons to keep nursing on demand." The last one we saw was grilling me about weaning, and when I got uncomfortable, he said "Relax! At our office we rarely recommend weaning before kindergarten! Because that seems to be when most kids are really done. You're doing great!"
So I really wish you had seen one of these nice folks instead.

[Lactivist85]

I didn't read all of the responses but I hope this helps.

1. I would not worry about her weight if she's reaching all of her milestones and seems healthy. (My dd was 19 lbs from 10 months to 15 months or longer)
2. If you feel like you really want her to gain try this: Limit solids to 2-3 times a day just for "playing" and learning purposes and try to get her to have more hindmilk (which has more fat content). You can do this a couple of ways. You can pump for a few minutes before the feeding and then latch the baby on or you can feed from the same breast for 2 or more feedings (block feedings) to get her to take more hindmilk and less foremilk.
This may help as well:
http://askdrsears.com/html/2/T023600.asp

Also keep in mind that if your Nutritionist isn't specifically trained in breastfeeding, she is not reliable when it comes to this. Most Drs think that they are the end-all-be-all of medical information even though most are not taught anything/much about breastfeeding in medical school. If all else fails, you should contact LLL or an LC.
Good luck!

[ShwarmaQueen]

Breast is best. I'd continue nursing as long and as much as possible.

[winter singer]

Update

Hello again everyone,

We just had our doctor visit this morning and it went a bit better than the nutritionist visit last week, in that the doctor at least didn't think we should limit breastfeeding to morning and evening feeds. However, the nutritionist had been in touch with him and told him that DD had plummetted in the growth chart : (this despite the fact that I'd shown her the WHO charts, which show a much gentler drop in her weight gain :.

So the doctor was concerned about DD's weight. He said that when breastfed babies have a lot of small feeds, they never really get properly hungry so then they haven't as much appetite for solids. (This makes no sense to me - if that was the case then the ideal diet for grown-ups would be to have tons of little snacks all day!!).

So I'm supposed to offer DD the breast throughout the day, but at wider intervals. He also wants me to rent a scales and weigh DD before and after each morning and evening feed for a couple of weeks, to see how much milk she's getting at each feed. I'm supposed to get back in touch with him after that.

What do you think?? The whole issue seems more and more absurd to me since it really seems as though DD doesn't have a weight gain problem in the first place. In the ten days or so since I first posted to this thread, I've been following the advice that PPs gave me and encouraging DD to feed as often as possible, plus offering high-quality solids a few times a day. Interestingly enough, she did seems to want to feed a lot in the last few days, and not only that, she's been more interested in solids too, particularly salmon of all things. (Good brain food I guess!)

And when we weighed her at the doctor's this morning, she was up 180g (about 6 ounces I think) from 10 days ago. DH and I were pretty happy about this, but alas, the doctor didn't seem real impressed. Of course it could just be that the nutritionist's scale is calibrated a bit differently from the doctor's. In which case I'm kicking myself even more for going to the nutritionist in the first place....

Anyway, I really don't want to get stressed out about fluctuations in DD's weight from day to day. Thankfully, DH is on my side on this. He agreed with me that we'd use the scales to see how DD is doing generally but, if necessary, lie to the doctor about how much she's taking in at each feeding.

Ideally I'd like to find another doctor - the thought of being cross-examined on every detail to do with DD's feeding by this one again fills me with dread. Problem is that there isn't a huge choice in doctors around here - I live in a rural area - and at least this one seems to understand that I shouldn't limit BF (he even told me that he would be fine with my breastfeeding DD until she was 3 or 4).

Anyway - sorry about the long ramble. I guess I'm mainly wondering what people think about what the doctor said about frequent feedings and using the scales. Thanks for reading this far!

[rightkindofme]

My kid was in the 85% when she was 4 months old. She is now in the 30% at 15 months. She shows every sign of continuing to drop percentiles. She's healthy as a horse. She eats and eats and eats and eats. The thing is, she also runs and runs and runs and runs some more. She's working those calories off. My theory is: well at least they won't start harassing me in a couple of years to put her on a diet.

[KristyDi]

Originally Posted by winter singer

He said that when breastfed babies have a lot of small feeds, they never really get properly hungry so then they haven't as much appetite for solids. (This makes no sense to me - if that was the case then the ideal diet for grown-ups would be to have tons of little snacks all day!!).

How does he know that? I've never seen any research that suggests anything like that. I'm pretty he's using "common sense" (aka pulling it out of his)

Originally Posted by winter singer

So I'm supposed to offer DD the breast throughout the day, but at wider intervals. He also wants me to rent a scales and weigh DD before and after each morning and evening feed for a couple of weeks, to see how much milk she's getting at each feed. I'm supposed to get back in touch with him after that.

That seems rather extreme for a child who is otherwise healthy and meeting milestones. And why only the morning and evening feeds? To be useful wouldn't you need to know the total amount of milk ingested? What useful info will this provide? The only thing that's going to come of that is stress for you and then the dr will either declare your LO is getting "too much" breast milk (and I'll call BS and say there's no such thing) or declare that your LO is getting "too little" (and I'll call BS because your LO is nursing at other times and they weren't measured)

Originally Posted by winter singer

What do you think?? The whole issue seems more and more absurd to me since it really seems as though DD doesn't have a weight gain problem in the first place. In the ten days or so since I first posted to this thread, I've been following the advice that PPs gave me and encouraging DD to feed as often as possible, plus offering high-quality solids a few times a day. Interestingly enough, she did seems to want to feed a lot in the last few days, and not only that, she's been more interested in solids too, particularly salmon of all things. (Good brain food I guess!)

And when we weighed her at the doctor's this morning, she was up 180g (about 6 ounces I think) from 10 days ago. DH and I were pretty happy about this, but alas, the doctor didn't seem real impressed. Of course it could just be that the nutritionist's scale is calibrated a bit differently from the doctor's. In which case I'm kicking myself even more for going to the nutritionist in the first place....

I'm inclined to agree with you that this is absurd. If what you're doing got you somewhere in the neighborhood of 6oz in 10 days I'd say keep that up.

Originally Posted by winter singer

Anyway, I really don't want to get stressed out about fluctuations in DD's weight from day to day. Thankfully, DH is on my side on this. He agreed with me that we'd use the scales to see how DD is doing generally but, if necessary, lie to the doctor about how much she's taking in at each feeding.

Ideally I'd like to find another doctor - the thought of being cross-examined on every detail to do with DD's feeding by this one again fills me with dread. Problem is that there isn't a huge choice in doctors around here - I live in a rural area - and at least this one seems to understand that I shouldn't limit BF (he even told me that he would be fine with my breastfeeding DD until she was 3 or 4).

Personally I'd try to avoid lying. With my dr I'd flat say that since my dd's weight was in the x% on the WHO BF chart and had only dropped x%tiles that I felt the constant weighing was unnecessary.

On the formula fed charts, my dd was in the 95% at some point in her 1st 3 months (can't remember when exactly) and by her 12 month visit she had dropped to the 10%. He was most concerned that she had "gained less than 2 lbs in 6 months" He subtly pushed weaning, I flat out told him that wasn't going to happen. He encouraged me to push whole cows milk. I pointed out that she was getting whole human milk and asked if he was using the WHO BF charts. He said he wasn't and I said I'd see how concerned I was after I plotted her weights on a chart made for bf babies. All this was very polite and it was very clear that he didn't really agree with me, but that he respected my role as the parent. I went home and plotted dd's weights on the WHO charts and found that she has hovered pretty close to the 50% mark her whole life.

YMMV