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9 mo old not on growth charts- doc asks to give 36 oz of formula

post #1 of 10
Thread Starter 

I really really wanted to exclusively breastfeed. To give a history of our breastfeeding, my dd was born with SGA (small for gestational age) and at birth she was 4 lbs and 6 oz. she was in the hospital for a week, where i didnt get any proper help with lactation and she was mostly on a formula diet :-(. I started pumping from her 1st day of life and was getting around 8 ml of milk per pumping session and I pumped around 5-6 times per day.


After coming home at 1 week, I had to continue pumping since the ped said that it was imp for her to gain wt and that we had to continue supplementing. I was unhappy, but at that time supplementing seemed to be the right thing to do.


I breastfed dd, pumped 8 times (in 24 hrs) and supplemented my baby with breast milk and then formula. I think I was so stressed, that I was not making a lot of milk and I did not have any of the signs that normally comes with the milk coming in.


When dd was a month old, I stopped pumping and supplementing and was exclusively breastfeeding for 9 days. Unfortunately, dd was not getting enough milk- she did not poop for 18 days and was crying all the time. So after the 9 days I got back to pumping, desperate to make more milk. It was back to breastfeed,pump and supplement 8 times a day.


This went on for another 2 months DD was not able to remove more than 1/2 oz of milk by nursing, I was not able to pump more than 7-8 oz per day and no galactagogue helped. Meanwhile her diet of formula went on increasing. I reached my breaking point with respect to pumping and decided not to pump anymore. 


So after dd was 3 months, what we started doing is first nurse and then give bottle of formula. I would do this 6-7 times a day and comfort nurse her to sleep sometimes. But since I really wanted to her to get more breastmilk than formula, I limited her formula intake to 20 oz although the ped said she should have 24-26 oz. This felt better since pumping had taken its toll on me, but supplementing was still making me depressed.


This continued for another 2 months and when dd was 5 months old, with encouragement from two close friends who did/do CLW, I started nursing her at every opportunity and slowly cutting back on formula. At 6 months dd's weight was 12 lbs 10 oz.


Now dd at 9 months is getting around 4-5 oz of formula, around 1-2 oz solids (started at 6 months) 2-3 times a day  and is nursing. Her weight is 13 lbs, so in 3 months she gained only a few oz. The ped is very unhappy and said that if I dont give dd 36 oz of formula, she may face lot of developmental difficulties, brain may not grow properly and be obese and diabetic when she grows up. ( Is this really true??)


I am worried and not sure what I should do. DD at 9 months is crawling slowly, starting to sit on her own after crawling at times ( she used to sit up very stably at 7 months), climbs over dh and me when we are sitting on the floor, kneels down, babbles, recognizes faces, smiles a lot :-), enjoys music.


Are there other moms who went through a similar experience and can you please share your views and help me decide what is the best for my baby?





post #2 of 10
I'd like to see any studies that show that a baby that is very small or grows very slowly will be brain damaged OR obese! I think it's all theories, with very little foundation.

DD was underweight, and slow growth, especially early on. I breastfed and she never had a bottle, but we supplemented with donated milk when needed (at most 300 ml - about 10 oz, I think, a day, but only for a few days).

I think 30+ oz sounds a lot, especially if you have some milk supply (when DD was nearly 4 months old, we were told to expect her optimal daily intake of breastmilk to be ca 600 ml - 20.24 oz - a day, and supplementing was calculated from that). I certainly had milk, as DD wasn't loosing, and was gaining slightly.

We were referred to a specialist ped., a very experienced dr (one of the most well-thought of in this country). He told us that if the head circumference isn't growing (due to lack of food), it can indicate that the brain isn't developing as fast as expected. However, the moment you start providing enough food, the baby's body catches up quite quickly (as seen, we were told, quite dramatically with some babies adopted from orphanages overseas). He was assuring us that even if our DD had been starving that did not mean that brain development would be an issue in her future.

And the latest research indicate that overfeeding babies can be related to obesity. I really hate it when they try to scare parents into submission! We were told our DD would be brain damaged if we didn't supplement with formula, by the Well Baby Nurse. (I fired her. Later, when she told me to "Stop being stupid, and just bottle-feed her formula).

At 9 months, is your baby on solids yet? In your shoes I would try to offer more solids, make it fun, and hopefully baby will gain.

That said, some babies are just small and grow slowly and everything is fine but everyone (drs and nurses etc) get really worried. DD is one of those. Yes, I had low supply, but she also is little, and tends to grow in fits and starts. And I have two friends with tiny 1 yos, one of them have just gone through a whole lot of testing at the hospital (nothing wrong, just small), the other is about to have it done in the new year. They are happy, healthy babies, although have been quite slow to take to solids (which really worries the drs!). Incidentially they are also babies with exzema and food allergies (One of them had it from 2 or 3 months, DD and the other child developed/showed symptoms later on). Not sure what to make out of that!
post #3 of 10

For starters, the info that I have heard is that overfeeding leads to obesity.


However, with that said, children are usually considered failure to thrive if they


1) Lose 3 growth percentiles


2) Fall off their own growth curve. 


If she's only gained 6 ounces in 3 months she has definitely fallen off her own growth curve.  Brain damage can happen in an undernourished baby, children have a lot of brain growth that needs to occur in the first year or 2 of life, and if they don't have the nourishment to do that they can regain some things, but not all.  Other things can happen, also, like rickets, and the fact that the body can take nourishment from the heart muscle and bones just for day to day function.


Your thingy says you are in TX, so you should be able to hire one of many lactation consultants.  I think you need to do several things, and all of them very very soon.


1) See a lactation specialist, preferably one who is outside of a hospital and sort of crunchy.  One who knows how to look for tongue ties and such (some are better than others).


2) Get a SNS and supplement the formula as she is nursing (LC should be able to provide this)


3) As your ped for a referral to the feeding clinic at the local children's hospital.  They will have a feeding specialist, a developmental specialist, and a nutritionist at least. 


Something else may be going on with your daughter that your ped may not see, or she could have some sort of oral issues, or so many other things.  You need more opinions, it will be easier to accept and understand if they all say you are under feeding her, but if there is something else that is missing you'll be happy you went there, too.


I think with her weighing so little several things could happen, and they might not be right, but you wouldn't have any control.  If your ped thinks you are deliberately under-feeding her, a child protective services case could be opened and she could be taken from you.  Also, it might come to a point where they recommend a feeding tube for her (formula can be pumped into the stomach at night while they are sleeping).   You need to be pro-active with her health so that neither of these things come to fruition, and so that she has no long term effects from this lack of growth (and possibly nutrition, I don't think that anyone can assess her nutritional intake over the internet, more sophisticated equipment is necessary).


All of this comes from a mom who didn't quite try as hard as you have to breast feed, you amaze me and are my hero.  My son had very very similar issues, and around 3 months I gave up the pumping/nursing/SNS routine.  I was trying to go to school, too, and was only 9 months away from graduation.  Up until just last week I've second guessed my decision, but I had a friend who is an excellent lactation consultant and an expert in tongue tie look at his mouth and tongue.  She said he has very high muscle tone in his swallowing muscles and no tongue tie.  I believe now he has a combination of dyspraxia and suprabulbar palsy (a type of cerebral palsy that only affects the speech and swallowing muscles) and that he probably would NEVER have been an effective nurser (he still has troubles eating and drinking).  I did the right thing for he and I in the circumstance we were in.  It was hard, I felt defeated, and I still grieve what I didn't give him.  But it was right, I couldn't pump around the clock any more, my other children and my schooling needed my attention, too.  Just because my other 2 children successfully breastfed for  2 years was no guarantee this relationship was going to work


Whatever happens, you have given it the best chance that is possible, and no one is saying to quit nursing (well not me anyway) but you will probably have to find new ways to get food into her if nothing else is going on.

post #4 of 10

Aww I just want to say I know it is so hard to be caught in the middle, as a mom who truely wants to make breastfeeding work and suspects that docs may not have your breastfeeding interest at heart and want to do the best thing for your DC. Believe me, I've been there.


I second getting evaluated by an LC independent of the hospital. Breastfeeding is important but feeding your baby adequately is most important. You've done a great job thus far!

post #5 of 10

I'll put this out there, take it as you will. 


My oldest daughter was exclusively breastfed, never once had a bottle. She started with cow's milk from a sippy cup the day she turned a year old which was also the day I stopped nursing. I was already five months pregnant at the time and had very little milk left. I was young and didn't realize the potential damage I was doing by refusing to supplement her with formula. She was dehydrated and chowed down on any food I offered which was often dry. She drank some water from sippy cups and was not getting anywhere near the amount of fat or protein she needed. I really regret my stubborness. She's six now and academically advanced but is chubby. My other three children are not. I truly feel that she is heavy because of her lack of adequate food as a baby. I should have swallowed my pride and, as much as it would have pained me, given her formula. I'll always wonder if any issues she may have could have been caused by poor nutrition but I'll never know.

post #6 of 10

I whole heartedly second the SNS. If you need (which you obviously do!) and you don't want your supply to suffer, go for the SNS. That way you are getting the time at breast your supply needs, and baby is getting the added formula she needs.



Also consider donation? Milkshare and Eats on Feets.


And I am concerned about the scare tactics you DR is using, talking about brain damage and obesity. It doesn't sit well with me.

post #7 of 10
The first rule is to feed the baby. 8oz. Of breast milk has to be supplemented with either 18-24 oz. Of breast milk, or, because it is usually less calorically balanced, 30+oz of formula. If you don't make enough milk, and some of us just don't, then you have to supplement in order for your baby to be healthy. I have igt, so I only make around 15-18oz/day. My daughter gets 15oz of formula or so per day, but I formula feed on demand. If your baby is still hungry after supplementing, she is probably not getting enough. I make 1.5-2oz at a time, so we nurse, then formula supplement 6or7 times a day, followed by formula. At night I nurse her two or three times, but we don't need formula then. If you have low milk, consider feeding the baby plenty of supplement (formula or donated milk), like 30 oz, sounds like, during the day, then you may be able to experience your desired comfort nursing in the night.

Both of my children are slim, but they both have 90/95th percentile head circumferences and are healthy and on their curves. I formula supplement(ed) on demand after nursing. It sounds to me as though your baby is hungry and that you need to feed her more. Whether it gets up to 36oz of formula a day or not is irrelevant, so long as she gets what she actually needs. Withholding food to preserve a dream of more breastfeeding than formula feeding when one has a quite low supply does not sound like a safe or healthy option to be going forward with. Combo feeding is still breastfeeding, and formula does not undo the benefits of nursing. Undernourishment, however, is not good for anyone's health.
post #8 of 10
Yes, but my point is, the OP has had a supply, which obviously has been ok (together with 4-5 oz of formula and small amounts of solids) up until now (look, baby is gaining, if ever so little, so there can't possibly be a lack of 30 oz! More likely 5 or 10.) and while it may no longer be adequate it hasn't disappeared entirely. So supplementing 36 oz of formula can only have a few different results:

1. Baby keeps taking breast milk and formula and gets seriously overfed and has to vomit up excess.
2. Baby refuses extra, un-needed formula (more likely if you use SNS, and put it on at end of feed. This is what DD did with excess donor milk).
3. Baby drinks all the formula and cuts down on breastfeeds dramatically. As a result, mum's supply is likely to tank.

The OP must have a supply, just an inadequate one. Even when DD was losing weight, early on, I still had a supply, and only needed to supplement a little. And later on, when DD's weight stalled - no gain at all for a month at about 3 months of age - I never needed more than 250-300 ml of supplement (we can therefore assume my supply provided more than half of what DD needed).

In the OP's shoes, I'd start supplementing maybe about 10 oz (spread out, so only about 2 oz a time), in an SNS, AFTER, or at the tail end of, a good feed. After a week, weigh and see if there is an improvement. (But if you can ask a good LC , I would. Or possibly e-mail Dr Jack Newman?)

That a baby cries after a feed and will take a bottle doesn't necessarily mean they are hungry.
post #9 of 10

36 oz is no longer supplementing.  The dr is telling you to stop BFing and switch to formula.  And while I don't agree with his numbers, I do agree that she's not getting enough.  You're obviously not producing enough and need to supplement with something.  If you're not supplementing her on demand (which I can't judge by what you said), then I'd highly recommend starting.  If you are supplementing her on demand, then I agree with the pp, and you need a 2nd, 3rd, 4th opinion to discover why she's not growing.


I would also recommend ditching the bottles and working with an SNS or Lact-Aid exclusively.  There is a learning curve, but once you (both) have the basics down, it can go quickly.  Nurse her for however long (5 min, 10 min, whatever works for the 2 of you), and then add the tubing for the supplementer.  She'll still be at the breast, stimulating your supply, but she's also getting more food.  No pump will ever be as effective as a baby at moving milk - and as you discovered, pumps don't work for everyone (they don't work for me either).  I would also have her evaluated for ties.  My little guy's lip tie went undiagnosed until it was too late for my milk supply - he never learned to nurse effectively because of it.  If she is tied, getting her clipped may or may not help at this point with your supply, but I don't imagine it could hurt matters. 


At 9 mos, I don't know that you're going to be able to find a whole lot of donor milk unless you know someone with excess.  After 6 mos, nobody wanted to donate to my DS anymore, figuring he was old enough for solids, I guess.  After that point I only got milk from a few long-term donors who just email when their freezers are full... and now (at 15 mos) I'm down to 1 regular donor.  I'd suggest finding a formula she reacts well to and that you can stand the smell of, and go from there. 


As for the emotional aspect, I'm afraid I have very little advice for that.  It's something that you have to accept within yourself - that you did everything you could, and this was the outcome.  When you're adamant about BFing and fail, it is extremely painful - I spent 6 mos in a depression about it, and discussing it can still bring me to tears.  There is nothing anybody else can do to change that for you, I'm afraid.  I hope you have some good emotional support - if you need to talk, feel free to PM me... But mostly this is just emotional work you have to do within yourself.  If you can manage to see a BFing friendly therapist, that may help you. 

post #10 of 10
Originally Posted by cristeen View Post

As for the emotional aspect, I'm afraid I have very little advice for that.  It's something that you have to accept within yourself - that you did everything you could, and this was the outcome.  When you're adamant about BFing and fail, it is extremely painful - I spent 6 mos in a depression about it, and discussing it can still bring me to tears.  There is nothing anybody else can do to change that for you, I'm afraid.  I hope you have some good emotional support - if you need to talk, feel free to PM me... But mostly this is just emotional work you have to do within yourself.  If you can manage to see a BFing friendly therapist, that may help you. 

Yeah, that!!!  I haven't had time to be depressed about it, but I have grieved here and there.  It's very sad.  I had 4 years of successful breastfeeding with my other kids, I'd ask myself "how and why did I fail this time?".  Because Charlie is different, that's the answer.  Be kind to yourself.

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