Paediatrician threatening Failure to Thrive

[themammy]

I need a rant more than anything..

I had a hospital appointment today for my 9 month old. She was seriously ill at the start of the year with a chest virus and developed double pneumonia on top of it and was hospitalised for 2 weeks (oh - the battle to breastfeed her then, but that's another story). It was a slow recovery and since then she has caught two colds which have knocked her back a bit. I was actually really happy with her in the last three weeks and was nearly going to cancel today's appointment, but thought I'd better go. I thought we'd be sent on our way with the hospital's blessings, never to see them again.

But oh no!

My baby has been exclusively breastfed from birth. I introduced solids at 6 months, but she wasn't interested until about 7.5 months. Some days she eats like a horse, some days she's not bothered at all. She was on the average line on the (formula) growth charts in the early days. She lost a lot of weight when she got sick in January. She has been weighed on 3 different scales, the hospital scales, the public health nurse scales and the g.p's scales, which all seem to give drastically different readings (recently she was weighed on 2 scales on consecutive days and there was a difference of almost 1 lb in the readings). So her weight chart is all over the place.

The paediatrician today was saying my daughter's weight has dropped to the 10th percentile and that any more of drop and she'd be getting into failure-to-thrive territory. This woman had never seen or met me or my baby before today. I pointed out that even though she did drop, she is still maintaining steady growth along that line, albeit low down in the grand scheme of things. The paediatrician said that she had started with a 'normal' baby weight and should therefore maintain a 'normal' baby weight.   I pointed out that her weight dropped when she was seriously ill, and was nil-by-mouth for 5 days, being drip-fed. The paediatrician said that 4 weeks ago she was weighed (on the g.p's scales) and climbed to the 25th percentile and now she has dropped back down again. I pointed out that that was on a different weighing scales and if we only looked at the public health nurse's figures, she has never got back up to the 25th percentile, but has maintained a steady course on the 10th. I said to the paediatrician to look at her. She is as lively as they come, full of beans and very happy. The paediatrician said that "that may be now, but the figures on the growth chart indicated that she won't be like that for long and some intervention is required". I pointed out that her length is also in the 10th percentile (which to me indicates she is the perfect weight for her size). The paediatrician said this was irrelevant.

Then she asked me about breastfeeding and how often I breastfed. I feed on demand. The paediatrician insisted this was the problem. That my daughter should be eating 3 good sized meals a day (does anyone know a baby who will eat three good sized meals every day). She should only be getting two feeds of 250ml each a day. She even suggested I should perhaps express my milk and give it to her in a bottle to ensure she is only getting 500ml max. She reckoned my baby is getting too full of breastmilk and cannot eat 'proper' food and that is why she is not growing properly. I said I would talk to my la leche league leader before I changed anything to do with our breasfeeding relationship. The paediatrician didn't like that and said that I am endangering my baby if I continue to feed on demand.   

It drives me NUTS. Why don't they get that breastfeeding is not simply equivalent to 250ml of nutrition in a bottle!!! They don't understand the nurturing and bonding and mothering and that both my baby and I would be heartbroken to reduce or eliminate this relationship. I know in my heart of hearts my baby is fine. But now that woman has planted seeds of worry in my head and I feel stressed looking at my little girl. I know I will get over this, but right now I feel like our innocence has been robbed, that instead of enjoying our mealtimes I'll be watching how much my little girl is eating like a hawk. And I have pangs of guilt and doubt when I let her breastfeed as she wishes. I have felt so angry and upset all day. I just needed to get his off my chest.

Thanks for listening.

[konayossie]

Oh, mama! That's terrible. You are doing exactly the right thing and that hospital pedi is crazy! I've never seen them mix weights across dr.'s office's before--that's just asking for trouble. My DS has been below the 3% since he was born, and our pedi has always been much more understanding, never threatening us with FTT since he was maintaining his own very low curve, except for once when he had a GI bug for a couple of weeks and he actually lost weight. Thankfully, our ped took us at our word that he had been sick and just noted that and said it was nothing to worry about unless he continued to fall off his own curve. We have seen a number of different docs with DS and no one uses the other's weights to measure his progress--they all only use the weights obtained on their own scale.

On the eating thing, 3 meals a day for a 9 month old is crazy. At 2, I am doing really good if I can get 3 "meals" down DS, and when he was under a year, he was almost entirely breastfeed. Solids were just for fun (at his choosing).

You know what's best--keep up the good work!

[JudiAU]

What absurd advice,,,cutting back on perfect nutrition to starve your baby into eating less perfect nutrtition.

[JudiAU]

I can't seem to edit but wanted to add that my aunt's child was failure to thrive? Why? Because she DIDN"T NURSE on demand and night weaned at four months. They read a lot of relgious/your baby controls you/CIO and she would only nurse on a schedule. It was horrible.

[PatioGardener]

Fortunately we have Mama Bear instincts, and yours have alerted you to the fact that the advice your ped is giving you is wrong. It's even wrong by the ped's own association's recommendations!

How frustrating for you, Mama, but how lucky your baby is to have a Mama who will listen to her instincts and keep nursing! I would think that the first step to treat FTT in a breastfed 9 month old would be to say "let's get some more Mama milk into her!", not "pump and only give her 500 mL" !!!

Can I ask (approximately) where you live?

[themammy]

hi

thanks for comments

we live in ireland, where breastfeeding after 6 months is virtually non-existant, maybe 6%, maybe less.

every other mother in waiting room had their babies on bottles.

i know i'm doing the right thing so it's really distressing to be told you are putting your child at risk.

i'm supposed to go back in three months to prove my daughter has gained weight. i don't think i'll go.

[minnowmomma]

Drop the ped and get a general practitioner you will get less hassle and feel less stress,The stress btw could cause you to not have as much milk so stop worrying,but don't see this dr again.Her mind is already made up.

[kristandthekids]

That's so weird. When they said "Failure to Thrive" to me about Oldest they told me NOT to give her solids because they were harder to digest and would burn more calories.

I swear they make this stuff up as they go along.

[PatioGardener]

First, let me say how sorry I am to hear that she was so sick. It's frightening to have a sick baby! My little one was in the hospital at 8 weeks old, and also had slowed in his weight gain. Once he was well his weight gain really picked up!

Have you plotted her on the WHO chart? That will give you a better idea of her growth compared to a typical breastfed baby.

If she is not maintaining a curve, then my first instinct would be to get more milk in her :). I'd try to increase my supply (oatmeal, fenugreek and blessed thistle or even domperidone if needed, pumping to increase supply etc.) AND I'd try to increase how much milk she gets - more nursing, feeding pumped milk with an open cup, breast compressions and a visit from an IBCLC to see if there was any tongue-tie or any other reason for slow weight gain.

Also, any solids I feed my little guy I try to make packed with nutrients. Avocado is amazing (great fats and high in calories), and there are lots of other 'high impact' solids too.  Here's a good guide to fats and calories, and other nutrients are here at the bottom of the page .

I'd also weigh her now with a health visitor or at a community health center, and again in a week or two and see how things are going. So many things can affect weight gain it's important to keep an eye on it if baby has been having trouble.

Please stop back and let us know how things are going, Mama!

[KristyDi]

Oh Mama!  How frustrating!

Have you seen this chart from Kellymom that shows the fat and calorie content of common baby foods vs breast milk?  Breast milk has more fat and calories than most of the foods you'd give a baby so trying to get a baby to gain weight by replacing mama milk with food that is lower in fat and calories is insane.  I know finding that made me feel a lot better about sticking to my guns when my Dr was encouraging me to wean DD at 12 months to get her to eat more "real" food.

I'm glad your LO is better and I hope you're done with the hospital and that ignorant ped.

[dancingflower]

Oh, this Doctor's advice is so irresponsible! "Oh yep, this baby is failing to thrive, so let's cut down on his main source of nutrition". What does it take to become a Doctor nowadays? This woman is loosing perspective. She wants to confront you with the discussion of solids intake against extended nursing and using your baby's low weight to support her personal opinion. How can she forget that your baby's low weight is due to having suffered an illness? How can she forget the patient's history and needs? And I know of so many genuinely good and smart people who couldn't even dream of having access to a medical school. It gets me mad, you know?

I'm glad you know that by 9 months, your baby's main source of nutrition is breastmilk. The best source of information I found in the web about the nutrition of a breastfed  baby was on Kelly's mom. It says that by 1 year old, roughly 70% of the child's nutrition is based on breastmilk and 30% from solids. 

And just so you don't loose perspective, know that, by 9 months, my boy (who didn't have to brave illness and hospitalization) was nursing on demand, basically just playing with his solids and keeping himself in the 90th percentile. There is nothing wrong with your baby's diet. She got ill, had a set back and she will catch up.

But certainly you have to watch her nutrition and growth. Try to discover strategies of supplementing her nutrition that are developmentally appropriate. I'd say, find out what is a hit on her palate. Also try different ways of presenting (preparing or dressing) the same food. When she doesn't eat, relax because your milk is there for her. Try (and I say just try) to offer solids before nursing not after. If it's not for her, normal. In our home I couldn't even think of delaying any nursing section by 9 months, neither could I have my baby's patience on a high chair with a slightly empty stomach. But each child is different. If she takes to it, it may help her eat more solids. It does to DS, but I could only try it at around 10/11months. 

Later, try to find a Doctor on whom you can trust. We are good, well informed mamas but a bad Doctor can cause a great deal of emotional harm while a good one can be a great parenting partner.

Take care of your baby and don't bother with that insensitive person who holds a diploma.

[Marissamom]

let me guess, the g.p.'s scale was the one that measured almost a pound heavier? weights on different scales shouldn't be that closely compared because there can be up to a pound of difference on different scales. it wouldn't hurt to offer more solids, but you shouldn't cut down on nursing to do so. as long as she's getting enough milk it should be plenty for her (I say as long as she's getting enough milk because my DD has a posterior tongue-tie that did cause weight gain to slow after 4 months, and it did pick up a lot once she started eating more solids, it wasn't until a year later that I realized she is tongue-tied). 

[themammy]

I wasn't around a computer for the past 5 days. Thanks for all your responses.

I plotted my DD on the WHO chart, and according to that she's around the 20th percentile, not down under the 10th, as the paediatrician said. Also the calorie-per-food list was very helpful. Instinctively I seem to have been offering her most of the highest calorie-content food anyway. So that's reassuring.

She's actually been eating pretty well the last few days, even though I'm still breasfeeding her whenever she wants. Eating well until today that is - & it's so stupid, it's just one day, but I get all worried when I see her refusing food. I agree with what a previous poster said about the emotional damage - one day when she doesn't feel like food (I think she's teething again & we were travelling today too) & I'm terrified she's not going to gain enough weight.

I'm going to meet with my la leche league leader this week and if she feels that this pedi is actually giving damaging advice (as opposed to just bad advice) then I'm going to tackle the hospital over it. I'll bring DD in to the public health nurse to be weighed in a few weeks. I trust her. Last time she weighed DD, her comment was that although she was on the lighter end of the scale, she was still gaining weight on a steady path. So she wasn't particularly bothered. Still, all it takes is one 'expert' to plant the seeds of doubt.

Thanks again for the replies.

[PatioGardener]

Originally Posted by themammy 

I plotted my DD on the WHO chart, and according to that she's around the 20th percentile, not down under the 10th, as the paediatrician said.

Great to hear you are feeling more confident!

Has your DD been at the 20th percentile since birth? I don't think it matters where a baby is on the chart - it is the overall trend that matters. If baby is always around 20%, or always around 90 % then all is fine. If baby started at 90th and has fallen to 20th that is more of a red flag.

I hope LLL gives you some useful info too - I always like going to 'my' group!

[averlee]

To me, this is full on crazy.

A baby under 2, if having slow gain, should be nursed MORE, not less. They should have been telling you this kind of stuff:

Wake baby to nurse before you go to bed.

Offer the breast more often, every hour or two, while baby is awake.

Encourage baby to stay on the breast longer, then offer the other side, then offer the "third" side.

Instead of water offer breastmilk in a cup.

Instead of mixing cereal or puree with water, use breastmilk.

Lay with baby during naps so if she wants to nurse, you're available.

Never make baby wait, drop everything to breastfeed whenever possible.

Get more rest, eat well, and reduce stress to help boost your supply.

I know it sounds harsh, but I think they give this bad advice on purpose. Breastfed babies are healthier and have fewer illnesses all the way throughout their lives. Doctors are counting on making lots of money off ear infections and diabetes.

[themammy]

OK

I have been taking all of your replies on board and I completely am at ease with the fact that breastfeeding is not the root of the problem.

However, I also took on board what previous posters have said about crossing the percentiles. As I think I've said before, I don't normally have much time for growth charts, but this was niggling at me. So I looked DD's log book closely, first time I've paid attention to it. And it did shock me. She was born at the 75th percentile. By 15 weeks was down at the 50th (not too worrying in and of itself), then got sick at 5.5 months and dropped down to the 10th. And she's not recovering, she's 9.5 months now. A drop from 75 to below 10 - that is a cause for alarm.

So I started to research why a seemingly healthy baby with a good diet but respiratory trouble would be failing to thrive. And the answer I came up with was cystic fibrosis. Another symptom of CF is a salty-tasting baby. I've been licking my poor DD for a few days now (God love her) and fear that she is salty.

So I brought her to my g.p. yesterday - my wonderful g.p. who has been so supportive of my two homebirths, even though they were the first and only ones for the practice, and absolutely supportive of my decision not to vaccinate. And I hoped she would slap me on the wrist for self-diagnosing on the internet and tell me some other wonderful logical explanation. But she didn't. She said that cystic fibrosis was very much on her mind and when she sent me to the paediatrician in the hospital, she thought they would start the series of tests for it. She couldn't believe it was overlooked and was absolutely appalled at my consulation with the paediatrician. She rang the hospital there and then.

It took a few hours to get hold of the senior paediatrician, who then needed to review DD's file. But the hospital rang back yesterday evening to say DD is to come in next Thursday to start a full day of tests. CF is not the only possibility - but there are a lot of pointers that show it could be the cause of all her problems. Ireland has the highest incidence of CF in the world, with 1 in 19 people being carriers. There is no evidence of it mine or my husbands family - but it only became diagnosable in the past 30-40 years. My mother had a brother who died aged 2-3 days old. A complication of CF is that some babies cannot clear the meconium from their intestines at birth. This becomes critical after 2 to 3 days. I fear this is what happened my mother's brother, 70 years ago and this is my side of the family's connection to CF.

Anyway - I thought I'd let you know and ask for your prayers for the next few days, especially for my little girl.

Thanks

The Mammy

[Birdie B.]

Oh, that must be so hard! I will pray for a good outcome, and I hope you get some good news soon! You are a fantastic mother!

[averlee]

My prayers, and my heartache, for you and your baby.

[PatioGardener]

What an awesome Mama you are! I'm so sorry that you and your lovely baby are going through this. I hope that it all comes back normal. At least they are now testing the right things and not telling you to wean or to limit nursing!

Did you plot your baby's weights on the WHO curve? Are you still seeing the same drop in percentile? (You see, I am still hoping that this is all just because your doc is using an out dated growth chart!)

[pinky]

Mama, I hope you hear that all is okay with your baby.

I just wanted to add that 500 mL of milk (human or otherwise) is a crazy number for a 9 month-old.  In the U.S., the standard for any baby under a year is 32 oz. (about 1000 mL), even if they are getting formula.

I also wanted to say that my dd was born big (8#4 oz), but grew slowly, and was only 17 lbs. at a year.  I hope your dd is just one of those kind of kids and all is well.