Failure to thrive dx, nutritionist and catch up growth??

[Snowflower]

My Dr has diagnosed my baby son with FTT. :(  Which seems really harsh because he IS growing, just slowly. He was born at 6 lbs 13 oz on oct 5th. Went down to 6.7  5 days later.  On dec 12th (2 mo 7 days) he weighed 9 lbs. So he's gained on the average 4.7 oz per week. not great, I know. But FTT??!  My doctor has stated that he needs to have a bunch of "catch up" growth and has given us an 'urgent' referral to a nutritionist. (And insisting on supplementing w formula) When I asked what they will do for us, meaning tests, evaluations and such, they said no tests...just a consultation. but for what?? If they are not going to test my milk somehow to see if it has enough calories in it...then why should I go? I am NOT under weight, eat super well....he doesn't eat anything but BM... I am confused. I would just go for the hell of it but insurance won't cover it and we are broke. Didn't help having 3 extra co pays for weight checks. Anyway, I am going to a lactation specialist tomorrow am, I'm just seeking any experience with nutritionists and slow weight gain. Sounds strange, knowing as much as I know about breast feeding. (this is my 2nd child and I struggled w my first as well...but she was born a bit bigger.) ...and is 'catch up growth' a real thing? I don't get it.

Thanks in advance for any insight shared <3

[Bokonon]

Average weight gain in a breastfed baby that age is 5-8 oz. a week.  So technically your baby is gaining a tiny bit less than average - not a huge cause for concern IMO.  It sounds like your doctor isn't very supportive.  What would a nutritionist possibly do for a newborn?

Your baby started out small and may just continue on that path.  Small isn't necessarily bad!  Is your DS having plenty of wet and poopy diapers?  Nursing at least 8 times a day?  Hitting milestones?  Another thing to remember is that there is a pretty big growth spurt around 8-9 weeks, so you are just before that.  It could make a big difference!

I would make sure the lactation consultant you see is an IBCLC.  And honestly I'd consider trying to find a more breastfeeding-knowledgeable pediatrician who doesn't freak out over something that's slightly different from average, and won't suggest formula right away.

[Snowflower]

thanks for replying quickly! I am getting a new Dr. er...well, my old Dr back. My wonderful awesome Dr left this practice so this one I landed by default. NOT on the same page about anything. I fear she is setting me up for an unnecessary hospital trip. She has already threatened. She is appalled that I do not vaccinate. I just don't feel confident in her. She's sweet enough and all...but..why would she insist on a nutritionist and not a lac consultant? And the 'catch up' growth is confusing. Does it mean he needs to gain double time?? How would that even work? She keeps telling me about other babies situations...one of them the mom was not making fatty enough milk so when they gave him some formula he gained 11 oz in TWO days. Is that for real?!    I feel like she's trying to break me. This sucks.

oh ya...yes lots of wet and poopy diapers. nurses at least 8 times per day. I've been nursing him hourly to get my supply up...color is beautiful...alert....

[Bokonon]

Originally Posted by Snowflower 
She keeps telling me about other babies situations...one of them the mom was not making fatty enough milk so when they gave him some formula he gained 11 oz in TWO days.

Yeah, other babies' situations have NOTHING to do with yours, and it is ridiculous to try to compare two infants with different genetics.  Even babies in the same family don't always gain the same way!

Gaining 11 oz. in 2 days isn't good IMO.  She likely completely derailed that breastfeeding relationship and exposed the baby to all the risks that come with formula feeding, not to mention the long-term risk of obesity by gaining so quickly!  Yeah, I would run, fast, away from this doctor.  She sounds more harmful than helpful!

[Bokonon]

And, no, gaining weight twice as quickly is not a good idea, especially when your baby is not failing to thrive - which would mean not hitting milestones, sickly, not gaining weight, etc.  Your baby IS thriving.  Extra-rapid weight gain is not healthy.  That said, if your baby suddenly gained 9 oz. in a week, that wouldn't be alarming or unusual for a breastfed baby - my babies gained about 1-2 oz. a day in the first few months, but that was THEIR growth pattern, which tapered off significantly after 6 months.  My second gained 14 lbs. in her first 6 months and 3 lbs. in her second 6 months (still nearly exclusively breastfed save for the crumbs of solids she would actually take), and only 4 lbs. in the year and a half since!  She is thriving, smart, active, healthy, tall, and just so happens to be slender.

[Snowflower]

thanks for the reassurance. I am needing it right now. My DD was in the small % then when I started her on solids at 12 mo she grew quicker. She stopped bf at 21 mo and I fed her like amazingly well. She's 4 now and off the charts in height. She's a solid thing too. So I may not have the biggest supply or fattest milk (I am a vegetarian) but it's the healthiest option. Can not wait to find my old Dr and feel comfortable again. This is bull.

eta- she is also hitting me hard with the 'this is the crucial time when the brain is developing and this could damage him for the rest of his life' bit. It is a tough thing to hear. 

[mvmamma]

Hello Sweet Snowflower,

My heart is breaking for you right now!  Trust your Mama wisdom!  You know your baby is thriving with your Mama's Milk.  Babies grow at different rates. Breastmilk is the best for brain development, not formula.  My son is at 10% wt and 50% ht (at 5 y.o) and always has been, daughter is at 75% wt and 90% ht (3 y.o) and EXCLUSIVELY breastfeed for 1 year.  I am 5ft 1 inch! Go figure.  By the way, i did not share the fact that DD only had breastmilk for one year with the pediatrician............. 

You need a new pediatrician.  Good luck and try to filter what the pediatrician's tell you with your own intuition!

[Snowflower]

Thank you thank you thank you! i love this community. mothers all over the Earth on the samepage and sharing our love and knowledge with each other. Welcome aboard.

[Megan73]

ITA agree with Bokonon - a breastfeeding-friendly doctor would have suggested you see an IBCLC instead of jumping to formula.
I suspect the LC will tell you to nurse, nurse, nurse, use breast compressions and perhaps switch nursing, pump after feeds and feed baby the EBM with a cup etc. etc.
Kellymom.com has great resources on normal infant growth and how to increase BM intake.
I just wanted to add that all the research shows babies don't gain well because they're not getting enough milk, not because your milk is somehow too "low calorie" - and vegetarianism has nothing to do with it.
Your milk is perfect for your babe and I bet with a little help from someone who knows what they're talking about (unlike your ped!) she'll be gaining well in no time.

[Alaura5]

Hi Mama- 

I just wanted to tell you that we were in the exact same situation a few months ago. My son was bigger at birth (8lb 6oz.) but lost about 9% of his birth weight and then gained really slowly--initially less than 3 ounces per week. He didn't regain birth weight until 4 weeks old. I worked closely with a lactation consultant and started pumping after each feed and supplementing him with my own milk. It didn't make a huge difference, he still only gained about 5 ounces per week, despite getting 7 extea ounces per day (on top of very frequent nursing ob demand) which should be a decent amount extra. He's now 5 months old and still hangs out in the 12% for weight and the 60% for height. He has developed normally if not a bit ahead of the curve and is otherwise a healthy thriving guy. Our pediatrician mentioned formula as an option but was supportive of our method. He recently saw my son for a weight check and was so pleased with how he looked (even though he is still small in relation to his height) that he said he thinks we can stop worrying about it now and just assume he's a slender guy. Easier said than done, I still pump a few times a day and supplement with extra milk at bedtime and freeze some. 

This is all to say that I am so sorry you are in this boat. We were there and it ended up being a lot of worrying for nothing much. Definitely find a more supportive pediatrician. Failure to Thrive is a big label, and should not be given to a newborn who is just gaining slowly. Also working with a lactation consultant and going for weight checks through her support group was really nice and took some of the pressure off. Hope this helps! 

[ASusan]

You might have the LC carefully check his latch, and look for tongue ties, frenulum tie, etc. It's possible he isn't transferring milk well. (although wet diapers may contradict this)

Does he have any signs of gastro distress? burping a lot, reflux, pain, colic, green poop, bloody poop...is there ANYthing that could suggest a food sensitivity? (A nutritionist will most likely NOT be helpful in this department.) If so, it is possible that a food (or class of foods) that you're eating is bothering his digestive system to the extent that he's not absorbing well.

Can you eat more fats yourself?

[darthtunaqueen]

Woah woah woah... back the truck up.  11oz in 2 days???  I deal in grams/kg, so that's 311g in 2 days. That's *totally* inappropriate.  At work (am NICU RN), if a term babies gains that much in 2 days we start freaking out.  

Some babies are slow growers, some babies puke ALL THE TIME no matter what you do (and still grow).  I know we get all excited at work when babies drop off the curve, but usually they're premies and we're trying to grow them so they can go HOME.  

If he was FTT, wouldn't he be lethargic and not interested in playing?  Kinda how super jaundiced babies look and act?  I agree with all of the above.  Find a new paediatrician.  

[Snowflower]

Thank you for the support, ladies! I saw a  IBCLC and she was helpful. He was getting about 2 1/2 oz at a feeding(early morning) so she recommended switch feeding, domperidon, feeding 10 times/24 hours and breast compressions. All things I am familiar with because my DD was also slow to gain. Though I didn't take the domperidon, just herbs. The medicine seems to be helping. I went in to the LC today for a weight check and he had gained almost 4 oz in 5 days...so a little better. She also would NOT write FTT on her paperwork and in fact crossed it out on the paper she faxed over to my Dr. That was nice. She said it was probably for insurance reasons, but she disagreed and wouldn't fib about it. I am waiting for my previous (awesome) Dr to call me and let me know when and where he will be practicing so that I can join that group. This Dr is not for me.

Asusan,  He has lots of wet and poopy diapers. The LC watched him nurse, but said nothing about any latch issues, so I assume he's doing good. He does not seem to have any issues like being uncomfortable in his tummy except when he needs to burp, then he obviously feels better when he does. He is a really happy guy when he is awake. He smiles and laughs and goo's and gaa's, he does the baby dance and will just hang out and look around...he's way more content than my first who was (and still is) pretty 'high needs'. Would getting more fats in my diet help? 'Cause I'll eat more if it will! Fats and iron and B vitamins are the hardest part of being a vegetarian. And if there is a food sensitivity that is making it difficult for him to absorb, where would I go to find this out?? A muscle testing kinisiologist?(sp?) for an infant? Should I take him to a Chiro that works on infants?

Alaura5, thank you for sharing your experience. I will pump once I get my supply up from the domperidon and give it to him as well. I also got one of those 'Milky's' things that catches the milk from the other side while nursing, 'cause I leak A LOT. It says I could get 1-4 oz's per feeding! He may just  be a little dude his whole life, my DH's entire family are all very small people. I  totally agree that FTT dx should not be thrown around lightly. There are parents that are dealing with that dx on a very real and serious level. It is not ok. 'Slow weight gain'  and 'FTT' are 2 VERY different diagnoses.

Allison, I know, Right?!! Why would she tell me this, like,' get him to gain almost a pound over the weekend, then I won't be so worried'  That sounds insane to me, and I am no Doctor. She even said to me that formula was 'the easy way'...like I care about 'easy' when it comes to my kids. ug. And is it really 'easier'? I think not. And he is not lethargic at all. Thanks for chiming in...hearing from a RN is also reassuring. 

I'm just gonna keep nursing a lot and taking my domperidon  I am keeping  a little journal and making sure he eats a full switch feed every 2-2/12 hrs, setting alarms at night, etc. Hopefully my supply will grow and just nursing on demand will do the trick. And getting out of this Dr's care ASAP. Thank you again...I do not know what I would do without you all.

Edited by Snowflower - 12/20/11 at 11:57pm

[Dietitian]

I think it is wonderful that you are breastfeeding your child and trying to give your baby the best nutrition possible. I also feel it's great that you are switching Dr's to someone you feel more comfortable with and someone who you feel will listen to you and not try to push you into something you do not agree with. I agree completely that your baby probably did not meet standard FTT guidelines... that was a quick "diagnosis"... so do NOT worry too much. 

However, I do want to point something out here. As great as it is that you are seeing a lactation consultant (they are WONDERFUL), seeing a Registered Dietitian would be very helpful for not only yourself but also for the health/nutrition for your baby. I noticed that a few people wrote comments that seeing a "nutritionist" would not be useful in this situation. That is actually NOT TRUE. Not only does it matter the method, sucking ability, amt of times fed, etc. it of course matters what you are putting into your body as well. This is where seeking help from a Registered Dietitian would benefit you greatly, which very often is overlooked as a great resource. There are ways through your diet to increase milk supply besides the techniques a lactation consultant can instruct you on. In fact there are some RD's who are also certified lactation consultants as well. This is definitely an area where there needs to be more RD jobs in Pediatric and OB/GYN offices. Nutrition really starts for your baby at the pre-conception stage, then of course during pregnancy, lactation and so on and so forth.

I just wanted to shed some light on an area that is dear to my heart. As I am one of the many registered dietitians out there trying to make a great difference in nutritional health in a world (or country) where good nutrition is lacking greatly. It is unfortunate that insurance companies do not cover many "preventative" services such as nutrition therapy, because MAYBE we wouldn't be in as big of a health crisis as we are today. It's time to be PROACTIVE and not REACTIVE. I wish you all the luck and happiness with your baby!!! 

[Dietitian]

I think it is wonderful that you are breastfeeding your child and trying to give your baby the best nutrition possible. I also feel it's great that you are switching Dr's to someone you feel more comfortable with and someone who you feel will listen to you and not try to push you into something you do not agree with. I agree completely that your baby probably did not meet standard FTT guidelines... that was a quick "diagnosis"... so do NOT worry too much. 

However, I do want to point something out here. As great as it is that you are seeing a lactation consultant (they are WONDERFUL), seeing a Registered Dietitian would be very helpful for not only yourself but also for the health/nutrition for your baby. I noticed that a few people wrote comments that seeing a "nutritionist" would not be useful in this situation. That is actually NOT TRUE. Not only does it matter the method, sucking ability, amt of times fed, etc. it of course matters what you are putting into your body as well. This is where seeking help from a Registered Dietitian would benefit you greatly, which very often is overlooked as a great resource. There are ways through your diet to increase milk supply besides the techniques a lactation consultant can instruct you on. In fact there are some RD's who are also certified lactation consultants as well. This is definitely an area where there needs to be more RD jobs in Pediatric and OB/GYN offices. Nutrition really starts for your baby at the pre-conception stage, then of course during pregnancy, lactation and so on and so forth.

I just wanted to shed some light on an area that is dear to my heart. As I am one of the many registered dietitians out there trying to make a great difference in nutritional health in a world (or country) where good nutrition is lacking greatly. It is unfortunate that insurance companies do not cover many "preventative" services such as nutrition therapy, because MAYBE we wouldn't be in as big of a health crisis as we are today. It's time to be PROACTIVE and not REACTIVE. I wish you all the luck and happiness with your baby!!! 

[Dietitian]

Another note.. I must have missed your last post. You asked..... "Would getting more fats in my diet help? 'Cause I'll eat more if it will! Fats and iron and B vitamins are the hardest part of being a vegetarian. And if there is a food sensitivity that is making it difficult for him to absorb, where would I go to find this out?? A muscle testing kinisiologist?(sp?) for an infant? Should I take him to a Chiro that works on infants?" This statement right here is EXACTLY why you seek a Registered Dietitian. This is exactly what we do!   I hope this helps!