undernourished babe?

[Missy]

Hi everyone!

You all were such a great support when we first learned about ds' allergies and the ped. subsequent recommendation to wean. We stuck it out, ds is, in comparison to two mos ago, relatively clear. His eczema is activated almost daily by the cold, but nothing like it was in November.

We saw a different ped. today than that woman we saw in Nov. He agreed that breastmilk is the best choice and that we should indeed put off vaxes indefinitely. (I do believe that the initial break out was the result of his first round of vaxes in August--he broke out within two weeks and got steadily worse until our blow out in Nov.) Now the problem is weight gain; he hasn't gained anything since September. He is, at 7 mos., active, happy, social, sitting up briefly without assistance, rolling over, playing with us, talking with us. But he needs more calories. The ped. is asking me to pump 25 oz/day before nursing so that we know how much his little body is getting. He agreed that perhaps much of his fluid is going to moisturize his skin.

I'm not sure exactly what I'm asking, except--help? I want my little guy to be healthy!

Thanks!

Missy

[mom3]

Since it sounds like everything else is on track. He may just be a slow gainer. Some babies are. One of my twins had only an 11oz weight gain over a 10 week period (from 6 to 8.5 mos) but he still grew 1.5 inches. His brother gained 1.5 pounds over the same period and grew 2 inches. Is your son getting longer, just not fatter? I wouldn't worry too much about the weight gain as long as all the developmental areas are fine. Each babe is their own individual self.

[DaryLLL]

Your ped is asking you to pump out 25 oz in one day? And then what, give it to your baby by another feeding device? And tell him, the ped, if you can indeed get those 25 oz out? I am assuming he thinks the baby needs at least 25 oz/24hrs to grow 'fast enough?"

So are you going to try this, do you think it makes sense? I see a couple problems with it.

First of all, what kind of pump would you be using and have you pumped before? It can take time to learn to let down to a pump. And you need a really good one, like a rental Medela, for all that pumping in one day.

The pump will never be as efficient as a baby at getting the milk out. Your baby may get many oz. more in the course of a day than you can pump.

Next, what will your baby think? If he is used to nursing many times a day, won't he get upset at not being allowed to one day? What kind of device will you use to feed the pumped milk? Ask any going back to work mom how difficult it sometimes is to find a way to feed expressed breastmilk. A bottle may not be a good choice, as it could confuse the baby after even one feed. Some babies won't accept EBM from mom at all, but need another caretaker to give it to them.

Now, I would suggest this. What are your baby's diaper outputs like? Does he soak 6-8 cloth dipes a day? Does he poop every day or so, or if he goes longer, is it copious when he does go?

Is it really true that a baby with eczema will soak all his fluids up into his skin? Is there research to prove this, or is it your dr's theory? Does he seem dehydrated in other ways? No tears, sunken eyes or the like?

If he really is dehydrated, or not getting enough to eat, would yr doc agree to you just offering to nurse him more, rather than go thru the rigamorole of all that pumping? You can offer every hour, you know. Or more often, if the session was very short. Do you co-sleep , so he has access to the breast all night? many babies this age are distractable during the day, and nurse better in the night. this is called reverse cycling. It is normal.

(Do you use humidifiers in the house, if you are in a cold climate?)

Your doctor was not given any, repeat, any training in human lactation or infant nutrition in med school. He is going by the seat of his pants, quite likely. He is used to moms with 7 mo's giving artificial baby milk, which can be measured going in, and would like to make you resemble them.

I suggest you see a IBCLC (and experienced ) LC.

[Missy]

whoops!

Sorry for the double post.

[Missy]

Thanks, DaryLLL and mom3--

DaryLLL, You described much of my own confusion. Yes, my son soaks at least 6 diapers and poops, if not every day, every other and, if he goes any longer, soaks everything in sight. His eyes show no sign of dehydration and malnourishment; my sister was astounded when I told her because of how bright and alert and healthy his eyes looked. His upper arms and legs, however, do look pitifully small. But, he was a very sick baby in November (thanks in no small part to the first pediatrician) and I just thought it would take some time for his body to catch up.

I do, unfortunately, have experience pumping. I was teaching half-time when my dd (now 7 yrs) was a baby and full-time for a few months with ds1 (now 3 yrs). I used a medela and had moderate success, particularly with ds1. I left work to be with my kids and was really excited that I wouldn't have to pump this time. My pump is not quite medela quality; it's an obscure electric, hand-controlled pump that works surprisingly well. But, the idea of pumping 25 oz. is overwhelming. What I did yesterday was pump, give him the bottle and then nurse immediately afterwards to ensure that he's getting the hindmilk. In November, I briefly followed the first ped's advise to pump for a week and use alimentum (formula) while he cleared up--I didn't last the week; I had too many concerns about the formula which my allergist later confirmed and I was worried about compromising my supply and his health. Ds2 will take the bottle but he's not thrilled. He does cosleep and nurse for much of the night, but recently I think he's doing more teething than eating.

I would be happy to start nursing every hour, if necessary. The dr. didn't like that suggestion. The babe weighs less than 12 pounds and I know he should have gained something in four months. My mom said the same thing you said--if he were truly dehydrated and malnourished, he would be in the hospital. He would also be sick--he has never gotten even a cold. All of his health problems have been from allergies and eczema.

I did bring this up at a few LLL meetings and no one had any experience or ideas with such severe reactions. We are going to see the allergist on Saturday (great dr.) and I will ask for the name of a lactation specialist.

Any further suggestions are welcome!!

Missy

[DaryLLL]

Sounds like you are making progress. Why pump, and bottle feed the EBM, then nurse? Even if your dr doesn't like the idea of nursing every hour, any exped bf counsleor (like me or an IBCLC lac consultant) will tell you that is the best way to build up your supply, if necc.

Since his diaper output is great, and he is healthy, and alert, and meeting devel milestones, sounds like you are on the right rack. I wasn't familiar with his history of illness, and allergies, both of which can contribute to slow weight gain. I have a close friend whose baby is allergic to 140 foods, and she has always been small. (now that she is 2, her allergies are lessening, just FYI).

If he is distractable when nursing, try to nurse in a quiet dark room. If he is a thumb sucker, or having pacifiers, offer the breast instead, whenever he seems to want to suck.

Good luck, stay strong, and your dr sounds very ill-informed!

[Nitenites]

Okay, I'm a little confused - does your ped want you to boost your supply, or does he want to measure how much your ds is getting? If your ped wants to know how much your ds is getting in a 24 hour period, how about renting a digital scale and weighing your baby before and after feedings? Is this a possibility? It seems like if your child is showing no other signs of dehydration or illness, and the only concern is measuring intake, then the most logical course of action would be to measure intake, not your output with a pump. . It doesn't seem to me that pumping would accurately reflect how much your ds was eating, but would instead just reflect how much you could pump, which doesn't mean anything!

[JessicaS]

Your Ped sounds very enthusiastic...

All babies gain differently and grow differently. My dd weighed the same at one as my neice did at 3..and my neice is super healthy, she is just small. Are you or your dh of smaller stature?? I think this is just genes...

[Piglet68]

I just wanted to add my support and agree completely with DaryLLL. It simply doesn't make any sense to try to pump that much rather than having your baby nurse, just so the doctor knows how much he gets??? Good lord, who CARES how much he is eating, it's his HEALTH that matters. This whole obsession with ounces per feed drives me CRAZY. This mindset is a product of FORMULA FEEDING and really irrelevant to a BFing mom.

I can't understand why your ped would "not be happy" with you nursing every hour. Doesn't he want your son to get more milk? Is it HIS breast the child will be latched onto? What the h*ck is his problem??

Sorry, things like this drive me NUTS. I can't believe what STUPID advice doctors give women. They are so ignorant about BFing it is downright scary.

Your baby sounds totally healthy, fine, just small. YOU as his mother will know when something is wrong. Just nurse, nurse, nurse is my advice. You poor woman, sounds like you've already been through enough!

(sorry to sound angry but stuff like this just really irks me!!)

[Irishmommy]

Is it even possible to pump 25 oz in a day? I've never been able to pump more than 2!!

I like everyone else's suggestions. The only thing I can think to add, is to find another ped. Third time's a charm and all that!!

[Momtwice]

I agree that DaryLLL is giving EXCELLENT advice.

I agree with the advice to nurse very often.

I agree that American pediatricians are not trained in breastfeeding. There are articles at the American Academy of Pediatrics that confirm this.

A pediatrician who is not happy with you nursing every hour KNOWS NOTHING ABOUT BREASTFEEDING and his advice to pump 25 ounces a day (!!!) when you are RIGHT THERE TO FEED THE BABY confirms my opinion of him. There may be a place for pumping and supplementing, with the help of an IBCLC, but nursing more often could be just as good if not better.

I agree to see an IBCLC for advice (a board certified lactation consultant.) These initials indicate a trained, board certified professional with extensive training in breastfeeding support.
I would recommend a second opinion from a better pediatrician.

What courses in breastfeeding support has this doctor taken? If he has children were they breastfed and for how long? The answers to these questions tell you the value of his advice.

My dd nursed every hour or so at that age, and nursed often at night (we coslept.) I agree that some babies are easily distracted and need to be reminded to breastfeed.

[chellemarie]

I have to agree with Daryl, as well.

25oz in a day!? If he were suggesting you pump enough to give a couple ounces via syringe at each feeding (tubie and boobie), it *might* make more sense.

Call up your LLL folks and see who they doctor with. Interview the doc and make sure you're on the same page...or at least in the same section of the library.

If his eyes aren't sunken, skin isn't loose and he's peeing and pooping, he's got to be fine.

If your ped disagrees...ask him if he knows even ONE adult who can pack away the food and not gain weight while everyone around him gets fatter just watching that guy eat. We ALL know at least one person like that, don't we? Can't babies be the same way?

[beckylou]

ask him if he knows even ONE adult who can pack away the food and not gain weight while everyone around him gets fatter just watching that guy eat.

No kidding!

Pumped every day at work with first ds and got real good at letting down for the pump. A good day yeilded 19oz or so. Became a SAHM with second ds. In the 21 mo I nursed him, I could never pump more than 3oz a day.

Pump 25 oz. . .That's just crazy!

My 2nd ds was a slow gainer, too. He dropped to 2% at his 1 year check. I knew he was getting exactly what he needed from me, but I still felt guilty.

Finding a doc through your LLL sounds like a good idea. At least you'll know he/she is knowledgable about bf. Hang in there, Missy!

[Qtopia]

missy, you've gotten a lot of great advice! as i am going through a similiar situation with my ds re: weight gain, i wanted to share what i've learned so far.

1) you've heard this already but it bears repeating: most doctors know SQUAT about bfing. take EVERYTHING they say about it with a HUGE grain of salt. the vast majority are NOT experts and any 'advice' they give you is really just an OPINION (and usually an ill-informed one at that). the stupid scale is NOT the most important measure of wellness, despite what the docs want you to think.

2) not all IBCLCs are created equal. i know that many people here rec. that you talk to one, but i must say that i have not been impressed with the 2 that i have talked to. the 1st IBCLC agreed with the doc that i should supplement w/ formula and did not EVEN ONCE suggest that i increase nursing sessions, look into herbs and/or prescriptions to increase milk supply, or even say that if i did supplement, i should use a SNS. so i ignored her advice and found another IBCLC. i saw this one in person, asked her to check the latch etc. she 'checked' the latch by sitting 3 feet away and looking while i bf'd and pronounced that it was fine and that i should supplement with formula. again, no mention of increasing nursing sessions, reglan, domperidone, or SNS. so the lesson here is, even having the int'l bd. cert. does not ensure that you are getting good bfing advice.

3) THE ONLY EXPERT ON YOUR BABY IS YOU! don't be afraid to trust your gut, as many of the ladies here have suggested. i think too often we moms look to 'experts' to tell us if our babies are doing well, when in fact our hearts usually KNOW whether our babies are well or not. if you need medical advice to back up your own observations about your baby's health, dr. jay gordon (www.drjaygordon.com) and dr. jack newman (he has a website, too, i'm sorry i don't have the address in front of me) both go by the mantra "look at the baby, not the scale". they might be good sources for you to mention to any peds you talk to.

i know it is hard to ignore the 'numbers' but trust your heart.

good luck!
QM

[DaryLLL]

beckylou--

to clear up a bit of confusion, missy's dr wants her to not nurse at all in one day, and pump out everything instead. So, obviously, she may well be able to get out 25 oz, or more or less. If you could pump 19 oz while separated from your baby, it's the same thing.

When you are nursing all day, you may not be able to pump anything extra out. Your body is making exactly the amt of milk the baby requires. If you pump at the same time every day for a few days to a week, you will trick your body into thinking of it as a growth spurt, and it will start making that extra.

[Missy]

I hardly know how to say thank you. Sometimes when I'm frantic with worry, I miss what should be obvious or I start doubting my instincts. You all really kept me focused.

Of course, at this rate, I'll be completely out of pediatric care options.

We're not going back for our Monday follow-up. The allergist told us today that our baby does indeed need time to recover; he has been through a lot and sometimes the body needs more time to heal. He also needs more protein to replace that lost to his severe eczema. He suggested that we contact both a nutritionist and a lactation consultant and that I increase my intake of protein and nurse more frequently. Yes, the weight is a concern BUT my baby is developing within a normal rage and seems to have a very strong immune system. We're doing something right.

Seems like you all know a heckuva lot more than my pediatricians.

Thank you again!

Missy

[Jish]

Becky, I know what you mean. I didn't pump regularly since I was a sahm and there was no way that I could pump 25 oz in a day if I had needed to. My babes could surely get that much from me, but if your body isn't used to using a pump it would be really tough to pump the same amount that your babe would consume. It would have taken me a week to get 25 ounces: I understand the doctor wanting to know just how much the baby is consuming in a day but expecting a mom who is not used to pumping that much to be able to do so is unrealistic. It would be so much easier if our boobs had ounce markers.

[Missy]

The pediatrician called social services after we cancelled our appt!!!

We saw the allergist (who is also a pediatrician) on Saturday and decided to follow his recommendations, including seeking the advice of people trained in the dietary needs of an infant with allergies and were considering a new pediatrician, so we cancelled Monday's weigh-in. I spent Monday making calls to the specialists and on Monday evening the ped called and went ballistic when I explained that we were going to follow-up with specialists who had experience with Sterling's situation. He hung up on me and called the allergist. The allergist (who is the most soft-spoken, gentle man--think Mr. Rogers, only more so) said the man was on a tirade and that he appears to have an ego problem. I got a recommendation for a good ped and called her on Tuesday morning and got an appt for this Thursday. I went to pick up my daughter from school and, when we came home, there was a card from a social worker. Meanwhile, my husband was at work calling our now former ped and learning that he reported us as being neglegent parents and starving our baby. He asserted that he knew what was best for our son, not these specialists, and for some reason he was really disturbed that the allergist's letterhead listed him as an adult and pediatric allergist and pediatrician. He was insulted that we had sought help from another pediatrician! My husband also learned that the ped. expected our son to have gained 5 lbs!!! 5 lbs in 4 days!!! The allergist learned that, if our son hadn't gained sufficiently (5 lbs), we were going to be ambushed. Our son was going to be put on formula and sent to the hospital for tests. The man has lost his mind! He wants to play god with our baby. He wants to be the one to save this little boy and we disrupted his first plan and now he's on plan B. We haven't yet spoken to the social worker; we left a message on her voice mail with the phone numbers of our allergist and new pediatrician so she can call and confirm that we're following up with appropriate care and, if she does her job, it should end there. But I am seriously freaked out. This is my baby!

Help!
Missy

[Lucky Charm]

Missy,
i would freak out too. social services scares the hell out of me. they can make your life miserable. hopefully, the names of the follow up pediatricians and a visit will be it.

will they come to your house? do some sort of visit? I would be scrubbing the floors, a complete nut case.

i read through the posts after finding your new thread on page 1. Is your 7 month old babe really 12 pounds? how much was he at birth? 12 sounds kinda tiny, especially at his age. but, like you said he is healthy and happy. you are nursing well with adequate supply. i am just curious as to why a mom with good supply, time to nurse has a baby thats 12 pounds.

good luck and try to calm down. i know easy for me to say, a million miles away in cyberspace. stay focused.

[Moon]

Wow, Missy, I am so sorry you are having to go through this, and I will be keeping your family in my thoughts.

I live in NoVa, too, and if you don't feel funky about it, I'd love to know (in pm) what ped this is so I can avoid him like the plague!

Cheers,

Moon