What to tell ped?

[merrick]

I'm trying to decide how to handle dd's next ped appt. The last two times we've gone she has told me that I need to be nursing dd only every 3-4 hours. She says it's better for her and better for me. Ok, you know, I get how it could be better for me, but how the heck is it better for a hungry baby to wait to eat because of some arbitrary schedule?

The last couple of times I haven't really said anything. But I know she's going to bring it up again. I haven't decided if I'm just going to kind of smile and nod like I have before, or if I'm going to actually challenge her. I know what she's saying is wrong. I am not going to put my dd on a feeding schedule. She's only 3 months old now! The ped starting saying this at her 1 month checkup! And I hate the thought that she's giving this advice out to new impressionable moms who might not know how bad this advice is.

If I do challenge her on this, I'd want to have backup. So if anybody has any info on why scheduling is bad for young infants or advice on how to handle this situation I'd appreciate it.

[mothragirl]

bring in ANY literature on breastfeeding. a copy of the womanly art perhaps? i would switch peds too. maybe ask her why she thinks such a young baby needs so little food?

[<<>>]

yeah I'd switch peds too...
I get that it's not always an option and hopefully someone will have some good literature...

[firstkid4me]

Switch peds, I've tried bringing literature to show a doctor he was wrong (told me not to bf while dd had rotavirus because of the no dairy rule) and he just waved it away (with long, dirty fingernails.) Emily has to see him (he's the only other ped in the office, and our ped is out having a baby until December) for her 18 month check up, but I'm ready to ask him exactly how much of his 8 years of schooling was spent learning about breastfeeding. When he says none, I'll just wink and say, "Well, I have 18 months on you, so I'm not sure you're really prepared to be giving ME advice on this particular subject, now are you?"

[lacysmommy]

Originally Posted by merrick

The last two times we've gone she has told me that I need to be nursing dd only every 3-4 hours. She says it's better for her and better for me. Ok, you know, I get how it could be better for me, but how the heck is it better for a hungry baby to wait to eat because of some arbitrary schedule?

I think you brought up the perfect point to bring up with your ped already. You should start by asking her why it's better for the baby to wait. Tell her you eat when you're hungry, and sometimes that's more often than every 3-4 hours. So if you can't even wait that long between meals, how can a baby be expected to?

If you're not up for a debate on the day you see your ped, just ask her to explain her reasoning behind why it's better for the baby. Ask it in an innocent want-to-know kind of a way. Then when she gives her answer, don't say anything else, just smile and nod (unless you decide that you are up for a debate after all). If you feel like a confrontation will affect your child's care, you can simply drop it at that point with no harm done if you decide to keep her as your ped. You were just curious, after all! Or you can follow up with a letter or bring it up again at a later appointment.

[Momtwice]

My suggestion:

Give the pediatrician this statement from the American Academy of Pediatrics
http://ezzo.info/Aney/aapmediaalert.pdf

The (AAP) reaffirms its stance that the best feeding schedules are the one babies design themselves. Scheduled feedings designed by parents may put babies at risk for poor weight gain and dehydration.

And if she still argues, I would seriously consider complaining in writing to your insurance company (if applicable), to her partners, to the hospital she works with (And send them the statement or quote it)...once your records are safe at your new doctor's office.

This is from 1998 by the way!!!

[Susuhound]

OK your ped seriously neds some updated education. peter Hartmann is THE guru of breastfeeding reseach. see this paper...

http://www.biochem.biomedchem.uwa.ed...rrent_research

basically the time between feedings can ONLY be regulated by the individual mother and baby physiological pair.

Daly et al. (1993b) used the CBM system to measure the changes in breast volume of seven breastfeeding mothers over each breastfeed during a 24 h period. From these measurements they could determine the maximum and minimum volume of the breast over the 24 h period, the storage capacity of each breast (maximum-minimum breast volume), the degree of emptying of the breast, before and after each breastfeed, and the short-term rates of milk synthesis. They found that the storage capacity of the breasts ranged from 80 to 600 mL. The breast was not necessarily completely emptied at each breastfeed (Mother A; Fig. 8), indicating that the infants regulated their milk intake presumably according to their appetite. Daly et al. (1993b) suggested that the storage capacity of the breast influenced the frequency of breastfeeding. Compared to mother A, mother B had a much smaller storage capacity and her infant nursed more frequently. By more frequent breastfeeding this infant was able to obtain at least as much milk as the infant of mother A (956 vs 896 mL/24 h, respectively).

[numom499]

ACtually, its not even "better for you". Its "better" for a woman's health to breastfeed as much and as long as possible. It helps prevent things like breast cancer....

[Susuhound]

Oh yeah I was going to say - I think she means better for *her* as in if you fail at breastfeeding your baby will be sick more often and have more visits. i'm so cynical.

[Hayes]

How about the American Academy of Pediatrics POLICY STATEMENT on breastfeeding stating that bf babies should be fed ON DEMAND. Or their rebuttal of Ezzo's methods of scheduled feeding that has caused sick babies and even dead babies.

[katja]

Originally Posted by firstkid4me

I'm ready to ask him exactly how much of his 8 years of schooling was spent learning about breastfeeding. When he says none, I'll just wink and say, "Well, I have 18 months on you, so I'm not sure you're really prepared to be giving ME advice on this particular subject, now are you?"

So true, that.

[LoveChild421]

Originally Posted by Momtwice

My suggestion:

Give the pediatrician this statement from the American Academy of Pediatrics
http://ezzo.info/Aney/aapmediaalert.pdf

I agree- she can't argue with the official AAP statement! I think it's really important that you do challenge her- think of all the new moms who have no idea what to do and come to her for advice. Moms and their babies deserve accurate information.
I wonder how many of the moms who go to her decide they don't have "enough milk" and start formula because their babies are crying to be fed every hour or so. The whole "every 3-4 hours" line of thinking is very formula-centric- that may be how often most formula fed babies eat because formula is harder to digest but I've never in my life known a breastfed infant who only eats every 3-4 hours!

[doula mary]

There are a couple things you can do:

1. SWITCH DR's....he is not BF friendly and I doubt you will change his mind.

2. Nod, smile and lie (white)....don't tell him what you are doing. He is a Dr....trained in medicine not a parenting expert OR a breastfeeding expert. He is lucky if he had 1 hour lecture on breastfeeding in school.

3. Skip your well child checks..why pay someone money to tell you your baby is OK, meanwhile exposing them to germs!

Mary

[nakagain]

Isn't there a statement somewhere talking about how depending on each womens breast capacity determines how often a baby needs to nurse. For example..with my lower milk supply due to a thyroid condition my babies have to nurse ALL the time for a shorter amount of time verses my sister who has a ton of milk only nurses a few times a day for a long time...make sense? Every women is different so to set a time limit for breastfeeding makes NO sense whatsoever and is very dangerous.

[aisraeltax]

i think i would be confrontational on this one, b/c as you said, if he is giving this information out to new moms who may be more impressionable.
i think you said it was a she though...
i would simply take the statement to your new appt. and give it to her and say "im really concerned, b/c i KNOW that what you said was wrong...but other new moms may not, and i fear you may be giving BAD advice". but thats just ME and i can be a *itch sometimes (surprise! surprise!).

the nurse at my son's dr. (family pract.) is now trained not to ask me how much he eats or how frequent. after 7 months, we have drilled into her head that he is BF and ON DEMAND. the last visit (and yes, i just go for fun!) she just reitereated? bf? yes. still on demand? yes. the first, second and third visits were "how much is he eating" me: i dont know..we are bf'ing on demand. "how often"....me: i don't know...we are bf'ing on demand.
at his 6 mo. appt. he was 18.9, so he's getting enough.

good luck!

[Synchro246]

If you are like me and get a little nervous being confrontational you could simply say "Based on what research?" when s/he says to schedule feedings. If s/he stammers or comes up with some crap say "Oh I am familiar with a lot of research that says that babies should be fed on request- I'm more comfortable with this". You can also say that you are there for medical advice only.
If s/he continues to argue switch peds, and write a letter or two.

Laura

[sparklefairy]

Originally Posted by LoveChild421

I've never in my life known a breastfed infant who only eats every 3-4 hours!

I didn't until one of mine did. I was sure he was starving, but he just wouldn't nurse any more often and he was gaining fine. Then he outgrew it and nurse like a "normal" baby . That's also when his weight dropped off :

This doctor doesn't seem to realize that many babies do eventually reach a 3-4 hour pattern as they grow into it and that limits can be set with some older nurslings if that's what mom decides is best for mom and babe. It's like the assumption that only mom can comfort a breastfed babe but anyone will do if mom's not breastfeeding.

[elanorh]

I'd bring information (print-outs of the AAP pdfs linked above, stuff from Kellymom (which also has citations at the end, of studies etc.), and if you bring your stack of bf books with the pages about scheduled vs. on-demand feedings, mark the pertinent pages on those with post-its (and don't lend them to her, although you could give her a list of books to read in her "spare time.").

Give her the hand-outs, and tell her that you're concerned about her "3-4 hour" recommendation and that while you know she means well, she could inadvertantly be undermining a mother who is less informed about bf and how it works than you are. That since you know she takes pride in practicing sound medicine, you thought she'd appreciate this information so that in the future, the information she gives to new moms is accurate and supportive of bf, which after all is the preferred feeding method for infants per the AAP and etc. [In other words, stroke ego and be "positive" about her as much as possible while still getting the information to her]. If she feels attacked, you'll just be a "bf zealot who doesn't know what's good for her," and she'll ignore you (I'm guessing).

[If there's an LLL group where you are, maybe they do "sponsorships" for docs to attend lactation conferences? If they do, you could even suggest that as more continuing ed for her, since "it's something which you as a doctor are definitely concerned about."]

If she tries to argue with the information you present, tell her *right then* that you want your files, and you're switching to a new ped because you will not continue to work with someone who will ignore their own professional organization's guidelines so blatantly. Don't leave the office 'til your files are in hand.

It could get ugly - but honestly, I think it's worth it if it might cause her to give better bf information/support to other clients. I know a lot of moms just do the "mmm-hmmmm, yes, we're sleeping through/giving solids too early/CIO/etc." response to their Peds. And I think it's a disservice to their child, to other clients, and even to the Ped. When the Ped looks at the healthy, happy child who s/he thinks is the result (in part) of his/her abysmal advice --- how can s/he learn to question that advice?? Except to hear that, actually, we're just fine without CIO, baby is still bf at 23 months, etc. I understand that sometimes it's what the parents need to do, but if it's possible to rock the boat a bit, there might be some good outcomes.

(This is all easy for me to say, since I've got a relatively AP Ped, who's never talked about CIO with us, or scheduled feedings, or when to wean - she was very positive about us bf through the second year of Ina's life and really hasn't been negative at all).

[merrick]

Thanks everyone!This all just came out of left field and I was not ready for it! I actually switched to her from a ped that was woefully ignorant about breastfeeding. I was told that she was very bf friendly and good with kids. At our first visits she was great! Very supportive of bf. Talked about not giving pacifiers or supplements and to bf on demand. She also bf her own kids, although I don't know for how long. She didn't even bat an eye when I told her ds still nursed. Then all of a sudden it was this 3-4 hour stuff!

I still have a few weeks until our next appointment. I think what I'll do is when she asks me how often dd nurses, I'll just tell her I nurse her whenever she's hungry. Then if she tsk tsks me again about the schedule thing I'll whip out the info. Maybe she'll read it and change her advice. Maybe not.

I would switch peds, but to be honest this is the third ped I've been to and I don't think I can find one that'll be any better. The first was not very supportive of ebf and every single visit told me that ds should be sleeping in his own bed. They were also always concerned about ds's weight and didn't have very good bedside manner. The second knew pretty much nothing about bf (the whole ebf is only for third world countries type thing and ds HAS to have whole milk) and was very alarmist. Every time I left his office I was worried about some awful condition ds might have. This guy mentioned a concern about cystic fibrosis just because ds is thin and has problems with constipation. Despite the fact that he's never had any kind of respiratory problem besides a mild cold! SO basically this ped is the best of the bunch so far and I've had no problems with her except for the bf schedule thing.

[Ammaarah]

I would be honest...you feed on demand. If she gives you any crap, just say you are a firm believer in "If it ain't broke, don't fix it." And if you do decide to switch pedis, maybe you could get a recommendation for one in your Tribal Area here or at La Leche League.