Getting Some Pressure from Dr to Suppliment- Long, Sorry

[sunflowers]

I'm starting to second guess myself in my decision to not supplement with formula.
The background: my dd was a preemie with all of the preemie issues. She spent a considerable time in the NICU on TPN (IV nutrition) and had issues with anemia of prematurity which required several blood transfusions. I pumped for her until we could learn to nurse, which thankfully happened after 4 months. I thought everything was fine after that until she was diagnosed with anemia again at 9mos old. She was just starting solids but not doing well with them. She went on a theraputic dose of iron and at her last appointment her hemoglobin was back to normal (2 months of iron suppl.). Good news- except now the Drs are starting to hassle me about her weight. She is 14lbs at 11.5mos old. I feel this is OK since she weighed 2lb4oz at birth and is roughly 6x her birth weight but they want her to be "on the charts" at 1 year old (I'm only 107lbs myself so genetics play a part here, too). To be in the 3rd% on the standard growth chart she'd have to weigh about 17lbs for her actual age or 15lbs for her adjusted age. She's really not too far off but she hasn't gained anything in the past month.

The Dr (hematologist) suggested I suppliment 2 feedings/day with formula for gain. She thinks my supply may be low. I resisted her and she said that when I wean to cow's milk she'll really fall behind(!?). Plus the iron issue will still be present to some degree probably for the rest of her life. She stressed the whole cow milk and anemia connection. I got a referral to a nutritionist and the appt is in December but now I'm getting worried. Am I right- or at least OK- in refusing to give formula in addition to BM? Would it be beneficial for me to see a LC? I just need a little feedback to see if I'm way off base.

[thefragile7393]

Originally Posted by sunflowers

The Dr (hematologist) suggested I suppliment 2 feedings/day with formula for gain. She thinks my supply may be low. I resisted her and she said that when I wean to cow's milk she'll really fall behind(!?). Plus the iron issue will still be present to some degree probably for the rest of her life. She stressed the whole cow milk and anemia connection. I got a referral to a nutritionist and the appt is in December but now I'm getting worried. Am I right- or at least OK- in refusing to give formula in addition to BM? Would it be beneficial for me to see a LC? I just need a little feedback to see if I'm way off base.

LC. LC for sure. I can't give anything on your situation, but definitely see an LC. A hematologist does NOT know anything about bf'ing. And I love the assumption that you WILL wean to cow's milk....not every child drink's cow's milk! Definitely see an IBCLC....and I'm sure someone else will come along with some great words.

[timneh_mom]

Oh yes, please do see an LC. It sounds like you have really been through so much with your little one... SO many doctors are just not educated enough to really give you good breastfeeding advice. Keep in mind that the iron in your milk is more readily absorbed than in formula, AND, I believe your milk also has more calories. And for the hematologist to even assume you will "wean" her to cow's milk!! Why not suggest you keep nursing as long as possible, since it's so good for preemies?

I would talk to a good LC, determine whether you have low supply. If you need to supplement, you can always supplement with your own milk. I have even heard of moms pumping, letting the milk settle, and scraping off the cream and supplementing with that!

take care mama...

[sunflowers]

Originally Posted by timneh_mom

Oh yes, please do see an LC. It sounds like you have really been through so much with your little one... SO many doctors are just not educated enough to really give you good breastfeeding advice. Keep in mind that the iron in your milk is more readily absorbed than in formula, AND, I believe your milk also has more calories. And for the hematologist to even assume you will "wean" her to cow's milk!! Why not suggest you keep nursing as long as possible, since it's so good for preemies?

I would talk to a good LC, determine whether you have low supply. If you need to supplement, you can always supplement with your own milk. I have even heard of moms pumping, letting the milk settle, and scraping off the cream and supplementing with that!

take care mama...

It really has been a hard road for us nursing. While still in the NICU, the doctor wanted to start adding HMF (human milk fortifier) to her BM. She already had a perforated colon so I was afraid the HMF would lend even a greater risk to the possibility of NEC so I refused it. I suggested to use hindmilk feedings for more calories. She never heard of that (or the connection between formula/HMF and NEC in preemies, either) but she agreed and it seemed to work. It's a good idea that I'd forgotten about, Thanks! I'll contact the LLL here for a referral to a LC to address the supply issue. I don't think I have a low supply but I'm not a LC and it's my 1st time nursing so what do I really know, right? Thanks for the responses. I know it's kinda outside the "normal" challenge.

[laohaire]

Our LC made ALL the difference to us. I hope you have a similar experience (unfortunately there are some lousy ones out there... but the minority!). Unless you have low supply I don't see any possible need for you to supplement. Wishing you the best of luck.

[2 in August]

I also was pressured to use formula. I am, but hate it and don't give him much at all. It took 4 tries and lots of tummy problems to even find a formula that worked for him. If you read through the thread I started wwyd? supplementing, there is a lot of good advice. I am trying to up my supply so I can stop the formula. It can be a slippery slope and some babies, like my 5yo dd once she got a bottle never really nursed well. Go with your instincts. I know that even though my 8wk old is only 7lb 7oz he is healthy and developing normally. It's been hard with the dr being on me about him not gaining enough weight, but I know he's ok. That's why I'm not pumping him full of formula to the detriment of his nursing.

www.drjaygordon.com/development/bf/scales.asp

Somebody posted this link for me and it really put my mind at ease.

Hang in there and trust your instincts!

[violet]

Dr's assume low supply for any apparent growth chart issues. But the growth charts were made for full term formula fed babies. check out the WHO site on the new growth charts recently developed that take into account ethnicity and feeding method. www.who.int/childgrowth/standards/en/

Babies don't grow at a steady rate - more like a climbing stairstep. So she may be at a plateau between two appointments, then gain. And yes, your genetics should be taken into account. My babies are big at birth then start dropping off the charts. But they are proportional, active, and developing. More important than steady chart gain is her developmental signs - which as a premie are usually adjusted as well. Don't they see 12 months as some sort of milestone for premies - they want them to be "caught up" with full terms. Isn't that rather arbitrary???

what do you think? Do you feel like she is satisfied at the breast? Is she relaxed or fussy? Is she active and learning new things?

As for supplementing -- breastmilk has the most readily absorbable iron. Formula is no where near as good at providing iron. Have you had your iron checked? Keep yours up and your milk will have enough.

At almost a year, is she nursing less at night? That can be another way to up the calories -- wake up and feed again at night. Those early morning hours are the best for increasing milk supply because your hormones are optimal.

If the dr keeps pressuring you, before you agree to supplement, go for a middle ground. Such as -- "how about we see an LC and I promise to add 2 nursing feedings a day and have another weight check in 2 weeks and go from there?" And at that age, consider supplementing by another method, not a bottle.


best wishes and happy nursing
violet

[sweetpeasmom]

Definitley a LC.
Sounds like she's doing well weight wise. My dd was also a preemie and she gained very slowly, she was actually never even one the charts, she was that far behind. I never once got pressured to supplement. She was healthy, growing (albeit slowly but still growing) I'm trying to remember what my dd's weight was around that time and I think it was between 10-12 pds.

[sunflowers]

Thanks, everyone!

It would be impossible to go into all of the problems we've had IRT dd's delays and medical issues. So many things have been a problem during the past year and I really think nursing was one of our challenges that were successfully overcome! She has been on an amazing developmental "spurt" recently, too! She began to sit unassisted, crawl, eat finger food, pulling to stand, and babbling! All of that in less than a month. It's really pretty remarkable since so many medical professionals were doubting she'd ever be able to do some of those things. The terms "global physical and mental delay" was tossed around after a particularly devasting MRI. Which is the primary reason I'm trying not to take the Dr's admonations to heart. That, and also we have had growth lags in the past. I try to look at her growth over several months instead of just several weeks. She has consistantly stayed on the same "curve" since she was born. It's just not on the standard growth chart! She certainly doesn't look malnourished and is happy and alert. And according to the WHO tables that Violet linked, she's a little over the 3rd % for her adjusted age.

We actually have recently been on a sort of daytime "nursing strike". She'll nurse several times per night but during the day she's not very interested except when she 1st awakes in the am, at naptimes, and before bed. That's 4x per day, one breast only. I've been offering her the other breast when she's done the 1st side but she's not taking it. Just is satisfied with 1. I'm calling my LLL leader today to get a referral for LC with some preemie experience.

And if I did supplement, it would have to be a cup. She won't take a bottle and hasn't for almost 6 mos! Once we were nursing at the breast only, she started to refuse all bottles. Now when she's offered one she chokes and gags- I don't press the issue because I'm fine with nursing her. No need for unnecessary stress, IMO. She's been through enough!

[laohaire]

Originally Posted by sunflowers

She has been on an amazing developmental "spurt" recently, too! She began to sit unassisted, crawl, eat finger food, pulling to stand, and babbling! All of that in less than a month. It's really pretty remarkable since so many medical professionals were doubting she'd ever be able to do some of those things.

CONGRATULATIONS! That's terrific!

I don't know anything about your baby or what you guys have been through, so I might be off base here, but I think professionals are way to quick to label delays that way. People are different, and your baby has obviously been through so much.

I'm not saying that professionals shouldn't call attention to a "concern" (I think they should) but it seems like they did a whole lot more than that, and it was a little early to be so definitive to you.

For the record, my 13 month old doesn't crawl or pull to stand or eat, and I'm satisfied that she's fine (she's been sitting unassisted since 8 months and babbling since forever, though). She was evaluated by Early Intervention last week, too, and while she did score as delayed in gross motor skills, neither of the two evaluators were convinced there was a real problem; they seemed to feel she was just setting her own pace.

So I wonder if that perspective will help. Mine also just yesterday seemed to go through some leap, she did about 3 new things yesterday and improved how she did other things too. So maybe yours will just grow and develop in spurts like that!

[birthgreeter]

Originally Posted by violet

Dr's assume low supply for any apparent growth chart issues. But the growth charts were made for full term formula fed babies. check out the WHO site on the new growth charts recently developed that take into account ethnicity and feeding method. www.who.int/childgrowth/standards/en/

Yes!!! I so agree!!!