Not enough calories in my milk!?

[Shahbazin]

Is it even possible for someone to have "not enough calories" in their milk?!

Background: I've been fighting with weight gain issues with my 2nd DD since she was diagnosed with severe reflux at 8 weeks (Sept.). We put her on Prilosec, she started gaining 1/2 oz/day (compared to 1 oz/week), then, a month later, we lost our home in the wildfires in Oct.- can you say stress) & moved in with my DH's parents. This caused another plateau- she went back to 1/2 oz/day gain for a while, but then was dropping off again by Thanksgiving - saw an LC, rented a hospital grade pump, tried fenugreek/blessed thistle. Mild improvement, then dropping off again by Christmas (I've quit fenugreek - makes me throw up) - supplemented after nursing with milk based formula for 6 days (I figure she's 5 months, formula's sort of like early solids at this point), got good gain (& eczema), went to soy based supplementing for 3 weeks - no gain at all (& very little soy consumed, despite frequent offers - I figured she was full, I guesss she just didn't like it). Pediatrician freaks out at this at 6 month check, I'm not happy either - bloodwork tests done then show all is normal, & trial period of putting on formula (lactose free) over weekend (I'm pumping, & doing 1 late night nursing) results in weight gain.

OK - DD was 12 lb 3 oz Fri AM, & 12 lb 10 oz Mon PM (immediately after taking a 4 oz bottle of pumped milk) - we were doing a trial of 2 1/2 days formula, 2 1/2 days pumped milk (switched oved Mon. AM) - weight at a LC appt Tues AM was 12 lbs 8 oz, weight Wed AM at pediatrician was 12 lbs 9 oz. It seems to me, the kid was gaining 1 oz/day, no? And is thus is up 6 oz, & this is good. The extra oz Mon were just stomach contents. According to the Dr, no. See, according to her, DD lost weight from Mom-Wed, so obviously, my breastmilk is defective ("doesn't have enough calories"), & I need to switch entirely to formula, or at least dump formula in bottled milk to "fortify" it.

Granted, we are having some supply problems here - "lazy nurser" (very short sessions, rather spaced out, doesn't stay on if not getting as much - sort of "oh well, full enough" attitude) was the verdict, tied in with the reflux issues - not enough demand = not enough supply, so I'm glad this was identified, because even though she has weight issues, DD looks/acts great & makes a good # of wet dipes (if few poopies). I'm pumping seriously now, & have ordered some domperidone. (She's taking 23-27 oz/day, plus the 1 night feed, & I'm producing 14-17 oz, pumped.) But, what's with all this pressure to use formula? I mean, I feel really bad that I evidentally was depriving my kid of food, but as long as she's getting enough volume, my milk itself should be OK, right?

[thixle]

She sounds like she is gaining beautifully now
Try not to be so bothered by a doc that can't do simple math. (um, she just ATE 4 oz before she was weighed!)

What is the LC saying? Because it sounds to me like you are doing incredible! An oz a day is in the upper range of normal- and I applaud you for continuing to nurse through everything else that you have gone through

so obviously, my breastmilk is defective ("doesn't have enough calories"), & I need to switch entirely to formula, or at least dump formula in bottled milk to "fortify" it.

the calorie content of milk is different for everyone, at different times of the day, night, and nursing relationship... and mixing the two together-- what? Why would you want to make your milk taste like formula? So the babe will only want the super-sweet formula?

I think peds use the "doesn't have enough calories" line to make the parent feel less guilty. *because of a biological process beyond my control, I can now give up and feed my child formula- and others will be able to feed the baby, and my concious will be clear because I cannot do anything other than give formula*... it can go the other way, too. I had an old pro-bf doctor that told me my bm had more calories-- it made me feel good at the time, but has no real scientific basis. I mean, come on, they aren't testing for calories, are they? My DD was gaining slow, nursing often, what prompted him to say i had more calories? Wouldn't I have a fat baby that only nursed every 4 hours

But, what's with all this pressure to use formula? I mean, I feel really bad that I evidentally was depriving my kid of food, but as long as she's getting enough volume, my milk itself should be OK, right?

You have never been depriving your child of food. You have been going out of your way to provide your child with the best possible nutrition during some very rough personal transitions and your DD has had a hard time as well (tummy pains suck). I am very, very proud of you.

It really does sound like your milk is enough. I would wait a couple days and weigh again. Just keep in mind that if it's not the same scale, same conditions, it can skew the results quite a bit.

[leasmom1]

Same story!

My pediatrician said the same thing to me! My daughters weight gain slowed down a lot around 4-5 months. She gained only a few ounces between her 4th and 5th month. The pediatrician said that because I am a vegetarian I do not have enough fat in my breastmilk. She further stated that almost all of the vegetarian moms she worked with had the same problem. She suggested eating fish 3-4 times per weekand lots of avocados. I was also taking flax seed oil. It seemed to help, but I'm not sure if it REALLY did. At the same time we added a supplement 1x per day.
It sounds like you are doing everything you can! Hang in there!

[alegna]

I have never found, in all my reading on breastfeeding, reports of truly "sub-standard" milk.

Supply issues sure. And to the OP I would get rid of the bottles and work on your supply.

Metabolic issues in baby. Yes.

Reflux, allergies, etc.

But actual deficiencies in a mom's milk? Unheard of.

-Angela

[Little Bear's Mama]

Originally Posted by Shahbazin

Is it even possible for someone to have "not enough calories" in their milk?!

No. But, it possible for a baby not to take in enough calories (not suckling effectively, not suckling long enough, not nursing frequently enough, too long between feeds, ect).

Originally Posted by Shahbazin

Background: I've been fighting with weight gain issues with my 2nd DD since she was diagnosed with severe reflux at 8 weeks (Sept.). We put her on Prilosec, she started gaining 1/2 oz/day (compared to 1 oz/week), then, a month later, we lost our home in the wildfires in Oct.- can you say stress) & moved in with my DH's parents. This caused another plateau- she went back to 1/2 oz/day gain for a while, but then was dropping off again by Thanksgiving - saw an LC, rented a hospital grade pump, tried fenugreek/blessed thistle. Mild improvement, then dropping off again by Christmas (I've quit fenugreek - makes me throw up) - supplemented after nursing with milk based formula for 6 days (I figure she's 5 months, formula's sort of like early solids at this point), got good gain (& eczema), went to soy based supplementing for 3 weeks - no gain at all (& very little soy consumed, despite frequent offers - I figured she was full, I guesss she just didn't like it). Pediatrician freaks out at this at 6 month check, I'm not happy either - bloodwork tests done then show all is normal, & trial period of putting on formula (lactose free) over weekend (I'm pumping, & doing 1 late night nursing) results in weight gain.

Reflux and allergies can certainly contribute to slow weight gain, as can the kind of stress/activity related to moving and the holidays.

Here's some evidence based information regarding weight gain in breastfed babies:
http://www.kellymom.com/babyconcerns...ight-gain.html

Originally Posted by Shahbazin

OK - DD was 12 lb 3 oz Fri AM, & 12 lb 10 oz Mon PM (immediately after taking a 4 oz bottle of pumped milk) - we were doing a trial of 2 1/2 days formula, 2 1/2 days pumped milk (switched oved Mon. AM) - weight at a LC appt Tues AM was 12 lbs 8 oz, weight Wed AM at pediatrician was 12 lbs 9 oz. It seems to me, the kid was gaining 1 oz/day, no? And is thus is up 6 oz, & this is good. The extra oz Mon were just stomach contents. According to the Dr, no. See, according to her, DD lost weight from Mom-Wed, so obviously, my breastmilk is defective ("doesn't have enough calories"), & I need to switch entirely to formula, or at least dump formula in bottled milk to "fortify" it.

That is a good gain. Is your baby otherwise healthy? Growing in length and head circumference, meeting milestones, generally content?

Originally Posted by Shahbazin

Granted, we are having some supply problems here - "lazy nurser" (very short sessions, rather spaced out, doesn't stay on if not getting as much - sort of "oh well, full enough" attitude) was the verdict, tied in with the reflux issues - not enough demand = not enough supply, so I'm glad this was identified, because even though she has weight issues, DD looks/acts great & makes a good # of wet dipes (if few poopies).

Could you try feeding a little more frequently? What about breast compressions to keep the flow coming and help your baby take in more breastmilk for her efforts? Here's how:
http://www.kellymom.com/newman/15bre...mpression.html

Originally Posted by Shahbazin

I'm pumping seriously now, & have ordered some domperidone. (She's taking 23-27 oz/day, plus the 1 night feed, & I'm producing 14-17 oz, pumped.) But, what's with all this pressure to use formula? I mean, I feel really bad that I evidentally was depriving my kid of food, but as long as she's getting enough volume, my milk itself should be OK, right?

Right.

The research tells us that baby's milk intake (the volume of milk - not the amount of fat in that milk) is the only thing that has been correlated with infant growth in exclusively breastfed babies. As noted earlier, average fat content of human milk is highly variable, but has not proven to be significant when calculating baby's total energy intake or weight gain. http://www.kellymom.com/nutrition/mi...e-milkfat.html

Are you still exclusively pumping or are you nursing in addition to pumping?

[elanorh]

Your Ped's advice sounds suspect to me - among other things, lactose intolerance is virtually unheard of in infants. And your little one reacted to cow's milk formula with eczema.

If there continues to be a weight gain concern, it could be that the reflux is related to a cow's milk allergy and that your little one is reacted to the proteins from cow's milk which are in your milk .... In which case, the solution is NOT formula, but rather altering your diet (there are moms here and at the allergies board who eliminate dairy for this reason, if you decide to try this).

It sounds to me like you're getting back on track. Compressions worked well for me, with Ina. And - do consider the possibility that this is allergy-related.

[Shahbazin]

Thanks for all the responses! I have done dairy elimination from my diet (up until after she'd been supplemented a while) so that doesn't seem to be connected to the reflux; she's otherwise healthy, re milestones, head growth, activity (a little light on muscle mass & fat - she really should be a little heavier & taller). She's recently dropped some naps & spends a lot of time wriggling around (pushing herself w/her feet or rolling), getting up on hands & knees & rocking, laying on her back & bouncing her butt up & down, waving toys around & squealing while chewing on them, a lot of giggling & other noises, laying against me & bouncing up & down with her legs while holding on my shirt, etc. : She doesn't nurse long or frequently, despite my best efforts (even with compressions) - even when we were in our own house & could do more skin to skin. She's also real distractable.

I'm still ep'ing right now, except for 1 middle of the night/early AM feed - I'm trying to switch pediatricians (there's a branch of our HMO closer to where we're living right now, anyhow), but until we can prove she's gaining, we're kind of stuck with 1 more appt next week, so if stuffing her like a goose with a known amount is what it takes, that's what we'll do. Even with bottles, she often won't take a whole 4 oz (2 1/2-3 seems a favored amount, before she starts playing with it w/her tongue, laughing, & batting at the bottle), so I can see why I'm having supply problems. No suck problems, just not a big eater.

We did just get an infant scale, so now I can track her myself (she's always acted/looked fine), & what I want to do as a next stage is to get back to nursing, pump after, & supplement with pumped milk (but 1st, I have to make more milk). Ideally, I do want to get away from these #%** bottles (how on earth bottlefeeding a kid is supposed to be "easier" is beyond me). :

[Arielle]

My DD#1 was a failure to thrive baby. So I can support you on this one
Your body adjust to your babies needs. Its very stressful when you feel like baby isnt getting enough, so that makes your body work overtime which can deplete your milk. Have you tried Brewers Yeast? That helped me get my milk supply up. I would pump the extra, store it in the refridgerator for 2 hours, then take the fat off the top and incorporate it into a bottle of regular pumped milk. It helped her gain some so we didnt have to do formulas or cereal at a young age. Hope it helps!

You are doing a great job. Your hard efforts will pay off.

[kheppner]

I went thru your exact situation and DD was a failure to thrive baby. I got real tired of hearing it my lack of calories. I did some research and you can submit your BM for analysis to prove that you have enough calories. Once I did, my Dr shut up and let me work with the LC for my supply issues. DD had severe reflux and wasn't nursing effectively. Thru pumping and Domperidone, my supply is almost an oversupply at this point. DD is now 10mos, thriving, in the 10% percentile and loves to nurse. You're definately in my prayers!

HTH!
Kate