Our O.T. wants our 7 m.o.fed on reduced schedule - Mothering Forums

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#1 of 28 Old 06-21-2013, 10:14 PM - Thread Starter
 
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Hello! We have a 7 month old that was born 7 weeks early. She's ebf, but recently I have given her a little fruit or sweet potato puree for fun, not every day (I put it on her fingers and she sucks them off, so, not much calories there). She puts everything in her mouth but gives no other indication that she is ready for solids. No grabbing our food, isn't remotely close to sitting up, and loves nursing more than anything. Really it has only recently become enjoyable for me, she is delayed and had very bad colic. I waited a long time for those appreciative smiles and so forth!

Anyway, to the question. She has an occupational therapist, who at our last visit suggested that I am feeding her too often (every 3 hours)... that it would be better for the baby if she were transitioning away from breast and more to food, because the act of feeding herself is irreplaceable sensory stimulation. My daughter seems content with being ebf.

What do you think, would I be denying my daughter sensory stimulation by refusing to replace breastfeeding with meals? I don't feel like its time to cut back yet, it seems way too early. I found some anti-schedule info at la leche, but it was aimed at newborns. Thank you in advance!
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#2 of 28 Old 06-21-2013, 10:31 PM
 
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Ehhh... I'm not loving this suggestion from the O.T.  Specifically as a preemie mom, I don't like it.

 

The point of feeding the baby is to feed the baby.  Sensory stimulation and all that is nice, but there are lots of ways to get sensory stimulation.  There is only one way to get nutrition into the baby, which is to feed her nutritious and appropriate food that she is willing and able to eat in quantity.  Feeding the baby is irreplaceable calories, vital to her growth and development.

 

While I sometimes found it helpful to have set family mealtimes (when we will sit at a table and the adults will eat something and maybe talk and we will put babies who can sit in high chairs and give them some puree and some cheerios so they can be sociable), I do think that infants need to be fed on demand up to closer to a year (adjusted for prematurity and infant capability), and that even when we have set family mealtimes, it is often unwise to deny a hungry toddler a snack. 

 

Your child is 7 months from birth, and was seven weeks premature.  So really, she's more like a 5-6 month old then a 7 month old, and you also have to take that into account.  A child who does not sit independently is also not a great candidate for solid foods.  The purees and things you can give her don't have a lot of actual nutrition in them.  Sweet potato puree is basically some mush with trace amounts of vitamins A and C, and feeding it to her on a regular basis would take up valuable real estate in her belly without supplying her with the fat, protein and calories that she needs.  Occasional smears seem more appropriate.  To me.
 

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#3 of 28 Old 06-22-2013, 04:35 AM
 
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That sounds like a terrible idea and one that will end up causing supply issues. When kids are ready to play with food they will and you just can't stop then.

And seriously BFing is very sensory rich.
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#4 of 28 Old 06-22-2013, 07:06 AM
 
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My full term daughter didn't eat anything except breast milk until the month she turned a year. She would sit in the highchair and play with the food, and drop it to the dog. 

 

In your situation, I wouldn't argue with the OT.  It's not worth it to argue, and she has no authority in the situation. Just feed your baby as the baby indicates.


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#5 of 28 Old 06-22-2013, 07:48 AM
 
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My full term daughter didn't eat anything except breast milk until the month she turned a year. She would sit in the highchair and play with the food, and drop it to the dog. 

In your situation, I wouldn't argue with the OT.  It's not worth it to argue, and she has no authority in the situation. Just feed your baby as the baby indicates.

I wouldn't argue with the OT, but I would tell her what's up. " I thought about your feeding suggestion, and I'm just not comfortable with it. Sensory stimulation is wonderful, but my absolute priority has to be her nutrition. Her pediatrician and I are in agreement on this. She'll explore more foods when she's ready. At this stage, we need other sensory strategies."

Don't argue. State your decisions. Reference the pediatrician. Tell her she's still on the spot to do her job.
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#6 of 28 Old 06-22-2013, 12:07 PM
 
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That sounds like horrendous advice. Can you find a new O.T.? I think it's too early for your baby to be eating anything besides breastmilk.
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#7 of 28 Old 06-22-2013, 12:34 PM
 
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I don't know anything about preemies or OT, but as far as what she is doing with food right now, it doesn't really seem off to me. I mean if she is 7 months old and was almost 2 months early, she should be doing what a 5 to 6 month old would be doing (right?) and it sounds like she is. Full-term, cognitively normal babies develop feeding skills at different times too. I've had some that were really ready and some that were just meh about the whole situation.

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#8 of 28 Old 06-22-2013, 05:15 PM
 
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My full termer would spit foods out up til about 8mos.  And as for the bf not being "sensory stimulating" - has this OT ever bf??  Because my child was all over the place while nursing at that age and **** is (19mos now).  There was hair pulling, nose picking, almost lost an eye on several ocasions, then got a silicon chew beads necklace for her to teeth and play with while nursing...and that's just what was going on with her hands!  Every baby is different regardless of timeframe they are born.  And if your OT is really familiar with developmental differences between genders she'd know girls tend to develop communication skills first while boys develop motor function. My DD didn't use utensils until sometime after 14mos, prior to that she just would make one attempt with a spoon, drop the food and chuck the spoon across the room to use her fingers.  My friend's son was self feeding yogurt from a spoon at 8 or 9 mos.  You have to look at the bigger picture and see what your LO is doing well and know that's where her brain is focusing at this moment.  They have so much to learn it's not going to happen all at once no matter how hard the OT tries to make them happen.  She'll come around in her own time when she's ready. 

 

PS - my DD STILL has days where she nurses every 3 hours and like I said, she's 19mos :-P

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#9 of 28 Old 06-22-2013, 06:40 PM - Thread Starter
 
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Okay, cool, you guys have given me enough confidence to directly say, No, I will not be doing this and explain why it's important to continue to bf on demand.  By the way no the OT has no children.

 

I did not want to mention it initially to avoid clouding your feedback. The OT gave me a meaningful look and said that reducing feedings would be better for the baby.  The impression I got was "I know you want to keep bf but it's time to put your DD's needs ahead of your own."  I got the same vibe when she found out I *still* nurse her to sleep and cosleep. The whole thing really put me off my axis since it's the first time anyone had said anything like that to me, the first gentle condemnation of the way I am taking care of DD, and it was very uncomfortable.

 

Yes, by the way about development! The only area DD isn't delayed is communication.  She is actually considered to be at actual age appropriate there and works on it diligently! 

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#10 of 28 Old 06-22-2013, 07:27 PM
 
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I am kind of passive...I would likely tell the O.T. what she wants to hear, incorporate her suggestions as you see fit, and nurse that baby 'til the cows come home!

My son, who was born at 37 weeks, didn't really get into solids until he was well into his first year. He is 3 and still often prefers nursing to solids, to be honest...it can get on my nerves sometimes, honestly, but he is healthy as a horse, happy, and I figure it saves us on food, too...plus, there is nothing like nursing to transform a crazy, tantruming kid into a little love again. He eats plenty of solids, of course, but still nurses quite a bit.

Good luck, mama!

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#11 of 28 Old 06-22-2013, 07:32 PM
 
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Your OT does not seem to understand that when you nurse, you nurse on demand. It's not "feedings". It's sort of a lifestyle. And it's sensory AS FUCK.

 

You play with your daughter with toys and stuff, right? And you're already doing the solids thing with finger/spoon feeding. When she seems ready for spoon feeding herself, it looks like you guys will be all over that. So what exactly is she missing, sensory-wise? Nothing.

 

Your OT can go sensorally stimulate herself by herself and leave your nursing relationship alone. It is way too early to cut back on nursing.

 

For the record, I still nurse my 18-month-old on demand, and he eats fine.

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#12 of 28 Old 06-22-2013, 07:46 PM
 
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I have a preemie (11 weeks premature) I ended up cutting out the OT after 6 months. We just were not on the same page. She's 16 months now still BF. if OT wants sensory experiences related to food, put her in the high chair with some stuff right after nursing smile.gif
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#13 of 28 Old 06-22-2013, 08:26 PM
 
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I would go a step further and write a letter expressing concern about advice that could lead to a child that most needs breastfeeding being taken off it. Her advice could lead to weaning very early. Imagine people that take her advice!
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#14 of 28 Old 06-22-2013, 09:47 PM
 
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I would go a step further and write a letter expressing concern about advice that could lead to a child that most needs breastfeeding being taken off it. Her advice could lead to weaning very early. Imagine people that take her advice!

Yes, yes, yes to this!

Bring back the old MDC
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#15 of 28 Old 06-23-2013, 05:55 PM
 
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I can only agree with everyone else...I wouldn't be taking her advice. Good luck!

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#16 of 28 Old 06-23-2013, 07:15 PM
 
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It's not like sensory stimulation is ending soon or there's not another dozen ways to stimulate baby. Children refine their senses until the age of 6 years old. I have a preemie now 10 mos who I still bf on demand and she does eat solids, but I still nurse a zillion times a day. When she was 6-7 mos she was not that interested in food and she is on the small side and I prefer the calories and food intake to be from the boob rather than food. I have gone through abt 3 doctors bc they would say things like there's something wrong with my breast milk, she needs formula for more calories, etc. I ended up stopping the visits bc I'm with her all day everyday and she is growing and progressing. When she was 3 mos they said bc she wasn't tracking their little orange ball that she was delayed! It's just that she didn't do it at THAT moment. Can you do the exercises they do with her at home yourself?
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#17 of 28 Old 06-23-2013, 09:24 PM
 
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So many people responded with the same message that it seems redundant to reply, but I'm so furious about that OT recommendation that I had to chime in!

 

Now, I'm not an OT, but I do have a master's degree in early childhood development and have been an early childhood teacher for 12 years. I've come across many OT, PT, and Speech therapist that know their field, but are completely out of touch with the rest of the child.  You shouldn't promote one thing at the expense of another.  You really need to look at the whole child.  This is a common problem, though, from my experience.

 

Feeding on demand is just that, feeding ON DEMAND.  You feed on demand because you trust your child to tell you what her needs are.  This OT thinks this is okay at 3 months, 4 months, but not 7 months. ??? That makes no sense.  As a child gets older, they don't suddenly become incapable of telling you how much they need to eat.  IMO, you should nurse on demand until they self ween.  My daughter is 14 months and still nurses every 2-3 hours.  She eats plenty of solids now, but I wouldn't dream of denying her milk when she wants it.  I certainly can't even begin to imagine doing that to a much younger child who was born prematurely.

 

Your daughter needs MORE time, not less.  As you probably know, babies develop much faster in the womb than out.  So, developmentally, she'd be even younger than if she were born on her estimated delivery date. Whereas many babies are ready to try solids at 6 months, I'd guess she'd be more like 8-9 before she became interested.  (Though obviously, development is highly variable.)  Her digestive system might not even be ready for solids.  I run into this problem as a teacher a lot, too - children born prematurely expected to perform at the level of same-aged peers. This is completely unjust as these kids are being asked to do things in less time than their peers. Thus, they (and their parents) are made to feel like they are behind or slow when they are developing exactly as expected.  Sure, some may need a little help (like OT) to give them rich experiences, but they shouldn't be pushed beyond their developmental level.  Honor your daughter where she is RIGHT NOW in her development.  Mom's of 5-month-olds aren't being made to feel like they need to stress out and withhold nursing from their children so they can have sensory experiences with solids.  It's absurd for someone suggest you do that with your daughter - just because she was born prematurely.  She deserves more (care, love, nurturing, time, etc.) not less.  Grrrr, I get so frustrated about this!

 

I strongly encourage you to check out Baby Led Weaning.  The book is well worth the read and it talks a lot about how to know when child is ready for solids.  It really helps you to honor your child's needs.

 

The opinions seemed mixed about whether you should tell the OT or not that you won't decrease feedings.  My opinion is that you should definitely tell her.  It probably never even occurred to her that reducing feedings could be bad for her overall well being, interfere with your bond, decrease her nutrition, etc.  She's only thinking about her sub-specialty, not the whole picture.  But, that is how people learn.  Your style of parenting is probably something she hasn't encountered often, or even at all.  Her parenting experiences might be limited to how she was parented and what is on TV.  Heck, 10 years ago, I might have thought the same thing - before conversations with different people led me to question my preconceived notions and what is prominent in American culture.  (I still remember I was really put off when I babysat a boy who was intact.  At the time, I thought that was crazy.  The mom said, "oh, I haven't gotten around to it," which made me think she was really irresponsible. Maybe that was true, but maybe she had decided not to do it for all the reasons you shouldn't, but just told people that to get them to go away.  If she was indeed against circumcision, I wish she would've told me why because it took me about 10 more years before I learned more about circumcision and why it isn't necessary.)  So, what I'm saying is, she might really need to hear this.  I would tell her what you are doing and why (politely of course.)  Meepycat had a great suggestion, " I thought about your feeding suggestion, and I'm just not comfortable with it. Sensory stimulation is wonderful, but my absolute priority has to be her nutrition. Her pediatrician and I are in agreement on this. She'll explore more foods when she's ready. At this stage, we need other sensory strategies."  If you are comfortable going beyond that, I'd even explain further.  You might just plant a seed that could help her future patients (and even children) down the line.

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#18 of 28 Old 06-23-2013, 10:11 PM
 
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It sounds like the OT has mainstream beliefs--that by the time a baby is 7 months they should be getting a good portion of their calories from solids. The reality is, many babies arent ready to eat solids at that age and you, as her parent, know best when it becomes clear that she's ready for solids. Its also odd that she's recommending that for a baby who cant sit up properly! Thats the number one milestone a baby needs to have mastered before you feed them solids. This person clearly isnt paying close attention to your child, she is simply giving you generic advice, based on her age (which it sounds like she hasnt adjusted it to account for prematurity, uggh, so dumb).
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#19 of 28 Old 06-24-2013, 06:12 AM
 
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Agree.  Agree.  Agree.  Except you have a lot going on trying to take care of you and that little one...I wish there was a means of getting this OT educated without your having to do it.  What we need is some sort of pamphlet or linked research we can present to these professionals (pediatricians included) with the information and wisdom that we've acquired (a lot of which has been iterated here).  Then we could just hand it over and say, "Thank you, but I'm not sure you have ALL the facts."

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#20 of 28 Old 06-24-2013, 07:04 AM
 
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Considering that breastfeeding promotes sensory development as well as cognitive development. it seems illogical for the O.T. to reccomend reducing feeds especially in a premature infant. The data is overwhelming supporting breastfeeding as beneficial to sensory-neuro development. With the O.T.s other comment about nursing to sleep it seems her personal discomfort of knowing a child is breastfeeding past the newborn phase may be getting in the way of her professionalism. Whatever her point for making that suggestion it apparently is contradicted by the available data on neuro-cognitve and oral development and breastfeeding.
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#21 of 28 Old 06-24-2013, 07:09 AM
 
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Agree.  Agree.  Agree.  Except you have a lot going on trying to take care of you and that little one...I wish there was a means of getting this OT educated without your having to do it.  What we need is some sort of pamphlet or linked research we can present to these professionals (pediatricians included) with the information and wisdom that we've acquired (a lot of which has been iterated here).  Then we could just hand it over and say, "Thank you, but I'm not sure you have ALL the facts."
It would be helpful. There is SO much data though on this subject and so readily accessible. I have just skimmed through about ten links on the role of breastfeeding on sensory development, as well as cognitive and motor and oral, many in relation to premature infants.
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#22 of 28 Old 06-24-2013, 11:04 AM
 
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Can you find a different OT? One who at least is familiar with ebf babies? Seems like shes missing a lot of what i would consider vital knowledge.
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#23 of 28 Old 06-24-2013, 11:13 AM
 
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It would be helpful. There is SO much data though on this subject and so readily accessible. I have just skimmed through about ten links on the role of breastfeeding on sensory development, as well as cognitive and motor and oral, many in relation to premature infants.

There is a TON of data...even in more digestible abstract form...I did a search after my post also...so why are we battling with our children's HCPs?  Ugh.  My pediatrician tried to get me to "stop breast feeding just for 48 hours" so that he could diagnose breast-milk jaundice in my preemie.  Wish I had a pamphlet that said "Bite me."  Instead I said, hmmm...hmmm.  And then complained to my family, did my research, consulted my friends, took care of my itty-bitty, but couldn't muster the energy to educate the doctor. 

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#24 of 28 Old 06-24-2013, 11:16 AM
 
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Can you find a different OT? One who at least is familiar with ebf babies? Seems like shes missing a lot of what i would consider vital knowledge.

 

In your shoes, I would settle for an OT who could think things through about any babies.  It sounds like she's missing the forest, because she's overly focused on one specific tree.  I don't think the real tangle here is that the OT isn't familiar with breast feeding (although I can see how it looks that way).  I think the real tangle is that the OT is failing to consider the needs of the child.  That makes her a terrible OT.  Someone should point that out to her, and possibly her supervisor, not in a "you need to understand the importance of breastfeeding!" way, but more in a "this is dumb and dangerous advice you are giving, and no therapeutic work can realistically take place if we do not prioritize the physical health and safety of the child."

 

Rule 1 for babies is Feed the baby.  Babies who are not fed do not do well.  They don't grow.  They don't hit developmental milestones.  Well-fed babies lag behind developmental milestones now and then, all the time, and they often catch up.  When a well-fed child comes into therapy for a persistent developmental delay, the therapist can work from the solid base provided by good health and adequate nutrition, and assist that child in doing as well as possible.  By comparison, undernourished children can suffer lifelong health problems that therapy can't get them over. 

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#25 of 28 Old 07-02-2013, 02:33 PM
 
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Well I am an OT so I think I know where your OT was coming from in her recommendation. Now, I don't know the specifics about your child so can't give any advise for her treatment...but hopefully can help clarify things. My impression is that your OT is likely concerned about your daughter's oral motor development. Some research does point to the delay of solids being linked with oral motor delays. Now these studies do not compare bottle fed infants vs. Breastfed infants ( all babies are grouped together) and in my experience as both an OT and a mother who exclusively breastfeeds I find that oral motor development in EBF infants is typically superior. My thought is that your OT may be concerned about your daughter developing her chewing/swallowing skills and has this in the forefront of her mind when making her recommendation.

My personal view? I would stick with feeding on demand while ensuring my little one has lots of exposure to oral motor stimulation. If you need ideas for that...just ask your OT she should be able to recommend lots! Eating solids is not the only way to achieve this. I delayed solids for all my children and EBF until they were 8-9 months before starting any solids at all.
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#26 of 28 Old 07-02-2013, 05:58 PM
 
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I too, am a pediatric OT who also does feeding and ebf my own child. I completely agree with the previous OT's post. I'd also like to add if once you speak to your OT and she still doesnt honor your request, and if you dont feel comfortable with her, you can always switch to another therapist, whether you are in early intervention or privately seeing her.
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#27 of 28 Old 07-02-2013, 08:09 PM
 
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It's not "feedings". It's sort of a lifestyle.

 

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#28 of 28 Old 07-05-2013, 08:14 PM
 
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I would say, if you're really concerned, talk to your pediatrician. But as for my opinion- your baby needs to ear. She doesn't sound ready for strictly solid/ pured food. Maybe instead of every 3 hours tho, feed on demand? I dunno, I've heard that's better n it works with my 3mo (full term baby)
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