"Failure to Thrive" - Mothering Forums

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Old 07-16-2007, 05:02 PM - Thread Starter
 
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First post... appreciate any help! My 7 1/2 month old has been labeled "failing to thrive" by Dr. because she gained 3 ounces in 4 weeks. This caused them to recommend some blood tests and provision of a stool sample (which we did). The nurse I spoke with on Friday told me that my breastmilk isn't good enough for my daughter and that I need to stop solids and start giving her formula after each feeding. My daughter has been breast fed only up until 6 months when we started introducing solids. I need some information and suggestions! What can I do to avoid formula? I know there are other options for helping her to gain weight. Help.
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Old 07-16-2007, 05:07 PM
 
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Is the only FTT issue the weight? Is her other growth fine? Honestly, breastfed babies slow down in growth significantly in the second half of the first year. If all else is fine I wouldn't worry.

-Angela
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Old 07-16-2007, 05:11 PM - Thread Starter
 
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We are waiting to hear back about the test results. She is healthy in every other way. She is happy, sleeps well, eats well, is developing normally, and even has two new teeth!
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Old 07-16-2007, 05:18 PM
 
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If all else is well and she has wet and poopy diapers I don't think I would personally worry.

Have you weighed her before and after nursing to see how much she's getting?

Breastfed babies level off in growth in the second half of the first year.

How often is she nursing?

What were you and her dad like as babies?

-Angela
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Old 07-16-2007, 05:21 PM
 
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Babies naturally slow down in weight gain and even hault when solids are introduced, especially EBF babies.
I think you need to look at the symptoms more closely. Is your baby gaining? Is your baby meeting developmental milestones? Is your baby still growing?
1 weight check is not enough evidence to say FTT.
We just went through FTT, my ds (my 4th child, 3rd bf child) lost nearly 10% of his body weight, he went from 13.8 lbs at 4 mo old to 12. 14 at 5 1/2 mo old and his head stopped growing. We were being monitored over the course of several weeks b/c his weight stalled out and when his weight plummetted we were immediately hospitalized.
I am pumping and adding formula to my breastmilk to aid him in gaining his weight back, he is back to his 13.8lbs. Not once was I pressured to wean and strictly formula feed. Of course, w his food intolerances the formula would be quite costly. The medical grade formula is pricey as it is, fortunately I'm not using much per feeding.
My IBCLC friend wrote out some great things for me in an e-mail when the doctors were first suggesting different things to find out how much my baby was taking in or if it was related to a food intolerance or other like Cystic Fibrosis or Celiac Disease (we're Celiac) --

Quote:
Yes, test weights are appropriate for babies at any age - - weighing a baby before and after a feed, then subtracting the first weight from the second weight to determine the amount transferred from the breast. This is the only accurate method of determining a baby's intake/transfer of milk from the breast, and should only be done with a reliable baby scale such as Medela's BabyWeigh Scale. The lactation consultants at Winchester Medical Center should be able to help you obtain one of these scales as a rental item - - they may be available through Valley Home Health. At Inova Fairfax Hospital, we rent these scales for $4 a day. They are too expensive for families to purchase at $1,000 for Medela's price and about half that from Tanita. But the rent is very do-able and is invaluable in completing a thorough feeding assessment for a baby with weight gain concerns.

To perform an accurate test weight, the baby must stay clothed the same throughout the test weight. Clothes and/or diapers should not be changed during the test weight, and blankets should not be put on or removed during the test weight, in order not to skew the results. The weight is not intended as a true weight (nude weight), but rather to determine transfer of milk, so the baby can remain clothed throughout the test weight. Of course a nude weight can be done for the purposes of the physical assessment but would not be part of the test weight.

This is criteria from The Breastfeeding Answer Book (BAB) regarding Failure To Thrive:

Failure-to-Thrive in a Baby Older Than One Month
weight below 30th percentile
drop in rate of growth of length and head circumference
infant falls two standard deviations on the growth chart
evidence of malnutrition, dehydration - - sunken fontanel, grayish pallor, lethargy, loss of fat layer under the skin, strong urine, inadequate stools
infant does not meet developmental milestones
infrequent and/or ineffective feeds
mother experiences few let-downs
erratic or nonexistent weight gain
When the baby is diagnosed as failure to thrive, immediate supplementation is necessary.

Here's a brief excerpt from The Breastfeeding Answer Book about weight gain:

"Average weight gain for the first three to 4 months is about six ounces per week, although it is considered acceptable for some babies to gain four or 5 ounces per week. The very rapid growth a baby experiences during the first three months typically slows down during months four to 12. An average weight gain for a breastfeeding baby four to 6 months is about four to 5 ounces per week. An average weight gain for the breastfeeding baby six to 12 months is two to 4 ounces per week."

New weight guidelines have also come out in the past year that I am sure will be listed in the next revised edition of the BAB.

Pumping and bottle-feeding a baby is an option but is not accurate in determining what a baby transfers from the breast.

A better way to supplement a baby who needs supplementation is to use tube-feeding at the breast, such as Medela's Supplemental Nursing System (SNS) or Lact-Aid. If you get on Medela's website at http://www.medela.com you can look at their products to find the SNS.
Advantages of using a supplementer at the breast vs. bottle-feeding is that the breast continues to be stimulated and emptied which is critical for protecting mother's milk supply, and there is no risk of nipple confusion/suck confusion/flow confusion or nipple preference/suck preference/flow preference in favor of an artificial nipple/bottle.

Your baby should be nursing at least eight times in 24 hours, and more often during growth spurts. Length of feedings should not be limited in order for the baby to get adequate hind-milk. According to the BAB, "the baby may get plenty of fluids from the watery foremilk but not enough calories needed for growth" when feedings are timed or restricted to so many minutes per breast. One way to supplement a baby is by using Medela's SNS with some pumped hindmilk, to give the baby a high-calorie supplement. I have only seen the Whisper-Wear pumps in print ads. My education and training is to recommend a medical-grade electric breastpump when a mother wishes to express milk for supplementing her baby. The best known/most reputable medical-grade pumps in the U.S. are Ameda's SMB, Lact-E, and Elite; and Medela's Symphony and Lactina. Until recently Medela also had their medical-grade pump, the Classic, available. But they have phased out the Classic in favor of the Symphony.

Pacifiers should be avoided during a baby's waking hours, since no calories are given with this type of sucking. Keeping your baby in a sling (I recall you are a fan of this) is preferred over time spent in a swing (the sling allows more frequent access to the breast).
I have also read about proper weight gains and such on Kellymom website.

Don't formula feed just yet, I personally think your doctor is jumping the gun on this one. I wonder if the doctor is truly supportive of BFing with comments like this to make mothers freak out.

My dear friend wrote me much more, if you need to talk PM me or just write here.

HTH
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Old 07-16-2007, 06:03 PM - Thread Starter
 
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She's been small all along and we have been in for weight checks almost monthly. The doctor didn't suggest giving up breastfeeding altogether, just following up with 2-3 ounces of formula after each feeding. I just feel that my milk is the best there is and I wondered what I could be doing to make our breastfeeding sessions and my milk "better". Formula seems like such an easy out and I know there has to be other options. Thanks again for your help.
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Old 07-16-2007, 06:59 PM
 
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While I disagree with your doctor based on what you have posted here I think a second opinion from a medical professional is in order. I would ask around to see if anyone knows of a good breastfeeding friendly ped in your area. You could post in your tribe. Have all your records sent over before your appointment.

In addition you can help her get more fatty milk by eating a diet higher in fat (nuts, avocados, etc) and block nursing.
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Old 07-16-2007, 07:13 PM
 
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You might try pumping some of the foremilk off and then nurse the hindmilk which is fatter. I wait 30 minutes after I pump to nurse, but I'm sure some mamas are better milk machines than I appear to be.
If you choose to feed what you've pumped back, I would suggest a Supplemental Nurser System so you can get more stimulation and increase your over all milk supply.
Add a nursing session or two if your child is interested, I'm waking up at night to wake my sleeping through the night baby! He needs the calories.
I also would get another opinion, some children are small, some are big, some are average, and everything inbetween.
Get copies of all the labs they have ordered and be familiar with what they imply or do not imply.
Increasing quality - Omega Fatty Acid supplements, Marshmallow Root herb, saturated fats like avocados mentioned.
More calories equals more weight gain -- it's as simple as that. So, it can be done by nursing more or adding formula. Doctors standard is that milk (any milk) is roughly 20 calories per ounce. I don't know if you can increase the caloric value of bm, but maybe someone here knows.
Sometimes formulas are necessary, in our case with the weight loss, adding calories is necessary. I feel fortunate that the doctor suggested adding formula to my breastmilk giving it more calories than just doing a high calorie formula alone. They make Human Milk Fortifier, but it is dairy based, so we are using a hypoallergenic formula in a doctor prescript quantity to so many oz of EBM.

BTW - if a child is getting enough bm, he/she won't want to take 2 to 3 oz more of anything and if he/she did, he/she might very well spit it up. This is one of the problems my ds was having, his ability to intake more is not there, so anything extra is spit up quite easily. So, in theory the doctor just wants the child to have more calories, but in reality, the child is likely satisfied at the breast and not in need of more -- at which point it isn't likely a milk issue, it more probable to be a physical issue metabolic, genetic, malabsorption, allergy or intolerance. Which is why a good second opinion is needed.
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Old 07-16-2007, 08:38 PM
 
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In terms of how to make your nursing sessions more effective, have you tried Dr. Jack Newman's compression technique? (Google: breast compression technique - and it will come up).

My dd didn't gain ANY weight between her 3 and 4 month visits and my ped suggested supplementing. At the suggestion of my LLL leader, I tried the compression technique instead and by her 5 month visit she had competely caught up with her twin brother on weight gain.

At the same time, I also increased the fat in my diet tremendously, as another pp suggested.

Good luck
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Old 07-16-2007, 09:19 PM
 
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I'm so glad you posted this! We are having the same problem, though this has been going on for the past several months. I have a 9 month old who has gone from the 40th or so percentile at 4 months to the 4th percentile today at over 9 months. In fact, she has LOST weight since her May weigh in. We have an appointment for an oral evaluation this Thursday. She refuses all solids, so I'm still exclusively breastfeeding her and am wondering if she's getting adequate amounts of hindmilk. I don't know what to do. I'd like to rule out some of the other stuff previous posters have mentioned. Should I ask for blood work?

I'd appreciate anyone's help because I'm getting really worried. She, too, is content and active and meeting all her milestones. But now she's slowing in her growth as well...

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Old 07-17-2007, 02:30 AM - Thread Starter
 
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It might not hurt to get bloodwork done (well it hurts the little one and I cried harder than she did). We just learned today that it might be a thyroid issue with our daughter. I thought I was going to have to state my case for no formula, now we are headed down a totally different path. I have learned through info searches and this site that breastfed babies taper off in weight after 6 months. Go with your gut. You know what is best for your baby.
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Old 07-17-2007, 04:09 AM
 
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My BS-ometer is going off, but here's what I would recommend as a responsible medical person.

Call an LC that you like and trust, or a LLL leader. Ask them who is a good BF-friendly pediatrician, and see them for a second opinion.

I was surprised to learn that I picked a non-BF friendly ped, but I'm so headstrong and DS has been such an aggressive grower, that I just blow off suggestions to start solids early, to add formula, to wean, and not to co-sleep.

Let us know what the new doc says!
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Old 07-17-2007, 09:44 AM
 
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Thankfully, my doc hasn't suggested anything about introducing formula or made any reference to my bm not being enough. Though, they do think it's because she's refusing solids. I'm seeing my LC this am, and she recently went to a feeding conference. Plus, we'll actually be able to see what she's really taking in during a nursing session. This way, I can go to her oral evaluation this Thursday armored with information. I'll call to get the bloodowork ordered. I don't see how it could hurt to do that. Better now than later, kwim.

Thank you all for the information! It's been really helpful! I'll definitely check the thyroid too.
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Old 07-17-2007, 03:08 PM
 
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HUGS... no new advice to offer, just wanted to agree with the previous posters. Drs suggest formula so quickly.. there's almost always something else you can do instead first... ESP if baby seems healthy and is producing enough wet/dirty diapers!
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Old 07-17-2007, 03:33 PM
 
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Well, you all aren't going to believe the results of today's LC appointment, because I wouldn't have either if I hadn't seen it for myself. SHE HAS BEEN ONLY GETTING ABOUT 2 OUNCES PER FEEDING!!!!!! For reasons beyond me, I don't have enough supply. I've only been feeding her one side during a session. I still feel let-down, I still leak on the side not being nursed on, so I assumed that I had milk a-plenty. Plus, I've never had this happen with my first. The results are a snapshot, but we did the morning feed at the LC's, which would be the time I have the most milk to offer. I can't believe it. I've been starving my child.

The LC had me nurse on the other side as well and, in total, Maren got out about 4.6 ounces of milk! I'm 99% certain that this is/has been the problem, and once we solve it, then her weight should start coming back on. I'm still going to get all the blood tests just to be sure. I'm now renting a hospital grade pump and have to pump for 10 minutes after she finishes nursing on both sides to try to increase my supply. My concern is that she wasn't able to keep up the supply in the first place, so how do we know the problem won't return once I stop pumping? I'll have to ask the LC that next time I talk to her. Maren is obviously not fully emptying me enough to make my supply what she really needs. Who knows, maybe I'll need to continue to pump. I've always thought she was a lazy nurser, but had nothing to support it.

Now I'm worried about what the long-term repurcussions of this are. I read online somewhere that the first year of life is crucial in brain growth and those that are malnourished often suffer long-term effects in intellegence and often have difficulty as adults with social and mental skills. I'm praying this isn't the case with her. The LC did say that we are very lucky because most babies would have shown neurological damage by now. I just don't know what to think.
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Old 07-17-2007, 04:44 PM
 
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Neuro damage from malnutrition, if caught early enough, can be reversed. I am glad that they caught this, and shame on my BS-ometer!

Here we have the reason that they weigh and measure out the wazoo, but I have seen these stats used against BFing, so I'm cynical.

The answer is, youll know what to look for now, so you'll never let supply drop again. There are other ways to address supply, pumping is just the easiest and most natural with the fewest side effects.

I am so glad you caught this!
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Old 07-17-2007, 04:54 PM
 
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Oh hugs mama. I'm so sorry that you are going through this. Please try not to be so hard on yourself. I wonder how were you supposed to know that she wasn't getting enough if she's been content and meeting milestones? Other than the slowing down in growth, which they say breastfed babies do naturally after 6 months.

I feel for you because I always wonder if my second wan't getting enough milk b/c her growth slowed and she never nursed a whole lot. I felt like I was always offering and getting turned down. I would describe her nursing activity to the lac con on the phone and she always seemed to think I was being paranoid. But I felt like I was always counting diapers, and they never seemed to be wet enough. And with that I was told "oh those new disposables, it's so hard to tell b/c they're so absorbent, there's probably more in there than you think." It wasn't until she didn't gain any weight from her 9mo visit until her 12 mo check up that the ped started to get concerned too. And she made me come in for weight checks every few weeks. It was so hard to tell what was going on at that time though b/c she had a couple of colds back to back so her appetite was down and she never really liked solids. She's now almost 2 years old and barely weighs 22 pounds. I wish I would have been more persistent like you and done the test you did with measing how much milk they're getting b/c I always felt like I never had enough. But like yours, she only nursed on one side and when I would offer the other she would refuse. I struggle b/c again people would tell me she would protest if she was hungry. I don't know though, I think maybe she was just very laid back. I give you kudos for getting it sorted out! As for the damamge done, I wonder the same thing about my dd. Makes my heart break. I always wonder if I starved her. Uggghhhh.

Many hugs and good luck to you. Keep us posted.
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Old 07-17-2007, 05:26 PM
 
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I'm glad your answer is relatively simple -- feed the baby more.
4.6 oz form both sides is a solid feeding IMO. I'm sure you were told to nurse more often, I'd shoot for every 2-3 hours or more.
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Old 07-17-2007, 06:04 PM
 
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Yes, the LC did say that things could turn around by just nursing on both sides for each feeding session. But since we want to start putting weight on her asap, we're going with that AND the pump to try to jumpstart my supply a bit more quickly. We're not going to do any supplements for me yet. If things don't change in a couple of weeks, we'll look into things like fenugreek (sp?).

I really appreciate all the support here. I haven't been much of an active member since joining -- just not enough time really. I just want to thank all of you for your help!

And RootSnort, the nurse at the ped office and the nutritionist confirmed what you just said in that this shouldn't cause any long-term damage. In fact, both suggested that there is a good possibility that we can get her back on track to the weight she should be (as if this never happened in the first place). Of course, there's no guarantees, but there's a good chance as long as we stay on top of it and get things turned around. I'll just have to be patient and remember that it took us months to get here and it'll take months to get back. Here's hoping. Either way, I'm relieved to know that!!
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