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May 2011 Moms
kaydogger
member
EBFers Question/thoughts.
kaydogger
member
So DD had her 4 month appointment on Monday and she weights 13 pounds 6 oz.
At her 2 month appointment she weighed 12 pounds 7 oz.
The Dr was concerned about her not gaining enough weight. Her height and weight are both in the 29th percentile, so it's not like she's super underweight, the Dr just wanted it to go up and not just taper off on the chart.
I only BF & don't pump. I've tried pumping but only get about 1 oz when I do so it's not worth it. I feed on demand and she doesn't seem to be hungry or extra fussy after I feed her but she does get very distracted when she eats (eating for a couple minutes, then whipping her head around, then going back for a minute & so on....)
Aaaaaaaaaaanyway, the Dr wants me to start giving her rice cereal and oatmeal. I asked her if that would mess up my supply even more (if that's the issue) because she would be getting fuller from the rice and oatmeal. The Dr said no.
I'm so torn. I really wanted to just EBF for the first 6 months but if she's not getting enough, I don't want to be hindering her growth. I guess I should also note she's still waking up every 3-4 hours at night to eat. I always feed her when she wakes up but I also heard that means she's not getting enough during the day.
Thoughts? What would you do?
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Re: EBFers Question/thoughts.
You are probably going to get a variety of opinions on this, but I'll give you mine. I agree with your pedi in that your little one should have gained more than 1 pound in that two month period. It does sound to me that your current supply may not be enough for her to maintain the optimal growth rate. I know kellymom thinks it's not possible but I know many Moms who have determined they had supply issues once they added solids or started supplementing and their kid suddenly returned to their original growth trajectory. You could try fenugreek to see if you can up it though if you really do want to EBF still. Or you could try to feed her more often during the day to up your supply and get her more nutrients.
That being said, I would probably take the pedi's advice and add solids. I EBF as well and was struggling with a fussy baby at the 4 month appointment (he weighed 16 pounds at that time and was born at 6 pounds FWIW). The pedi said he may do better if I added solids to his diet and so I decided to do it. We're now on fruits too (I love the already mixed cereal/fruit combinations from Gerber). He is doing much better.
I would make an appointment with a lactation consultant ASAP!! She will be able to tell you how much milk your baby is getting each feeding and help you make a plan that is best for your baby and your BFing goals.
I would definitely try the fenugreek.
FWIW I am currently adding solids and EBFing. I BF DS first then giving cereal.
I would follow the pediatrician's advice and add cereal or oatmeal to your BM. I agree with the PP, one pound is too little weight gain over a two-month period.
I also EBF (DD has only had one bottle of BM) and hope to wait until 6 months to add solids, so I know where you're coming from in being reluctant to give her solids earlier. However, if there was an issue with lack of weight gain, I wouldn't hesitate to follow my pediatrician's advice and supplement or add solids. FWIW, DD weighed 16.5 lbs. at her 4-month appointment (90th percentile for height and weight) and was 7 lbs. 6 oz. at birth.
Did your pedi ask the typical "low supply" questions: how many wet diapers in 24/hours? How many dirty in 24/hours? This should be the indicator if your LO is getting enough, not just weight gain.
I would start, as PP mentioned, by seeking an LC to get a weighed feeding. If it is low, I would aim to up your supply as needed, which would probably include fenugreek and lots of pumping after nursing, a few hours after she goes to bed, etc.
I would also ask if you have tried block nursing, or letting her eat from one side only for several sessions so she gets lots of fatty hindmilk. Or if her dirty diapers are a bit green, indicating she may be getting an imbalance of foremilk.
There are definitely options before you just start giving cereal which, I agree, may cause bigger BF issues.
I agree with this.
Also, if your goal is 6 months, and you've made it already to 4, ask yourself how much energy you really want to put into getting to 6 months. I tried and tried and tried to up my supply with my DS from about 4 months on (and had an original goal of 6 months.) I stressed so much during that final month of nursing him and I sort of wish I had evaluated how important that 6 month goal really was to me. Ultimately my supply tanked just short of our goal. So, really ask yourself how important this is to you and go from there...
My little guy weighed 13.3 at his 4 month appointment and was 8 lbs at birth. He has consistently been in the 25th percentile in all measurements since he was born... I was actually worried about his weight gain, but my dr said she was not worried. I am petite, and my husband, although tall, also has a small bone structure. She told me that I was not underfeeding my baby and that they expect a baby to double birthweight by 6 months before they become concerned, and she said our LO was right on schedule for that. She also said that she is more worried when babies come in overweight, as she is very concerned about childhood obesity.
She suggested adding in oatmeal and baby food once we thought LO was ready and didn't push the idea; however, LO gets about 6, 4oz bottles of breastmilk daily and was sleeping for 6 hours at night before waking to eat. We did decide to add cereal, and he's been on it 2 weeks. Since then, he has slept 8 hours during the night without waking (which is awesome since I am working and am finally getting sleep). I also made a trip to the farmers market and picked up some organic butternut squash and made some of that for him and he loved it. I only give him about 2 tbs of squash and cereal 2x a day, but my supply has not been impacted so far. I always make sure he drinks his breastmilk before offering other foods.
Check with your pedi and see if they are using the growth chart for breastfed babies or formula fed babies. Apparently, there are two different charts. She said that breastfed babies typically don't catch up with formula fed babies until about 12 months....
The best advice she gave us is: do what you feel is right, not what everyone else tells you and not what the AAP tells you. You know your baby better than anyone else.
Good Luck!
This. I agree that one pound in two months does not sound like enough but I would visit with an LC before making other decisions. Good luck!
obviously i'm an internet person and not a doctor, but i would check out this article that touches on why breastfed babies slow weight gain down around 4 months.
article link
I would probably talk to my La Leche League leaders and a LC before I made a choice. I would think about how my "mommy instincts" felt - do you think your daughter is doing well, or were you concerned even before this appointment? Distracted eating is normal for this age, and it can lead to the night feeds to make up for it. Neither of those things is worrying at all.
Starting solids a bit early is hardly the end of the world, but it may or may not make a difference. Getting a second or third opinion is always a good idea if the first one is not resonating with your instincts or your parenting style. It's okay to question a doctor, I promise. It's also okay to change course if what you were planning on isn't working for your baby.
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I would make an appointment with a lactation consultant.
Is it possible that they measured her weight incorrectly at either visit? I feel like if my baby was not getting enough food because of a supply issue she would let me know...
You should do more research and see an LC before starting solids. Starting solids in a breastfed baby actual SLOWS down their weight gain. Cereal has far less calories than breastmilk or formula.
this is from Kellymom:
MYTH: "Your baby is small so you need to start solids."Another reason often given for starting solids is because baby is small (see Normal Growth of Breastfed Babies). I really don't see the sense in this. Ounce for ounce, breastmilk has more calories than most baby-safe solid foods and significantly more nutrients than any type of solid food that you can feed your baby. In addition, starting solids will quite possibly reduce the amount of milk that your baby is getting overall, rather than increase overall intake. One of the first recommendations for a baby who genuinely has slow weight gain is to decrease or eliminate solid foods and nurse more often.
DD is gaining barely a pound a month the last two months (she was 13lbs 12 oz at her 4 month) and my pediatricians suggestion was to wait on solids since she is gaining slowly. I went home and started fenugreek (3 pills, 3 times a day) and now she has gained 6 ounces in 6 days. She was always satisfied and peeing enough, but I think the faster flow and larger supply is helping her to get more.
If you do decide to start solids, it is much better to add something nutrient and calorie dense, such as avocado, and skip the cereal.