HELP.. breastfed twins failing to thrive at 15 months

MaygenDL0ve · January 2012

Need some help/advice w/ my 15-month-old identical twin boys.

They have been diagnosed w/ failure to thrive. They have exclusively breast fed and have always been low on the scales (AAP scales, around 4th percentiles). Now they are losing weight at times, and holding steady around 1st percentile at other times.

Stool samples indicate they have abnormally high amounts of fat. The finally saw a Pediatric GI specialist yesterday and he is checking their pancreous for enzymes. He also said to give them 16 oz of pediasure/day each. We've tried this before w/ no luck. He said to take away ALL their fluids including breast milk and they will cave after a couple days and start drinking the pediasure. I'm so worried about this; we co-sleep and breastfeeding is the only thing that comforts my boys and makes them happy. How can I do this?? They nurse before both naps and before bed, and several times at night.

Hope2Have · January 2012

I understand how hard it has to be... but they don't know what's best for them and although it's all that makes them happy, you have to do what they need. They'll start drinking it I'm sure. Prayers to you and your adorable boys!

mr+ms · January 2012

It seems like the GI is making an assumption I'd be uncomfortable with. What if they *don't* go for the Pediasure and your supply decreases. You have the 2 options now and you might end up with 0. Unless they have training specifically in breast feeding, I also tend not to fully trust feeding advice by peds/physicians.

How long does it take to get the enzyme results back? I wouldn't do anything hasty until then at least.

Personally, I would only wean if there was something directly harmful about the breast milk itself that couldn't be resolved through diet. Sometimes BF moms switch to pumping exclusively for a while if things need to be sorted out through diet either on your or the babies' end so that's another option.

Do you think it could be the taste of pediasure itself that your LO's dislike? Maybe a homemade recipe would be better? Then you can adjust the ingredients yourself so that they like the flavors. Do they tolerate dairy well? How about ice cream? That's usually a kid pleaser and brands like haagen dasz include real eggs. For now, I don't know if you'd want to give them extra fat because they're not absorbing enough or cut back for the same reason... that would be a good question for the GI. Or are they not really into sweets? Maybe a high calorie savory dish would work better?

GL - hope you find a good solution!

3003girl · January 2012

I would get a second opinion.

A friend of mine had a LO who was failure to thrive and they told her to stop breastfeeding so she would drink pediasure at 12 months. Well, the kiddo never drank the pediasure and ended up losing weight and the mom dried up. She didn't gain weight for NINE months until they finally figured out she was allergic to dairy. Now she is finally growing.

I would be wary of anyone telling me to stop BFing. See a LC or check Kellymom for reference. Like PP said, I don't take any Pedi or Dr's advice on BFing unless they have special training.

Also, are they growing in height and head circ? My LO didn't gain much weight from 12 -18 months and pedi is not worried at all. She is on the move, and still growing in height and head - he said that is the most important. But she also never lost weight that I know of.

mr+ms · January 2012

solidio:
they finally figured out she was allergic to dairy.

If the first round of testing doesn't lead to good answers, intolerances/allergies might be something to look into. Some common baddies are milk & soy protein and gluten (wheat, barley, rye) and those are very prevalent in the American diet. I think your LO's are probably old enough for the blood tests.

Also, it's possible for common meds like zantac and PPI's to impact digestion. We need sufficient stomach acid to break down food so that it can be absorbed and beyond that there are complex loops of signaling that go on surrounding the digestive process. So if stomach acid is suppressed, it could impact the release of some other necessary enzyme(s).

gebell · January 2012

Hey, I only have one baby to worry about, and it is stressful enough when she won't put on weight, so first of all, I want to say I feel your pain!

Failure to thrive - what does that mean exactly? Are your children happy - that would be my first question. Do they seem to be in any discomfort? They eat some solids right?

My daughter is in the similar percentiles as you mention - she is 16 months old. My doctor is fairly recently out of med school and very 'up with it' as far as research goes. She is fantastic because she made me relax and not get overly worried about this. She said that we need to take into consideration the genetic build of the children as well - they may be small in build genetically.

My daughter has just been getting her bottom molars (probably for the last month I think). Over this time she refused to eat most solid foods. As she was already on the slim side, she lost a fair bit of weight and I could see her spine bones sticking out! I was very worried, but just in the last few days, she has started eating really well again, and today I noticed her teeth are completely through now! Teething can really effect appetite so I've learned.

I agree with what someone else said - get a second opinion. Not all Doctors are right all the time.

Good luck.

3003girl · January 2012

mr+ms:
solidio:
they finally figured out she was allergic to dairy.
If the first round of testing doesn't lead to good answers, intolerances/allergies might be something to look into. Some common baddies are milk & soy protein and gluten (wheat, barley, rye) and those are very prevalent in the American diet. I think your LO's are probably old enough for the blood tests.
Also, it's possible for common meds like zantac and PPI's to impact digestion. We need sufficient stomach acid to break down food so that it can be absorbed and beyond that there are complex loops of signaling that go on surrounding the digestive process. So if stomach acid is suppressed, it could impact the release of some other necessary enzyme(s).

Yeah, actually, I should clarify. They finally found out she was intolerant to diary - and they think soy. She tested negative with the blood test, but they had already started to eliminate dairy and soy from her diet and she started eating and gaining. Then the blood tests came back negative, so the decided on dairy intolerance as the culprit. This was after seeing a few pedi's a GI specialist, allergist, nutritionist and who knows how many other doctors. It went on for 9 months.

So, OP, go with your gut and don't hesitate to get second and third opinions. But I would definitely be very wary of giving up BFing. BF has so many nutritional benefits, especially if your LO's are not gaining.

afc1189 · January 2012

These are all great responses. Go with your gut. I wouldn't stop BFing- sometimes I find that doctors dismiss breastfeeding after you hit the one year milestone which is so frustrating. Some doctors tend to "over treat" in a sense to have more control over the situation. They don't know the composition of your BM and don't know an exact measurement of how much your LOs are taking in.

I would keep breastfeeding. What if you stop and they won't take the pediasure or WCM? Try to add more high calorie foods to their diet- do they like avocado or smoothies? If you're willing and allergies are suspected with no positive allergy test, try an elimination diet. That's what I've done with dairy and feel much better myself. It's also fairly easy to do given all the different options out there now. Good luck!

tinaraye · January 2012

I agree with continuing to BF. Also, I think adding avocado and coconut oil to everything will add lots of healthy fat into their diets.

boogerbearoriginal · January 2012

What is the goal in having them take pediasure? What is he hoping to happens that will be worth you depriving two children of all fluids for days? Nevermind the comfort and nutrition in breastfeeding, humans need fluids daily.

I would seek a second opinion because that seems like a recipe for disaster. In my non-medical opinion purposefully dehydrating 15mo old babies to try to force them to drink pediasure does not seem worth the end result.

Ditto PP - how are their height/head circ measurements? Perhaps they are becoming increasingly active and thus "thinning out" but still growing. Are they meeting developmental milestones? Maybe they are just always going to be thinner people. I think it's important to make sure that something is truly wrong before taking drastic steps just because they don't match a weight chart.

You have to decide what you think is best, but I would not essentially forcibly wean my kids without a good reason and I'm just not seeing one here. Unless the Dr can definitively say BM is causing x problem I wouldn't stop.

Bride2b2004 · January 2012

I agree with everything the PPs said. I would not feel comfortable following that advice AT ALL. Have you tried seeing a holistic doctor/nutritionist?

BTW, your boys are adorable

jcsumm0 · January 2012

I agree w/PP about get a 2nd opinion before I would stop BFing.

If you want to try to get them to take some pediasure in addition to BM, I've heard you can get popsicles made with it (or you could easily make your own). Maybe they'd like a popsicle or slushy texture better?

Did they give you any indication of what that stool sample result might indicate?

I hope you get some answers soon!

nosoup4u · January 2012

Oh jeez, I'm sorry you're going through this. It definitely sounds stressful. I'll second what everyone else said - get a second opinion. I definitely question advice that says breastmilk isn't good for them - pediasure isn't more nutritious.

The books "Real Food for Mother and Baby" and "Nourishing Traditions" have a lot of info about rich foods to feed toddlers (though I'd definitely get a doctor's opinion about diet changes), like bone broth, whey drinks, coconut oil, etc.

Have you talked to an LC? They might have resources or doctors they work with who you could get other opinions from. hth and good luck!

TiffanyBerry · January 2012

I would probably find another GI. AFAIK, especially after a year, when breastmilk increases in fat content, breastmilk has more calories than pediasure. (Of course, you don't know exactly how much breastmilk they are getting, and that lack of certain numbers makes some docs suggest funny things.)

That said, though it is very difficult to test for at this age, if they are FTT and high fat in the stools, those are CLASSIC markers for celiac in young kids. They can get gluten through your breastmilk, so the FTT wouldn't have had to start when they started solids. You might wnat to check up on that and see if it seems to fit for you at all.

tokenhoser · January 2012

Count me on on the pile of people that think you need a better (I mean, second) opinion.

Talk to a LC. Talk to a LLL leader (she can also help you find a more supportive doctor - they know who likes breastfeeding in the medical community).

Finding ways to increase your babies calorie intake does sound important. I don't think replacing breastmilk with corn syrup enriched milk is the best way to do that.

emolm · January 2012

I've been thinking about this since yesterday and this is what I've come with:

Can you try different flavors of the pediasure? What about using a generic from Walgreens or WalMart? Like, the chocolate (or whatever flavors this stuff comes in) might taste different/better from brand to brand but will be nutritionally the same (example: I prefer the bubblegum walgreens version of pedialyte). Can you use Boost (the kids' version) or does it have to be pediasure (macbook keeps correcting to pedicure and it's making me crazy)? Depending on the tests you're waiting on, can you set up a referral to another dr in Lubbock/Albuquerque/Amarillo?

rosiemomma · January 2012

SECOND OPINION! Be very weary of a pediatrician that suggest 'brand' names especially if you start researching who owns 'pediasure' I would definitely dis-agree with my doctor if they suggested this and if they were not open to other suggestions I would find a new doctor.

Don't let this doctor ruin your nursing relationship! If it comforts your children and you still enjoy it, no reason to stop!!!

here is more:

https://www.kellymom.com/babyconcerns/growth/weight-gain_increase.html

https://www.kellymom.com/nutrition/solids/toddler-foods.html

https://www.kellymom.com/nutrition/milk/milkcalories.html

https://www.breastfeedingbasics.com/qa/nursing-beyond-the-first-year

https://thestir.cafemom.com/toddler/116520/5_toddler_breastfeeding_myths_that?utm_medium=sm&utm_source=facebook&utm_content=natural_fanpage

etoyama · January 2012

Booger+Bear:
What is the goal in having them take pediasure? What is he hoping to happens that will be worth you depriving two children of all fluids for days? Nevermind the comfort and nutrition in breastfeeding, humans need fluids daily.
I would seek a second opinion because that seems like a recipe for disaster. In my non-medical opinion purposefully dehydrating 15mo old babies to try to force them to drink pediasure does not seem worth the end result.
Ditto PP - how are their height/head circ measurements? Perhaps they are becoming increasingly active and thus "thinning out" but still growing. Are they meeting developmental milestones? Maybe they are just always going to be thinner people. I think it's important to make sure that something is truly wrong before taking drastic steps just because they don't match a weight chart.
You have to decide what you think is best, but I would not essentially forcibly wean my kids without a good reason and I'm just not seeing one here. Unless the Dr can definitively say BM is causing x problem I wouldn't stop.

Agree! Agree! Please do not stop BFing them. It sounds like a terrible idea to me. Please get a second opinion.

SnoopyLuv · January 2012

Head on over to the special needs board- I know there are some blogs out there for suggestions on how to fatten up a toddler's diet. Things like oils, butter, avocado, cottage cheese.

Similac makes pediasure- which is what some PP's are getting at- it's a brand thing and a money making thing. If they won't drink it, you can't make them and they will be worse. I would get a second opinion from a different pediatrician.

I'm so sorry you're going through this.

bino63 · January 2012

Second opinion yes. Also get referral to a pediatric registered dietitian. I am registered dietitian and would never recommend withholding all other fluids to force them to drink pediasure.

You will see the credentials RD after their name. I used to work in pediatric nutrition and would see a lot of failure to thrive that doctors would consult me on and they had fallen off the growth chart for one month and then were back on the next.

Also doctors are not trained in nutrition at all normally. So ask your physician what nutritional training he has had.

MaygenDL0ve · January 2012

Thank you for all of these responses. I feel re-empowered instead of lost, and my decision is clear: We will continue to breastfeed! I think the boys sensed something going on because where they normally only nurse 3-4 times for Connor and 5-6 times for Barrett, today was a LONG day of round the clock begging for milk!

I've got so much work/research to do. Mama's going mad in her kitchen trying to whip up all the options. Hopefully next week we'll know the results of the pancreous enzyme test. They were on reflux meds and allergy meds the first 7 yrs of their lives. Gosh I wish I were more educated on all of this before becoming a mother! There is no time for all the researcH!

3003girl · January 2012

good luck and keep us updated!

jcsumm0 · January 2012

Yeah, keep us posted!

You are doing a great job mama!!

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