Wednesday, February 17, 2010

Poor weight gain in older babies

Many of you probably remember that back when Shira was 4 months old, I was informed that her slow weight gain is obviously and without a doubt caused by me not having enough milk; and I was told to switch to formula.

I contacted La Leche League, tossed away the advice of formula-feeding, and continued to exclusively nurse my baby. Supposedly, if the pediatrician's theory was correct, I was to expect a major leap in weight gain once we started solids, but it never happened.

I never returned to see that pediatrician again, but if I did, I would dearly love to hear her explanations on why my child is still gaining slowly now, when my breast milk is no longer her primary source of nutrition. Perhaps it would make her think twice next time she's about to tell a young mother she "doesn't have enough milk".

Our current pediatrician made the ridiculous and insulting suggestion that we're underfeeding our child. For the record, Shira happens to be an exceptionally good eater. She'll eat practically anything and has an excellent appetite. She's healthy and very active. When we said so, we were told to stuff our child on bottles of milk and cornflour. I was also recommended to wean my baby so that she would eat more (quite a ridiculous bit of advice, as breast milk is high in calories, but especially ridiculous considering the fact that our daughter is already eating a wide variety of foods). Our pediatrician actually told us with all seriousness that "you can't add cornflour to mother's milk."

Now, that was one of the moments when I was very happy to have 4 years of nutrition studies under my belt. As I pointed out to our pediatrician, there are so many ways to boost a child's diet with healthy, calorie-rich foods, when it is really needed, especially when a child is not a picky eater. Truly, some pediatricians desperately need to upgrade their knowledge on both breastfeeding and children's nutrition.

Some days later, I happened to get together with two neighbors for a chat. It turned out that their children (aged 12-18 months), too, were labeled as not growing fast enough, and their concerned mothers had a whole array of frightening suggestions thrown at them, from various absorption problems to growth hormone deficiency.

I do believe that if a doctor suspects something serious is responsible for the child's slow growth, it's better to perform the necessary tests (though I personally wouldn't rush to do invasive procedures) and rather be safe than sorry. However, I must ask myself, if so many healthy children happen to be off the growth charts, might it be that the charts, not the children, are at fault?

Mother in Israel wrote about the topic some time ago: here and here

The comments below the posts are very informative as well. 


Serena said...

Oh, that hits close to home! The pediatrician we were going to suggested the same thing: that we weren't feeding our daughter enough food! We've never been back. I was beyond flabbergasted. If he could see her eat...

Our younger daughter, who also has a very good appetite, fell off the growth charts (which she'd already been at the bottom of) after she started solids. The doctor (a different one from above) took the sensible approach: keep an eye on her. After a few months, he was comfortable with acknowledging that that's simply her build: tall and lean.

The fact that we feed our children healthy food might have something to do with them not sizing up to those charts. The charts are off.

Rebekka said...

I don't understand the benefit of starving a child for nutrients in favor of giving a bunch of quickly-burned-off energy when that is the exact opposite of the nutritional advice they give to everyone else. How bizarre.

All I can think is that Shira must have inherited your body type, Anna - aren't you very slender? If she's happy and active and is otherwise developmentally okay, I wouldn't worry about it at all.

Matt and Heather said...

I think that it is common for dr.'s these days to suggest formula, and to also suggest that we aren't feeding our children well. But, what I think the real problem is that there is such a large percentage of parents who use formula now, that babies gain weight faster due to the amount of formula they are given. I think that if we looked at charts from years ago when women were primarily breast feeding, we would see that our children are right about where they should be as far as growth. Plus, if your child was not thriving, was lethargic, you would know as the mama that there was a problem. If that isn't the case, I say who cares what the dr. says :-)

LeAnna said...

That is precisely why we don't go see a pediatrician regularly. We take our son to a small clinic if he is ever ill, but I finally just quit doing the milestone check ups. My little one is 13 months and barely weighs 20 lbs. He is not a voracious eater, but he does eat, and actually weaned himself at 10 months (much to my sorrow...) He is just extremely active and a little guy, and it sure has not affected how he grows mentally- he's smart as a tack! I get so frustrated when Dr's assume that because a child is not chunky like the majority of the populous that they are underfed. For us American's we wonder WHY obesity is a problem? I for one happen to think it starts at the pediatricians office...
Way to go, Mama, for holding your ground! You keep doing what YOU know is best for your baby.

Heather M said...

My middle son has always been on the small side. He isn't off the chart, but close. I am fortunate that my pediatrian looks at me and said that he's fine, that he probably just takes after me is all (I am rather small).

Good luck to you.

Karen said...

I have a child who was not gaining well and it turned out she did have a medical condition, actually a couple of them. One was severe acid reflux, another was true milk and egg allergies. The reflux is treated with medication and diet modifications were needed until she outgrew the food allergies. She became a better eater with the acid reflux treatment and a variety of issues like eczema and poor sleep improved with the dietary changes.

Based on my experience, I think it is better to just get at least the minimum recommended testing done. There are hundreds of things that can cause poor weight gain, some of them serious, which is why doctors get concerned when a child is not gaining well. It can be very stressful for the mother to not know why a child is growing poorly. Even if no medical cause is found, it can't hurt to see a child nutritionist, which we did. The nutritionist can recommend the ideal diet for a slow gaining child, and if needed, he or she can also recommend behavior modifications that benefit the entire family and take the stress out of feeding times.

The last note is, genetics must be taken into account. A mother who is on the thin side like me and you can't be expected to have a heavy child. I was very thin as a child and I brought a picture of myself as a child to my daughter's pediatrician. My daugher clearly has my build. Even with the medical issues addressed, she is still on the thin side, and now the doctor says it is partly genetic.

CappuccinoLife said...

Wow Anna, sorry for all you are dealing with. Frustrating how they automatically blame breastfeeding for everything.

I think the charts are close to useless and heavily influenced by culture (American charts cater to the obesity fears here). Mine were off the charts in the opposite direction, but they were never and are not now obese by any stretch of the imagination. Fortunately we had a doctor who was reasonable and rational. lol

Mrs. Mordecai said...

My pediatrician got on my case for my son being too small. But the mother part of me revolted: he was happy, healthy, and hitting all his milestones ahead of schedule. Turns out he's just a skinny little boy. And there's nothing wrong with that.

Anonymous said...

I am so grateful that our pediatrician is very pro-breastfeeding, logical, and reasonable doctor. Yesterday was my son's check up and he gained a pound over the course of two months and I was worried about it as he usually gained a few pounds. I brought that up and she was very reassuring, saying she wouldn't worry about it as long as my son is healthy and doing well. If I want to, she said, I could add an extra feeding or solid food feeding, but she left it entirely up to me.

Are you going to find a new pediatrician, Anna? If you are, here's hoping the new one will be pro-breastfeeding and reasonable!


Hearth said...

I too am vague at why your pediatrician wanted you to add corn flour to your daughter's diet... how useless!

My children are on the opposite side of the scale - but both my husband and I are heavily built, and have always BEEN heavily built. My husband is also very tall. Of course I have big kids... why should my kids and your kids weigh the same??

How very VERY strange...

Bethany Hudson said...

Well, you know our story, Anna ;-) After being born over 8 lbs, Sophia rapidly dropped in weight categories (though didn't "lose weight"), particularly after starting solid foods. At age 12 months, she was no longer on growth charts at all. Our ped. did a blood panel, and we ruled out any absorption problems, thyroid or liver deficiency, and celiac disease. Fortunately, our doctor has been around long enough that she can look back on trends: Though Sophia is not even ON a growth chart by today's standards, in the 1980s, she would have been in the 20th percentile!!! Perhaps all this forced-timing formula feeding is simply skewing the growth curves? Stick to your guns, as long as Sheira is healthy and gaining weight ON HER OWN CURVE, and give her what's best: the mother's milk that God gave you to nourish her with.

Anonymous said...

My daughter was slow to gain for the first year or so, and then she shot up to the size of her older brother. We didn't visit pediatricians but I'm sure if we had they would have been all over us for her not following the growth charts properly. She was just growing on her own curve. She was bright and happy and exceeding milestones and loved to eat. So, I saw no reason to worry and do invasive testing.

The only time when it was an issue was in the first month of her life (when we still saw a pediatrician since she came a month early), she wasn't gaining enough, and the pediatrician we saw back then said we should supplement with formula. We said no thank you, and although everyone was very concerned, it turned out to be for no reason at all - she started gaining just fine. When we went to see the doctor at the end of the month he said proudly, "good thing you started supplementing" - and when we told him we didn't supplement, he just stood there a little bewildered, like, she actually made it on mother's milk? Wow.

Alycia said...

As I've mentioned before, both of my children were classified as "failure to thrive" based on their size. I also received some ridiculous nutritional advice when I brought my now 19 month old daughter to the doctor this fall - he told me she probably wasn't eating enough and to stuff her full of chocolate milk(!) and "whatever else you can get her to eat." This is not a picky child, and I feed her a good, wholesome diet fairly high in good quality fat. I refuse to pour corn syrup, white flour, and sugar into her simply to get her to gain weight! When I looked up my own percentile for my age and body mass index, I am only at 12th percentile when I am not pregnant... perhaps it stands to reason that my children are small! Where is the common sense?

Kimberly said...

Good grief. I can't think of a better way to send a child down the path of diabetes than to feed them corn flour, aside from straight up sugar water bottles. There is a reason cows are fed corn- to overly fatten them up. Good for you for seeing through that ridiculous advice.

Shannan said...

this kind of makes me think of the problems i'm told my mother had with me as a child... i didn't eat much and was skinny. she went to one doctor who panicked, wanted me tested for everything under the sun and questioned every move my mother made. another doctor though, seemed more willing to accept the 'no two babies are the same' concept... he told her to feed me as much as i would eat when i would eat, make sure it was all healthy and high in calories (nutritious ones) and as long as i was active and developing normally, don't worry about it... he said 'well she'll probably always be thin and always have a small appetite'... and what do you know, he was right! i'm healthy, active and eat well, but i'm thin and never eat a lot in one sitting. isn't it funny what can happen when a doctor just stops and thinks and evaluates each situation individually?

Anonymous said...

I am a new reader here but I love what I see and plan to stick around! I couldn't help but drop a note when I saw todays topic, as I am a breastfeeding mother myself. I have been blessed to find a midwife that believed in breastfeeding and many support places throughout my hospital and doctors offices, but have still run into those who disagree and will say anything to "promote" formula. It is my understanding that the charts used in pediatrian offices are made by the formula companies and are therefore altered to make the extra weight gain from formula look "normal". It is a marketing ploy which sadly many doctors buy into and try to push on the gerneral population. However, as followers of God we are always in a minority of our own and should not feel in the wrong for just another aspect of lives making us a minority. We should take it as a compliment that our children do not weigh in to societys standards.

There are other ways to know if your child is gaining poorly due to food alergies. You can watch the baby and know what foods bother her, if any. Even if the child is not yet eating solids, food the mother eats will show up in the baby and if there is a problem, manifest in rashs, poor sleeping, vomiting and other things and with careful looking to your diet can be quickly changed. Even easier when the child begins eating solids. Do not take any rash lightly. It could be an alergy and by watching the signs you will see how much you child can tolerate of that food, if any.

Mothers know best and you should not let anyone ele tell you otherwise.

Anonymous said...

It may be that people, including pediatricians, don't know what healthy children look like. Much like most people don't know what food portions should look like. You are right, I think the charts are off. And we wonder why there is an obesity epidemic in the industrialized countries?
A child starved for nutrients is listless with poor hair and skin. Why don't doctors judge by other signs than by weight charts?

AnneMarie said...

I think that since these growth charts are still based on formula-fed growth data it skews the doctors' assessment of breastfed babies. AND every child is different, yet they want to put all babies into one growth mold. My daughter has always been on the small side, as has my friend's daughter who eats a ton, but on the other hand the baby boy I babysit is breastfed and he's huge! It's different for every child and doctors need to take that into account more often.

Leah Burks said...

Oh, brother! I think sometimes it's best to proverbially pat our pediatricians on the head and say a polite "thanks" and get outta there! YOU know best how happy and healthy she is and like others have said, she is your daughter, and you are a slim person! My son eats like crazy as well, and is still near the bottom of the charts. Since both my husband and I have struggled with being overweight our whole lives, I actually am thankful our son seems to have inherited his grandfathers metabolism!

Literature Goddess said...

Hi Anna--
We've talked before about nutrition. My little guy is still little at 12 months, but he's very active and developmentally right on target. He eats often (just like me!) but is on the slender side---just like me :) Our doctor also said that when he started solids, that he'd have a jump in weight gain. Not so--he loves solids, but no huge gain. He's still gaining on the same steady curve--40 percent in height, 5 percent in weight. And I'm ok with that.

Something to think about: My husband and I laugh at the news reports of the obesity epidemic--it's not in our house! My older son at 16 is probably still the 50th percentile in height and the 10th percent in weight as he was in his first year--and that's good! We are an active family and we eat healthful foods. We don't get the obsession over encouraging fat babies. Babies will grow at their own pace in most cases.

My 12 month old is still happily nursing. We are going to a new ped this week--one we've heard is supportive of nursing babies (and their mothers!). I wish we'd found her earlier.

Thanks for posting about this. It makes me feel less alone.


Marianne said...

My son has always been in somewhere in the 25th-50th percentiles for weight. But I have a good friend whose daughter has always been off the chart. This child has never hit any of her developmental milestones (e.g. she started walking at 19 months and at 34 months, she still isn't talking). The pediatrician used her low weight to encourage my friend to seek other specialists (nutritionists, development pediatricians, and speech therapists). My friend is still convinced that she's just tiny and shy. My friend is petite and thin like you, but I think that sometimes, we can get caught up in that "little girls are supposed to be tiny" mindset and not worry about them being tiny. If your daughter, as you said, is developing within normal parameters, it's probably not an issue. But it seems like very low weight CAN be an idication of other problems.

Gothelittle Rose said...

Ohhh boy.

I addressed the issue of my own baby in my blog a month ago. She had barely gained from 6 to 9mo and the pediatrician said that they wanted to keep an eye on this. She had me go in for a weight check in a month, and that was yesterday.

My little girl had gained nearly an entire pound in a month, leaping up four percentiles, and the doctor wanted to know what I did. Well, I'd done just what I'd done for 6-9mo, breastfed except for one or two solids a day, since this poor baby would throw up if she had any more solids than that...

Though she's gaining well on breastmilk now, the doctor encouraged me to try a safe and old medication for her reflux. I started it today, and she's been a different baby, sleeping more, less irritable, and even more cheerful than ever!

So though I know the doctor underestimated my baby's caloric intake (she was stunned to learn that I'd been breastfeeding on alternating sides 10-12 times a day with each breast carrying at least 5oz, probably more, of milk), I'm still glad we stuck it out and got her advice on the reflux.

ROSIE said...

I have to agree...growth charts have become more and more skewed toward today's obesity epidemic. And I do find it ironic that formula companies' names are sometimes printed on the growth charts used by pediatricians' offices!

I breastfed all four of my babies and none of them were ever above the 20th percentile in weight after 6 mos. of age. Two of them have true food allergies which we discovered early and addressed. Two of them did not. We too have slender body types, and there are many petite people in our family tree. The children were healthy, rarely ill, growing in height and gaining slowly but steadily, and achieving developmental milestones on time or early (indicating healthy brain development, which requires excellent nutrition!). Yet, we too were practically accused of not feeding our children properly and being neglectful parents!

Some breastfeeding mothers do have trouble because the infant nurses briefly on both breasts, getting only glucose-rich "foremilk", without nursing long enough at either breast to get the fatty "hindmilk" which does add weight and also healthy fats important to brain development.

There are situations when it's definitely important to do some bloodwork or other tests, but there are usually other physical symptoms to go along with the clinical picture to indicate such testing (such as problems with diarrhea or eczema).

Nothing shocks me anymore... said...

There must be somethin gin the air lately with Pediatricians. My cousin took her daughter in for her 2y visit. At birth she was growth delayed due to placental problems and was a mere 5lb 5oz and less then the 5th percentile. At 2y she is in the 99% and 3feet tall! The Dr told my cousin to cut out juice.. She refused to believe the baby hates juice and only drinks milk and water. This is only a small issue with this Dr.. that will no longer be their Dr after this last visit...

Kate said...

Thankfully, I have a pediatrician for my children who only takes those charts so far. He actually opens his eyes and looks at the child. The child is happy, has a healthy glow, plenty of energy and isn't skin and bones. Must be doing just fine. :)

I will say that I didn't produce enough milk and had to switch to formula despite using all the usual ways to increase milk supply (and some unusual ones as well). I fought it tooth and nail but my daughter did drop so much weight her skin was actually droopy from the loss of fat underneathe!

I did look into homemade formula, but that was cost prohibitive. Instead, once she turned a year old, she went on raw milk.

I'm pregnant now and when I'm in my 3rd trimester I plan on contacting LLL to get a great head start on successful nursing. I also plan to line up mother's helpers to come and take care of things for 1 month to 6 weeks post partum so I can establish a better start in nursing.

Elisabeth said...

I noticed that on your side bar or maybe it's your wish list, you have "Nourishing Traditions" listed. I'd encourage you to get that book, especially if it's on your wish list. The infomation in there is invaluable. There is a chapter in there on "Feeding Baby". It's interesting to learn how our foremothers fed their babies! Another good book that I have seen recommended and just borrowed from the library is "Real Food for Mother and Baby". I'd recommend looking into that one too.

It sounds like Shira is a healthy little one. I can think of good real food like eggs and healthy fats that would help her more than cornflour! That's a sad way to feed a child!

Jiabaoyu said...

I'm not sure where people are finding these pro-formula pediatricians but the standard medical school curriculum has been that breast milk should be the only nutrient baby needs until 6mo when solids should be introduced.

I don't know of a single pediatrician / professor at my med school who advocates formula over breast milk for healthy mother and baby, certainly not for infants. The same goes for the OB-GYN service I was on. We constantly stress breast milk, yet some people still insist on the bottle. How odd that there are still docs out there that evidently hasn't updated their information since the 70's.

That said, I also rotated with the developmental pediatric service for a month. Failure to thrive is a serious and scary diagnosis and pediatricians are trained to keep a sharp eye out for that, and perhaps overreact to certain milestones not being met, including children that does not appear to not follow the growth chart. And I'd say, in the cases I've seen, these kids usually are starving for nutrients. I'm sure there are exceptions, but many are real cases of a either a sick child who can't eat properly or a negligent parent.

However, if parents have issues with a pediatrician, just find another one that better fit your needs. But do not avoid going to a doctor altogether. Many serious childhood issues can be missed if regular checkups are ignored. Because I did my peds rotation at a tertiary pediatric center, we see many cases of children with rare, but devastating diseases. Sadly, some of them can still have been avoided by more responsible parenting.

Anonymous said...

I have six children, 5 were breastfed for at least a 18 months. My #1 son and #2 daughter have always been slender, the others varied from chunky to "normal". A healthy child is strong and bright-eyed, not some "magic" number on a weight chart. The only child I saw that was actually malnourished and under weight, was one whose mother took her completely off of formula and only fed her a jar of apple dessert (at the age of nine months she was small, weak and obviously stunted compared to my then six month old.)
Mrs. McG

mother in israel said...

Anna, thank you for linking to my post.

Rosie wrote:
Some breastfeeding mothers do have trouble because the infant nurses briefly on both breasts, getting only glucose-rich "foremilk", without nursing long enough at either breast to get the fatty "hindmilk" which does add weight and also healthy fats important to brain development.
That is sometimes a problem in the early weeks, if baby doesn't latch on well or has timed feeds (i.e. mom removes baby and switches after a set number of minutes.) But once baby is gaining well, it's not much of an issue. Babies regulate their caloric intake if they have full access. :)

Mrs. Anna T said...

Just a few notes: while we aim for a healthy diet at home, it is by no means low-fat. We eat real butter and cream and drink whole fat milk. We also daily eat eggs, and healthy fatty plant-based foods such as olive oil, avocado and tahina.

As for switching pediatricians, it might be tricky because we have ONE pediatrician in our area and right now we're not in a position to commute regularly to see another pediatrician.

Pendragon said...

I'm with you on this one! We are evolved (or designed, if you prefer) to survive. Kids will naturally eat what they need as long as they have access to food.

When I was growing up, my mother was constantly worried that I wasn't getting enough food because I was a really picky eater and I was a shrimpy kid. But she decided that I would naturally eat what I need, so, despite her worry, she didn't force me to eat more than I wanted or to eat foods that I didn't want.

I think in the long run this philosophy helped me to remain a healthy weight to this day, rather than becoming overweight. Kids who are forced or urged to consume more calories than they would naturally have, I think, have a harder time controlling their weight later in life. This is because these kids develop or are forced into the habit of eating more than is satisfying to them. I believe also (and anyone trained in nutrition, please correct me if I am wrong) that the proliferation of fat cells in childhood makes it harder to shed fat as an adult.

Mommy-moto said...

I was a momma who had to use the bottle part time, simply because of an inability to pump.
I was producing enough milk for tow babies and my son nursed like a champ, put on weight and was (and is) healthy. But when I went to pump, I was barely able to squeeze four ounces (118.294 milliliters)!
When I went to work two mornings out of the week, my little guy needed to eat something, since I sometimes have to work well into the after noon.
I don't think a lot of women know about this problem, or even if other women have the same inability to nurse, but not pump, but it was very hard for me.

Mrs. Anna T said...

Mommy-moto, I had exactly the same problem when I tried to pump. I simply couldn't reach milk letdown with the pump, so I only got very small quantities. Eventually I figured out how to do it: I put Shira on my breast and let her nurse on one side until I felt milk letdown, and then I pumped on the other side and got enough for those few times I was away from her, or fasting.

Nevertheless, if I went to work on a regular basis when she nursed a lot, no doubt it would have been very difficult.

Literature Goddess said...

In my experience, most pediatricians are long as everything goes as they think it should. The minute you have a slow-gainer, formula supplementation is the first response.

I asked a friend of mine who is a nursing mother and surgeon about this--she said that most peds do not have to take any courses in lactation. She said "most have a vague idea that breasts make milk". :)

I think honestly that it is easier in the 10 minutes you have with a patient to suggest supplementation rather than gauge how committed the mother is and give advice on breastfeeding, or suggest a lactation consultant. It is sad because this sabotages breastfeeding in so many cases.

We (finally) found a supportive doctor. Our first appt was yesterday. My little guy is 1 year and 17 and a half pounds. But, he's very active, and in our doc's words, "perfectly healthy".

Finally. :)

Hi I'm Amy, said...

So I am sitting here after stumbling on your blog. I can't understand why Dr.'s say these things? We experienced the same sort of comments from a female dr. with our 3rd baby. I nursed her exclusively for the first year. She was plenty big. Although she is just thin and tall like our first daughter was. The Dr. Told me she was much to thin and needed to have weight checks regularly. Which drove me crazy. I had one Dr tell me to Stop nursing her altogether. It is just so amazing to me. God created breast milk as the perfect food for our babies. Why on earth do these dr's say these things. Good for you for sticking to your guns. You know what is best for your child! Keep up the good work! Being a Mother is the most important job that there is.