Do I have a problem?
I'm new here. I have a 4 month old son who is exclusively breastfed. This week at his check up I learned that his weight has dropped from 30th to 10th percentile. His pediatrician suggested that my milk is not as nutritious as it should be and gave me 3 options: do nothing different, supplement with formula or start solids. I thought all if that was craziness so what I did was start pumping after most feeds, power pumping at night, taking More Milk Plus and I made an appt with an IBCLC. I had the appointment today and even though she was excellent, the outcome was inconclusive. She isn't even really sure if I have low supply but still endorsed my pumping/supplementing regime. My baby got 2.5 oz at the breast btw. The one thing that she wants to look into more is my thyroid- as I do have hypothyroidism that is well monitored. I take Synthroid and my dose increased during pregnancy from 100 to 150 mcg. At 12 weeks postpartum I was still on 150 and my blood results showed I was basically hyperthyroid so my dr lowered my dose to 125 and I'm supposed to be tested next week.
Does anyone have any thoughts? Especially about the thyroid situation. My goal is to ebf until 6 months and then bf til 18 months or so.
Re: Do I have a problem?
What charts is your Dr using? The CDC charts or the WHO charts? Breastfed babies tend to gain more in the beginning and then level off, so it's no uncommon to see the kind of drop you decide - my babies actually dropped a lot more dramatically - for example my second was in the 90th percentile in the early months, and now is in the 10th percentile. In any case, usually one timepoint is less important than the trend - for example, a continued drop is more worrisome than shifting from 30 to 10 and then staying consistently at 10. Being in the 10th percentile is not worrisome in and of itself - there are as many babies at the tenth percentile as at the 90th. What about height and head circumference?
How many times in 24 hours are you nursing? Do you schedule or limit nursing in any way? One thing that never hurts is simply to offer the breast more often. Baby won't overfeed at the breast so it never hurts to offer. Especially if baby is sleeping a long stretch at night. Let baby comfort nurse as much as he likes - mom's breast is the original pacifier!
A single weigh-nurse-weigh is not particularly informative (although 2.5 oz is a perfectly normal meal size).
Also, breastmilk is generally the most nutritious food a baby can eat on an ounce-by-ounce basis, and is the primary form of nutrition in the first year. Unless mom is literally starving (as in, a famine situation), it's really unlikely that her breastmilk is not nutritious. Solids in the first year are mainly for learning tastes, textures and learning to self-feed, rather than their nutritional value. So I don't think starting solids will help much from a weight point of view. It sounds like your doctor offered you the option of continuing to breastfeed for now. Why not continue to do so and see where you are at 6 months?
Thyroid disorders can affect milk production, so that's good that you are staying on top of that. I'm sure mommal will have a comment about that!
Re: Do I have a problem?
:ita with the PP. As long as you're feeding on demand, my guess is that the decline in percentiles is the normal "leaning out" that tends to take place as breastfed babies go from being essentially sedentary to expending more and more calories on motion. At this point your baby is probably doing more kicking/rolling/reaching, and that can use up a lot of calories that previously got packed on as fat. Both my girls dropped significantly in their weight-for-age percentiles between 2 and 4 months, and dropped more between 4 and 6 months. Their pediatrician didn't care because she's familiar with the growth patterns of breastfed babies.
That being said, yes, please get your thyroid checked!!! It's really common for a moms to experience something called postpartum thryoiditis, and a typical progression would be for a mom to go through a hyperthyroid phase, followed by a hypothyroid phase. Postpartum thyroiditis is more common in women with preexisting thyroid conditions, so you definitely want to stay on top of this and get tested frequently.