Failure To Thrive

[@llli*trishb]

My daughter was diagnosed as FTT on Thursday. She will be 4 months old tomorrow. At birth she was 6lb 12oz.and 19.25in long. She weighed 6lb 4oz when we left the hospital. She was 8lb 11oz and 23in on Thursday. She is EBF and I want to keep it that way. Her pedi prescribed Similac Human Milk Fortifier, but her insurance doesn't cover it and neither does WIC. It is way too expensive to purchase. When we consulted with the pedi about it, he said I should pump all weekend and keep track of how much she is taking in. It took until yesterday at 4pm to get a good pump from WIC since mine is horrible. I haven't been able to pump much since she wants to eat at least 10 times per day. I have recently cut out dairy and soy because she has been a very fussy baby. It seems to help a lot and it has only been 3 weeks. She has also been on Zantac for silent reflux since 8 weeks. The pedi told me over the phone that if he cannot quantify how much she is taking in every 24 hours by me pumping and bottle feeding her and she doesn't gain enough by Monday, he will run blood tests. Then he went on to say that if the blood tests come back normal he wants her hospitalized. I do not agree with that since she is meeting all of her milestones. I think the pedi she saw (in the same practice) at her 2 month appointment dropped the ball and he doesn't know what else to do. She was getting regular weight checks from 3 weeks until 8 weeks due to slow growth, but I was told she grew enough at her 2 month appt and I only had to bring her for a 3 month weight check and a 4 month appt. I am frustrated and tired. I do not know what to do. I do not want to give my daughter formula just so he can know how much she is taking in and pumping is not working very well this weekend. Does anyone have any suggestions/experience?

[@llli*kst.7399]

Okay, let's back up for just a second. You said she is being treated for reflux and you cut your diet of dairy and soy. Why? Does she spit up excessively? What is her diaper output? How many wet and poop a day? What does the poop look like? How long does she sleep and how often does she nurse? Have you seen any other specialists like a GI or allergist?

Here's some of my thoughts. Pumping and bottle feeding, although the amount can be measured, will not be accurate of how much she is getting from nursing. What can be done with bottle feeding is taking two pump sessions and skimming the fat off one to increase her caloric intake. That can be a substitute for the fortifier. However that would mean increasing your supply and possibly causing other issues. My daughter could not tolerate the fortifier and I have read a lot of other moms here say the same. But if you are comfortable you can try it in say one bottle a day. I would find out if they are considered dairy and soy free however because I doubt they are. Also, speaking of the elimination diet. How long have you been at that? If it has not been at least 6 weeks you might not have a clearing and therefore might still have some effects from it. Again, assuming that is what's going on. I get the feeling though that you have been trying a million different things, which I totally understand, and it may be time to step back and re-evaluate it all.

[@llli*trishb]

She's been on reflux meds since 8 weeks. She has silent reflux, so very little spit up. She had sleep problems, weight gain issues, and extreme fussiness. It helps some and it helped her sleep a little longer at night. Until that point, she was barely going 1.5 hours before wanting to eat again no matter if it was day or night. I cut out dairy and soy 3 weeks ago to see if they were bothering her. About 1-1.5 weeks ago she began napping during the day. I'd say that is a good indicator that it is helping some. I was also told by an LC that if she is very fussy to try eliminating it for a few weeks. She has plenty of wet diapers (I CD and wash every other day and we have 36 diapers). She poops once per week. It usually looks yellowish and seedy, but has been green and slimy 2 times in the last month. She now sleeps about 8 hours at night and naps a few hours during the day. In the last 24 hours she has taken 3 (4oz) bottles and eaten an additional 8 times from me. I did find out that the HMF is not dairy free, but she would not have gotten it since it costs $97 for a 1-2 day supply. She has not been referred to anyone else yet. I just spoke with her pedi since he wanted to see how much she ate in a 24 hours period and he now wants to see how much formula she will take in at the office Monday morning. I go to the LC at WIC on Tuesday.

[@llli*kst.7399]

Okay, if it were me I would feed her every 2-3 hours around the clock, regardless of cues instead of using formula. 8 hours is an extremely long gap of time for someone diagnosed with FTT. I would be nursing constantly.

[@llli*scienceteachermommy]

You also could see about renting a very sensitive hospital grade scale. That way you could weigh her before and after each feed, which would give you a record of how much she is getting without having to pump and bottle feed.

[@llli*aprilsmagic]

Pumping is a horrible indicator of supply. Many moms cannot pump enough, but they have babies who do well when they nurse. So do not let them make you think you have a low supply if you don't really have a low supply. And based on stools and wets, your supply is normal.

You could pump and make double cream bottles. I have a cleft baby, and they are notorious for being FTT. I pumped and skimmed off the top inch or so of milk, after letting it stand, and I fed that or mixed it in; like you, they were worried he wasn't gaining enough. They wanted me to give fortifier, or mix formula in with my milk, and I was bound and determined that would not happen. I did the double cream bottles for a week, just enough to get them off my back, and then we were fine, and he is still thin, but it's OK.

I would strongly suggest getting a sensitive scale and doing before and after weighs so you can see how much she takes in directly from you.

And finally, I would get all her records regarding weight gain and see a different doctor for a new perspective. Make sure she is being weighed on the same scale every time first. Make sure they are using the BF baby chart, not the FF baby chart. Because, to me, what you are saying actually sounds OK. You might just have a little baby.

[@llli*trishb]

Update on Abbie: She weighed 8lb 12.4oz today. Her pedi was not too happy about that. He expected her to gain 2-5oz. I brought a 4oz bottle of pumped milk because on Saturday he told me he wanted to see how she ate and would have formula ready for her. He basically told me that if I didn't give her formula, he would want her admitted to the hospital for tests. I asked about the blood tests he talked about on Thursday and Saturday and he said they would take too long if she was not admitted. I talked about her MSPI and how she is sensitive to any soy or dairy. He said he would give me samples of formula and just wanted me to offer her 1oz after each feeding. I took the cans and agreed to go back for a weight check Wednesday morning. She also still has an appt with him for Thursday since it will be another pedi there Wednesday. When I got home I read the ingredients on the Alimentum can. There is dairy and soy in it even though it says it's hypoallergenic. Abbie reacted badly to soybean oil last week, so I will not be giving it to her. I am meeting with the lactation consultant from WIC tomorrow. I will talk to her about it. We are 99% sure that we will switch her to another pedi office and already have recommendations from friends.

[@llli*kst.7399]

I'm sorry but your pedi sounds like a bully. I don't think scaring and threatening a mom is the way to get a baby help. I hope you see another doctor that is willing to work within the parameters you are comfortable with.

[@llli*melissawoods]

He does sound like a bully.

That said most babies who are allergic to soy and dairy can tolerate Alimentum, if you go that route. Occasionally they can't and have to be put on prescription formula like neocate. Not saying you should, but I think in your shoes I would be trying anything. Her weight is scary low.

[@llli*trishb]

She has shown a reaction to soybean oil, so no Alimentum for her.I wish I would have checked the label before I got home. I will ask the LC about it today. I would be more worried about my daughter if she wasn't meeting all of her milestones.