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Thread: I think my pediatrician is wrong - what do you think?

  1. #1
    Join Date
    May 2012
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    Default I think my pediatrician is wrong - what do you think?

    Baby was born at 7 pounds 5 ounces by C section after I had been on IV for 18 hours. Her face was really puffy and so was mine, so I think we got filled up with fluids. She lost 10.8% of her body weight in hospital, they gave her formula bottles secretly behind my back without telling me, and they scared me about the weight loss. I was so naive that I was worried something terrible could happen to her. I wanted to breastfeed but she was very sleepy and wouldn't feed most of the time. She also struggled with nipple confusion. They wouldn't let me leave the hospital for 5 days until her weight went up, and her discharge weight was 6 pounds 11 ounces.

    It was hard to find a pediatrician. Everyone said they weren't accepting new patients. So I doubt I'll be able to switch to a new one. Also where I live a lot of doctors don't speak good english, so I am lucky to at least have a pediatrician that can speak english.

    Anyways my baby was a slow gainer. The pediatrician said that she wasn't getting enough milk from me and that I should switch her to formula. He said that the problem with breastfeeding is that you can't tell how much they're getting. Well I didn't switch her to formula completely but I topped up, both with formula and with breast milk that I was pumping. But she still gained really slow. After two and a half weeks of this I decided to put her back to the breast and we successfully eliminated bottles. It was a gradual process but we succeeded. She was back at birth weight when she was three and a half weeks old.

    She was weighed again two weeks after this and had gained 4 oz per week. The doctor still thought this wasn't fast enough and again tried to push formula on me. And I tried to explain that I believe my baby has reflux, and possible cow's milk allergy, and he dismissed both.

    Do you think she needs to go back on formula top-ups? She feeds 10-14 times a day, gets 6-10 pees a day and 4-7 poos. Her poop is bright yellow, mostly liquid but sometimes seedy and a bit stringy. She is a needy baby who needs to be held in my arms for most of the day.

    She is generally happy, she is 7 weeks old now and has just started to give me big happy smiles. She fusses at times. Her fussiness is associated with reflux-type behaviour. She will spit up a LOT after a feeding, needs to be burped very often, and acts like she has a belly ache and whines until I can get a good burp out of her. She often comes off the breast coughing. I cut milk out of my diet 3 days ago and since then, these behaviours have gotten less frequent. Her infant acne has gotten better, she's started sleeping better, and the red ring around her butt (which the doctor said was normal diaper rash and not a sign of allergy) has almost totally gone away.

    Do you think she has reflux and/or cow's milk allergy? Do you think I'm right or should I listen to the doctor? What is your opinin on the weight gain issues? Should I start topping up with formula again?

    I apologize for the long post but I wanted to be sure to include all of the relevant details.

  2. #2
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    Mar 2012
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    Default Re: I think my pediatrician is wrong - what do you think?

    It sounds like she is starting to feed better and I'm guesing the fussiness is due to the formula. My daughter is also breastfed, but I was supplementing with formula at the very beginning, until my breastmilk was established. She was very fussy - she would sometimes scream when she was trying to poop and didn't have regular bowel movements (when we fed her formula). The docter recommended switching to Similac Sensative and that helped a little bit. In truth, only when she is drinking breastmilk and ONLY breastmilk - was my daughter truly happy. If you must give her formula, I recommend switching to the sensitive version and only giving her formula every other feeding. This might help with her digestion.

    Also, burp her for a longer period of time... giving her time to let the feedings settle in her stomach. I've noticed my daughter is very needy as well and often have cleched fists. If I don't burp her for a good 15 minutes, she would throw up all over me. Sometimes, even after she burped, I have to burp her again just to be sure. Just today, I heard her burp and set her down to play. She started crying 10 minutes later and when I picked her up - BAM! Niagara Falls was unleashed

    The coming off breast coughing might just be your milk squirting down her throat a bit too fast. Give her a little pat on the back, before reintroducing your nipple. I have a tendency to choke my daughter since I suffer from overproduction
    Proud of Baby

  3. #3
    Join Date
    Dec 2006
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    9,280

    Default Re: I think my pediatrician is wrong - what do you think?

    Congratulations on the birth of your daughter. Also, kudos for overcoming so
    Many obstacles to obtain a nursing relationship. That is so positive. To me
    It sounds like you guys are doing great! That's plenty of wet and poopy diapers. Fussiness is not necessarily a sign of inadequate milk supply. It looks like you've found her to be sensitive to dairy and that's a good step forward in alleviating her discomfort. Don't forget to look for hidden dairy in foods like breads, and other packages foods. What was her lowest weight and what does she weigh now? Can you continue shopping around for a more breast feeding friendly
    Pediatrician?
    Lyn
    Nursing the girl with kaleidoscope eyes


    Mama to Daniel (12/3/06) and Lucy Jane (8/28/08)

  4. #4
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    Default Re: I think my pediatrician is wrong - what do you think?

    happynewmom, unfortunately no one here can answer your questions about whether you should be supplementing, as that is medical advice. I will say this-

    A doctor who says that
    the problem with breastfeeding is that you can't tell how much they're getting.
    is not a doctor I would trust with my breastfed baby, personally.

    I am also curious if all the weight checks (or at least the last two) were done on the same scale with baby in nothing or a dry diaper. Scale descrepancy is a huge problem when measuring newborn weight gain!

    Whatever happened before, I suggest you let that go (for now) and concentrate on now. A 4 ounce gain per week truly is on the slow side. Great baby is gaining, but that is slow. An ounce a day would be more like it. But, every baby is different, and there is more to good health than meeting certain weight gain expectations. Also, since the last weight check was two weeks after the previous one, I take it baby gained a total of 8 ounces in those two weeks. But isn't it just guessing to say that was spread out evenly over two weeks? Maybe baby gained nothing week one and the whole 8 ounces the last week, or some other combo.
    The poops sound normal in look and frequency. But how large are they? Make an "OK" sign with your hand. Are they generally the volume of the circle that you make with your pointer and thumb-or larger? That is the size that "counts" as a poop. A baby may make small streaks other times but those don't "count" when doing diaper counts. If baby is pooping enough, there is no real need to even bother looking at pees btw.

    When a breastfed baby is perhaps not gaining as well as they should, it is important to have breastfeeding assessed by a professional, an IBCLC. Is that a possiblilty for you? Because there is more than one reason a baby may not be gaining well.

    How is breastfeeding going? Your baby is nursing with good frequency, but is latch comfortable for you? How long does baby nurse generally? Have you tried breast compressions? Do you see/hear active swallowing during feedings? Also it would be fine to encourage baby to nurse even MORE frequently.

    The symptoms of issues at the breast actually sound like oald to me. Have you considered that? That is way more common than food allergies. Way.

    Also, realistically, how far can you travel, even temporarily, to see another doctor? Keep calling. Someone may have an opening now. Try to get local suggestions for doctors who are breastfeeding supportive/knowledgable. A pediatrician you can feel confident in is worth the effort.

    These articles may help: http://www.nbci.ca/index.php?option=...tion&Itemid=17 and http://www.nbci.ca/index.php?option=...tion&Itemid=17 and http://www.nbci.ca/index.php?option=...tion&Itemid=17
    Last edited by @llli*lllmeg; June 8th, 2012 at 10:37 PM.

  5. #5
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    May 2012
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    Default Re: I think my pediatrician is wrong - what do you think?

    Thanks so much for your responses.

    The weights were all done with baby in a dry diaper. Her poops are quite large and yes, we only count the large ones, so I am not worried about that.

    I have seen a lactation consultant, who watched us do a feed and said that everything is going well. I don't generally get sore when I feed her. Her feeding length can vary widely. Sometimes she will feed for only 15 minutes, other times she will be nursing and napping and stretch the feed out to around 45 minutes. Sometimes I do breast compressions and other things to make her stay alert when she gets drowsy, but other times I just let her nurse the way she wants to and let her fall asleep at the breast. I do hear lots of swallows and gulps. At the lactation consultant's office we did a weight check before and after a feed and it was determined that she got 60 ml from me. This was when she was about two weeks old. At that time I was also giving her supplements after feeds, but she'd refuse the breast sometimes. I don't give her any supplemental feedings anymore. She doesn't refuse the breast anymore either.

    I'm not sure about over-active letdown. I do hear clicks, and I spray if she comes off the breast suddenly. These are both signs of overactive letdown? I haven't looked into this possibility very much, to be honest. I have never 'felt' letdown, though. I always leak a lot from the other breast though.

    Her spitting up is what bothers me more than anything else, as I worry about it.

  6. #6
    Join Date
    May 2011
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    Default Re: I think my pediatrician is wrong - what do you think?

    Quote Originally Posted by @llli*happynewmom View Post
    I'm not sure about over-active letdown. I do hear clicks, and I spray if she comes off the breast suddenly. These are both signs of overactive letdown? I haven't looked into this possibility very much, to be honest. I have never 'felt' letdown, though. I always leak a lot from the other breast though.
    That definitely sounds like overactive letdown (OALD). I didn't feel a letdown for the first couple months even though I would shoot milk across the room. After a couple months I started to feel it pretty intensely.

    Her spitting up is what bothers me more than anything else, as I worry about it.
    Excessive gas and spit up are common with OALD. My son just spewed spit up all the time. Unless there is pain with the spit up, it is nothing to worry about.

    You can try nursing in a reclined position to help with the OALD. I would lean back on a few pillows, put my baby on my stomach or chest, and let him latch. You may need to keep tweaking your positioning for a little while to find something that works. That worked wonders for me. Some women will unlatch the baby at letdown, let the milk spray into a towel, then relatch the baby. Some women express a little milk before nursing.

    Keep burping frequently. You can also give tummy massages then bicycle your baby's legs in between feedings to help work out the gas a little at a time throughout the day.

    The good news is that babies grown into OALD as they get bigger. I sprayed milk for 15 months, but my baby only had problems with it for the first few months.
    K. Sophia - Mama to my little lactivore, the amazing Mr. X (11/10).

  7. #7
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    Default Re: I think my pediatrician is wrong - what do you think?

    The weights were all done with baby in a dry diaper. Her poops are quite large and yes, we only count the large ones, so I am not worried about that.
    Same scale? It's GOT to be the same scale or it is likely off, one way or another. You would not believe how much calibration can vary from scale to scale. I recently talked to a mom who had baby weighed twice in 24 hours on two different infant scales and the difference was half a pound. Also watch the nurse or whoever is doing the weight check carefully. If my doctor was concerned about my baby's weight gain, I would make sure the scale is zeroed out or whatever before hand, no one is pressing a finger on it or holding baby slightly off it, and the number is writen down correctly. Then I would ask for baby to be weighed again to double check. seriously.

    Can you see the LC again and do another before and after weight check? After about 2 weeks, a baby should be able to transfer 2 ounces (or more) at a feeding. Up until then, it could normally be less and still be fine. Remember one b4 and after check only tells you what happened at that one feeding, so the more you can do, the better to get the larger picture.

    Since baby is pooping enough and nursing well and frequently, I agree that the need for supplementation sounds questionable and I again suggest a second medical opinion. As far as 4 ounces gain per week being normal for some babies, I know that is what kellymom says, but (in my very limited understanding) from the latest info from the WHO breastfed babies weight gain study, from which the latest growth charts were devised, a larger weight gain is expected in the newborn breastfed baby. Since this baby had dramatic weight loss and got back uo to birth weight so slowly, I am much more concerned about the current weight gain not being quite there than I would be if the baby had gained normaly and then had a slower week, if that makes sense. But again, I would suggest this is something mom needs to discuss with a breastfeeding supportive and knowledgable pediatrician and/or her LC. Someone who is trained and can SEE the baby.

    Spit up has to be very, very severe to explain weight loss or poor gain, at least in the breastfed baby. Most babies spit up often and it can look like quite a bit. Here is an article on oald: http://kellymom.com/bf/got-milk/supp.../fast-letdown/ btw, although oald is often a sign of oversupply, it can happen independantly of over supply.

  8. #8
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    Default Re: I think my pediatrician is wrong - what do you think?

    I have no idea whether it was the same scale. Probably wasn't. The pediatrician's building is HUGE and we're often seen in a different room each time.

    Do you think the birth weight could have been artificially high due to being on the IV? I know that I did gain a lot of water weight, because when I got out of the hospital I lost 20 pounds within a few days.

    She hasn't been weighed for a while now but she's grown out of newborn sized diapers and into size 1. She still fits newborn size clothing (some outfits), though, but she also wears size 0-3 months and fills them out well, when before they were baggy on her.

  9. #9
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    Default Re: I think my pediatrician is wrong - what do you think?

    Yes the birth weight could have been unnaturally high. But it does not matter very much at this point, as all measures at this point should be from the lowest weight check (or most recent weight check depending on what you are measuring-total weight gain or most recent weight gain) and it's got to be on the same scale. Maybe your LC can have you in for a weight check every few days (on the same scale!) until you figure out what is going on?

  10. #10
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    Default Re: I think my pediatrician is wrong - what do you think?

    Sorry, I must have miscalculated, I'm looking back at my records that I wrote down. Her weight gain averaged 4.9 ounces per week. From 7 pounds 5 ounces to 7 pounds 12 ounces in 10 days. Is this more normal?

    She has been doing better every day since I cut out the dairy products from my diet! She has spit up only 5 times today and normally she would spit up at least once every single feed (12+ times every day)! Her diaper rash is 100% gone and her infant acne is like 85% cleared.

    Will try to get back in to see the LC but it's so hard to get in with her as its a free clinic. Until then I'm not going to supplement as I honestly feel that my baby is doing ok. I really hope her fussiness has been due to dairy allergy/reflux/overactive letdown and not something more serious.

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