Some questions?

[@llli*podutti]

I have a few questions following DS's routine visit to the pediatrician yesterday.
I had always found him "breastfeeding friendly" and I was surprised by a few of his suggestions and would like the opinon of other breastfeeding mums.

Firstly, he said that DS should only be nursing 5-6 times a day at this stage (16.5 weeks). I have been feeding on demand which usually comes to 7-9 nursing sessions in 24 hours. Is DS nursing too often? He said that I shouldn't nurse when he wakes at night and just put him back to sleep. DS usually only wakes to nurse once between 10pm and 6am and then only has a quick snack in the morning before looking for a proper feed at around 8ish.

He also said that I should give DS water when he is thirsty. Would this not damage my supply?

Finally, we discussed introducing solids. He agreed that it is best to wait until 6 months. However, he said that once DS is eating solids he will only need to nurse 3 times a day - morning, evening and bedtime - and he can go without while I am at work. I can't believe this is enough milk for DS! I won't be entitled to pumping breaks at work once DS turns 6 months so I would need to plan ahead to have a suitable milk stash in place. How much milk would a 6+ month old who eats solids require during the day (8am until 6pm)?

[@llli*mommal]

Your pediatrician is NOT breastfeeding-friendly!

4 month old babies should be fed on demand, or at least 8 times in a 24 hour period. Your baby is not nursing too often!

Nursing at night is a personal parenting choice, not a medical issue. If you are happy to night nurse, there is no reason not to do it. Night-nursing can be inconvenient for mom but it does not harm the baby. Many 4 month old babies, and even much older babies, still NEED to nurse at night.

Babies should NOT be given water. It will damage your supply- every time you give a supplement (water, solids, formula), your baby will take in less breastmilk. In addition, water can be contaminated with foreign substances which can make your baby sick, and because babies have such low body mass it is very easy for supplemental water to throw off their electrolyte balance. In some cases, hyponatremia (a.k.a. water intoxication) can be fatal.

Your doctor's advice on solids is pure idiocy. Solids should be introduced starting around 6 months, but the quantities should be very small at first (maybe a teaspoon or two per day) and should NOT be used to replace breastmilk in the baby's diet. Breastmilk is supposed to make up the majority of the baby's diet until around the first birthday, and therefore babies should continue to be nursed on demand at least until that point.

Some useful resources:
AAP policy statement on Breastfeeding and the Use of Human Milk http://pediatrics.aappublications.or...115/2/496.full
kellymom.com link on expressed milk amounts http://kellymom.com/bf/pumpingmoms/pumping/milkcalc/

PLEASE do not take your doctor's advice. It is absolutely terrible and is guaranteed to derail breastfeeding well before either you or your baby are ready to wean.

[@llli*aprilsmagic]

There is actually a very new and well done study showing that babies should not get any water for sustenance purposes before 12 months, and I thought I had the link, but I can't find it right now. So, no, no water.

And a baby should always have breastmilk before solids before 12 months.

I'd be looking for a new ped or be ready to disregard most of this doc's advice regarding breastfeeding (and probably meals in general) myself.

[@llli*mommal]

Your post made me so mad (not at you, at your pediatrician!) that I thought about it all the way to my doctor's appointment and then all the way home. What I was thinking was that your doc gives this advice not just to you, but to all the breastfeeding moms in his practice. And he probably has no idea the kind of damage he's doing. I figure that when a mom hears this advice, one of two things happens:
1. She thinks to herself "that's stupid" and continues to nurse as much as her baby wants. The baby continues to thrive, and when the pediatrician asks about number of nursing sessions and solids the mom just smiles at him and lies through her teeth. The doctor, thinking that the mom has followed his advice, assumes that it must be good advice because the baby is doing well.
2. She panics, thinking that she must be doing something wrong, and follows the doctor's advice. The baby is suddenly denied nutrition and comfort, and becomes very unhappy. Mom picks up the phone and calls the doctor, and the doctor says "Oh, he's probably just ready for solids a little early because your milk isn't enough for him any longer". Mom assumes this must be true and introduces solids, and baby takes to them eagerly because he's been denied nutrition from breastmilk. By 6 months, the baby is already eating lots of solids, and mom introduces even more and weans him down to 3 nursing sessions per day. Her milk supply decreases even further, and by 12 months (if not earlier) the baby is completely weaned because he knows there's little point in asking to nurse. And once again, the doctor feels like he grave great advice, because the baby is weaned and because he feels like he "saved" the baby from mom's inadequate milk.

Seriously, this whole thing just makes me mad. I strongly suggest taking the first route and ignoring the doc's advice while lying through your teeth, or better yet, ignore his advice and tell him why you think it's bad. I bet this guy never gets any moms pushing back at him, and therefore he thinks he must be handing out the best advice ever. Because no-one ever complains!

[@llli*nola]

I agree with the above responses. You're doing the right thing, keep it up.

[@llli*esthervegan]

I love my pediatrician because he
1. is really good at diagnosing illness
2. has convenient office hours
3. has privileges in all the local hospitals

And that's it. He has learned all about breastfeeding from me. If it was not for the book, "The Womanly Art of Breastfeeding" I would have mistakenly thought my doctor knew about lactation.
Doctors are the go-to professional when something is wrong, off kilter.
For healthy day to day breastfeeding information and support I trusted my La Leche League Leader.

[@llli*podutti]

To be honest, my response when the doc said I was feeding too much was actually embarrassment. I felt like a fool who didn't know what I was doing when it came to breastfeeding. The doc actually suggested that DS was making a fool out of me. I don't speak the local language so DH was interpreting for me. It is possible that some information got lost/confused in translation.
Everything I know about breastfeeding I learned from the internet and even I found some of the advice he gave suspicious. But my lack of experience/knowledge and the language barrier meant that I just sat there and listened to the advice. I will go do some reading up on introducing solids. I have aleady had my mother (who never breastfed) suggesting that solids should have been started at 3 months!

On a separate note I finally had some success introducing a bottle. DS happily drank 3oz from a bottle today. I'm back to work next week so this is a huge relief!

[@llli*phi]

Your doctor is the one who should be embarrassed. He is the one making a fool of himself with such terrible advice. My son is 19 months and has never gone a single day nursing less than 6 times, and those infrequent nursing days were all after 15 months and have been our super busy days. Usually he nurses at least 8 times a day. All our pediatrician has ever said to me about nursing frequency is that you cannot overfeed if you are breastfeeding, and so go ahead and let my son nurse as much as he wants.

[@llli*lcb]

I'm with all the moms above. This stuff INFURIATES me!! I'm a pediatrician and I didn't learn a thing about breastfeeding (OK, maybe a few things...but not much) in medical school or residency. I didn't know how to give any decent breastfeeding advice until I became a nursing mother myself. I learned everything I know from books, the internet and other nursing mothers...not from within my profession. And that's just embarrassing! I did, however, have the good sense to refer moms to LCs and not give advice I wasn't qualified to give. PLEASE don't listen to this guy and find yourself another pediatrician...preferably a doc who has had children and nursed them!

[@llli*mommal]

Your doctor is the one who should be embarrassed.