Repeat of Baby #1's Issues with Baby #2

[@llli*connectikate]

I have a 2.5 month EBF baby who is following the same breastfeeding pattern as his older sister - a pattern that lead to poor weight gain and mandated formula supplementation. I don't want to repeat the past because it has been one of my sources of "mommy guilt" for many years.

Just like his sister, in the beginning, breastfeeding was going great. At the one month check-up he was in the 69th weight percentile and had been following his growth curve. Two month appointment arrives and now he's fallen to the 47th percentile despite nursing 8-12 times per day and my having an adequate milk supply. Same story with his sister.

Now, at 11 weeks, he's refusing the breast during times when I believe he should be hungry, and the only time I can get good feedings into him are at night or when he is drowsy from a nap. When he is awake, he arches his back, refuses to latch and cries hysterically like I am torturing him. Again, same thing happened with my first child. I pump when he refuses me and I can get 2.5 ounces in about 7 minutes, so the well isn't dry. His sister cut teeth at 4 months, but still, I think it is too soon for him to be teething.

I am so confused why this is happening again and I don't know what to do. I don't want to supplement because that was a slippery slope that lead to my daughter weaning at 6 months and my pumping milk for the rest of her first year. He has a weight check on 2/28 and I am so desperate for him to get the green light from the pediatrician.

Advice would be so welcome because I am starting to dread feedings and just want my baby to be healthy and happy. I hate to see him so upset.

[@llli*carm3]

Have you tried laying down to nurse him when he fusses like that? My LO went through a phase around the 3.5-4 month mark (so a little older than yours) where she only wanted to nurse laying down. Same thing -it was like the boob was the worst thing in the world, until we went to lay down, then it was great! So maybe trying different positions (if you haven't done so already) is worth a shot.

As for the weight, try not to freak out too much in advance. Is he having enough wet/poopy diapers? Is he otherwise happy and meeting milestones? You gotta look at the overall picture.

[@llli*connectikate]

I can give the lying down a shot and see what happens. I usually nurse like that at night, or in a reclined position - but I haven't tried during the day. He's in the 77th percentile for height and the 81st for head circumference, so it's only the weight that is causing the concern. There are lots of wet and poopy diapers! Squished up the back and out the sides And he is otherwise a happy baby except for a little reflux. The feeding fights are the only time he's miserable. My husband and I aren't big people, but the doctors always grow concerned with the curve adjustment because both my babies were 9+ pounds and the suddenly start shrinking. It's a hard conversation to have with someone in the medical field.

[@llli*carm3]

I know that mommal has posted a link about how some babies are big and birth and then weight gain slows down, and then others are the opposite, and both are completely normal. I can't find it atm, but maybe you could PM her and ask for it? Or maybe she'll see this later and could post it?

[@llli*still.here]

Mama, it's perfectly normal for weight percentiles to vary. That change is not drastic and would not concern me in the least.

[@llli*mommal]

I know that mommal has posted a link about how some babies are big and birth and then weight gain slows down, and then others are the opposite, and both are completely normal. I can't find it atm, but maybe you could PM her and ask for it? Or maybe she'll see this later and could post it?

I think it's this article: http://www.aafp.org/afp/2008/0901/p597.html The article deals specifically with short/tall stature, not with weight- but the same considerations that apply to height also apply to weight. This quote from the article explains it better than I can: "A newborn's size is determined by the intra-uterine environment, which is influenced by maternal size, nutrition, general health, and social habits (e.g., smoking status). The average weight of a newborn is 7 lb, 3 oz (3.25 kg), and the average length is 50 cm (19.7 in).2 After birth, the growth rate becomes more dependent on the infant's genetic background.3

An important phenomenon, often called catch-up or catch-down growth, occurs in the first 18 months of life. In two thirds of children, the growth rate percentile shifts linearly until the child reaches his or her genetically determined growth channel or height percentile.3 Some children move up on the growth chart because they have tall parents, whereas others move down on the growth chart because they have short parents. By 18 to 24 months of age, most children's lengths have shifted to their genetically determined percentiles. Thereafter, growth typically proceeds along the same percentile until the onset of puberty."

Like the PPs, shifts in percentiles don't concern me much. The charts are just ONE tool for evaluating growth. If a baby seems happy and healthy, is continuing to grow in height and head circumference, and is gaining a normal amount of weight, then I figure the percentile drop can be accounted for by the catch-up/catch-down phenomenon mentioned above.

The one thing that concerns me from your post is the screaming and breast refusal. That, combined with the back arching, makes me wonder about reflux.

[@llli*lllmeg]

It IS a hard conversation to have with someone in the medical field. But it should not be. The AAP infant feeding guidelines is very clear that babies, if at all possible, should be EXCLUSIVELY breastfed. Supplementing a healthy, growing baby with formula ONLY because of his weight charting not following an exact curve is not following these guidelines. If your pediatrician keeps pushing formula on your healthy, growing baby due to a normal growth percentile shift I suggest, get another opinion. The growth charts are ONE tool for assessing a baby's health, they are not the only tool. Why would we have to see pediatricians for well baby checks at all if all we needed were weight checks and a chart? As you have experienced, Formula supplementation does not have to mean the end of breastfeeding, but it certainly may cause all kinds of issues and should not be prescribed unless medically necessary.

Is baby getting bottles at all now?

I do agree you want to figure out what is making baby unhappy at the breast. I think you have gotten good suggestions here- the behavior you observe could be due to baby being uncomfortable in the nursing position and also due to reflux and/or, forceful letdown. Some of the ideas that work well for forceful letdown (laid back (reclined) or sidelying positioning, frequent nursing) also may help with reflux. With one of my kids who had reflux it helped me to nurse in a slightly reclined positioning and with baby on me in the same alignment as I was-head at breast, feet more or less straight down, keeping baby's head basically directly above tummy and baby's body kind of straight.

[@llli*lllmeg]

I wanted to add that I am very sorry that you have had mommy guilt over what transpired with your older child. A mother who pumps for a year to give breastmilk to her child is a hero in my opinion.

[@llli*connectikate]

Thank you all for the words of wisdom. I am trying to let myself relax and let the fact that my baby is an overall happy boy who has big chubby cheeks be my guide, but I am caught up in the numbers and the medical side of things. The fact that the signs are all the same as my last experience has me anxious when maybe I don't need to be.

LLLMeg - we are still exclusively nursing with the exception of one bottle a week while I go to yoga class. He will transition more to bottles when I head back to work in about a month. Right now, I'm just pumping and freezing the milk when I try to feed him and he refuses me so my supply isn't compromised. Sometimes after I am refused, he will fall asleep, which tells me that I am attempting a feeding when he is exhausted and hungry and I need to get to the feeding earlier. Other times he just wants his pacifier and I don't know what to do for that situation.

As for the reflux, I'm not sure how serious it is since the symptoms mainly manifest at night and in the early morning, which is when he does his best feedings. During the day - when the refusal starts - he doesn't exhibit the coughing and congestion that suggests reflux. So I am unsure whether I can blame the behavior solely on the reflux.

I will experiment with more frequent feedings and different positions to see if I can eliminate the feeding fights. Everyone (except my husband) who witnesses the screaming and struggling tells me I should just give him a bottle so we will both be happier, but I know that isn't the right answer.

Thank you again, and hopefully I can update soon with positive news.