Advice needed:Advised by Endocrinologist to shift to formula

[@llli*aimeedeguzman]

My baby and I have been able to reach the 1 year mark of pure breastfeeding just a few days ago. I work from home for 3 days so I am able to directly feed her and on days that I go to office, she drinks expressed milk. I've been reading up a lot (esp fr LLLI) to make sure we maximize the benefits of breastfeeding. Since this is my first baby and first time in bf, I'm quite paranoid on how much my milk supply really is. It's a struggle to trust my body to make enough milk for my daughter - so I've been regularly taking Moringa Oleifera Lam capsules. I also drink mother's milk tea when I notice a drastic drop in my supply. Starting our 10th month (when DD also had 2 round of high fever which caused her weight to drop significantly), I noticed that my already decent pumping output of 5-6oz dropped to 3-4.5oz --- now I know that this should not be taken as the exact measurement of my supply but i really cannot help but notice the change and be extremely worried. Now, when i am away which is about 10hrs) DD only takes 9-10oz. When we are together, we have around 2 sessions of 20min nursing during the day and abt 2 "snack" nirsing of 5-10mins.

My husband and I are on the short side, both only stand at 5"4ft. My baby has been between the 10th and 25th percentile in the WHO growth charts (which I use to track her growth). She is one extremely happy and active baby, and has been really good at hitting milestones (she is now walking on her own). We've been seeing an endocrinologist 2x now and on the last check up which was a few days after she turned1, she told me that it's time to wean her off. My heart literally broke when I heard this as I really really struggled to ensure that my baby gets only the best milk! The doc explained using the WHO charts that she fell below the 5th percentile and so she is advising that the quantity and quality of my breastmilk may not be sufficient for my DD anymore. She explained to me
That although DD is hitting the development milestones, this may be hurt if she does not get the weight/growth. I actually asked her (since I had my Baby's growth chart based on the WHO charts printed out) on why on WHO she is still
Within the 10th and 25th percentile. And since their medical
System is using CDC charts, she just said that why in her charts its showing differently.

I would do anything for my baby, as any mother would. But my heart and mind tells me
That my milk is still whats best for her. I revisited my research on growth charts and recomfirmed thaT CDC actually recommends using WHO charts when it came out bec of the sample
Population and the critieria (which is 100% breasfwd babies as well as babies from other regions). I am just in a very very difficult position right now on what to do since its a specialist who advised this already. I am considering supplementing during daytime and keep mornings and nighttime breastmilk but of course i would prefer 100% to be breastmilk if possible.

Appreciate any advice!!!

[@llli*lllmeg]

Wow. Why are you guys seeing an endocrinologist?

Is she saying your breastmilk itself is less nutritious or less fatty or whatever, than formula? on what is she basing this? did she suggest what amount of formula your year old baby should be getting? I mean, most kids this age get none. And they don’t get breastmilk either-although of course I think they should get breastmilk.

How is other growth-is it just the weight that is supposedly a concern?

Is baby eating solids yet, when did she start, how much and what about does she eat?

Also I strongly suggest you get the book My Child Won't Eat by Carlos Gonzalez. Read the section on charting.

As far as pumping output, I always suggest first, troubleshoot the pump. But if you are saying you pump 3-4 ounces per pump session, that is above average.

[@llli*auderey]

yes, why are you seeing the endocrinologist?

suggesting that a 1 year old needs supplemental foods makes sense to me - breastmilk ALONE is not really enough for them. suggesting that magically your breastmilk has become insufficient in some way does not. it generally does not make any sense to recommend, for a baby who is not gaining, to take away the one sure source of nutrition. maybe there is some background we don't know?

i also don't understand your comments about the charts. you say she's between 10-25 on WHO charts, then say the doc says she's under 5th on WHO charts? is there a typo? also someone (actually 5% of someones) have to be under 5th %, so that in and of itself is not a concern. what might be a concern is if she dropped dramatically, lost a lot of weight, etc.

[@llli*aimeedeguzman]

@llli*lllmeg will definitely get the book now. Our original ped actually referred us during her 7th month to ensure that there is not underlying condition for her low weight and height. We decided to stick with her after that visit. Am not actually sure what her basis on her comment on the quality of my breastmilk - I failed to clarify on this, was trying hard to process what she was
Saying.

We started on solids when she turned 6 months, increased her meal time to 2x a day on her 8th month and DD is now eating 3 times a day, about 1.5 to 2oz of grain, veggies and sometimes beef or chicken. She does seem to enjoy eating her solids but i was also trying to ensure she gets majority of her food fr breastmilk.

The doctor also mentioned that a year old should be consuming at least 6oz per feeding session - which got me worried on mu pump output if I will strive to still continue with BM only.

[@llli*aimeedeguzman]

Sorry about that, the doctor was using CDC chart which at her last check up of 7.7kg and 70cm, fell below the 5th percebtile. While I was using WHO chart and these numbers are still with her growth curve which is between 10th and 15th percentile.

We have been doing great on solids eversince she started at 6months. I completely agree that breastmilk cannot lose its quality nor be less nutritious. I cannot think of any reason for her recommendation but only bec of her "falling off" on the CDC chart.

[@llli*auderey]

it sounds to me like you found an endocrinologist who knows nothing about breastfeeding. bf babies generally NEVER take 6 oz per feeding. unlike formula, which you increase as babies get older. her eating sounds pretty normal for her age. starting around now, she should be gradually transitioning to getting the majority of her nutrition through other sources. many babies (including mine) nurse a ton all the way through the 2nd year (mine nursed ~ every 2 hours i was with him including nights until 21 months), but agin solids intake should also be increasing across that time.

so, the question is, is she just small and always has been small, but gaining and growing appropriately, or was there something that changed at 7 months that made your ped worried? it is normal for some babies to be small. it is normal for bf babies to not gain between 6-9 months when they start moving (mine gained exactly zero beteween 6-9 month checkups). those things in and of themselves are not cause for concern, but maybe there is something else going on?

can you get a referral to a different endocrinologist who knows *anything* about breastfeeding? or go back and see her and ask her more questions about what her concerns are and why she's recommending weaning? "my computers use the CDC charts" is not a good enough answer.

[@llli*lllmeg]

The doctor also mentioned that a year old should be consuming at least 6oz per feeding session - which got me worried on mu pump output if I will strive to still continue with BM only.

This person knows nothing about breastfeeding. May be a great endocrinologist, but if she can site a single study on how much breastmilk a 12 month old extracts from the breast each time that 12 month old nurses I would love to know about it.

And what if a year old baby did not WANT six ounces of whatever? That’s a pretty large portion if you ask me. Is she also going to suggest a baby be forcefed?

My healthy and growing baby is 11 months old and lives almost entirely on breastmilk. She does eat solids happlily and eagerly but there is not a chance in you know where she eats 6 ounces at a time or probably, even in a day. I have no idea how much she gets from me when she nurses but I would be very surprised if I could pump out anything like 6 ounces.

If you want your baby to get more of your healthy and lifegiving breastmilk, you could try nursing more often when you are home or on your days off.

Get that book. It is written by a pediatrician. I think it will be very reassuring.

ps I agree with auderey. Is there a health issue or is this just who baby is? That is the question. Eliminating a source of excellent nutrition and comfort while you figure that out makes little sense to me.

[@llli*ohsmomma]

I agree with Meg and Audrey (and YOU!) - it doesn't make any sense to take away her breastmilk. If anything, offering more and also offering more variety at mealtimes makes way more sense to me.
You said she eats grains, veggies, and sometimes meat - has she tried things like avocado, eggs, bananas, cheese? Other high calorie, nutrient rich foods are peas, sweet potatoes, pears, cheese. If it were me, I'd be pushing all of these things at meal time. Peanut butter is also safe after 1 year and is an excellent source of healthy fat and calories.
If you are successful with encouraging her to eat these, it would be wise to encourage more fluids (BM!!) to combat constipation.

I wish you luck - it sounds like she's probably just a petite babe. I wouldn't worry if she seems healthy in every other way!

[@llli*mommal]

It sounds like a lot of worry over nothing. You and your husband are both on the small side, so it makes sense that your baby is going to be small, too. And it sounds like her height and weight percentiles are roughly equivalent, right? Proportionality is a good indicator that baby is getting plenty to eat. If she was extremely skinny for her height, or for that matter extremely fat for her height, then you might want to worry more about her calorie intake.

[@llli*aimeedeguzman]

Thank you for all the advice and reassurance. I have booked an appointment with another ped who is known to be a breastfeeding advocate. And we also started to have BM during mealtime and continuing on giving her high calorie food and sources of good fats. I know that continuing with BM is best - sometimes it just gets so hard with the negative feedback and advice. Will keep pushing forward!