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Thread: Supply issue? Want to avoid supplementing.

  1. #1

    Default Supply issue? Want to avoid supplementing.

    Hi! I've done a lot of reading here, but thought I'd try to get a more specific answer to my current situation.

    I'm a new mama to a happy, chunky-legged little guy who's 22 weeks old and currently 15# 5oz (as of last Friday). He was born at 9# 3oz, lost a few oz the first week, and then steadily gained until his gain slowed down as of his 4 month appointment, where my doc was concerned since his weight had gone from 92% to 78% and now is at 39%. (last 3 appts: 16 wk, 12 wk, 8 wk.

    His Height is 26 1/2" at the at 89% (22 3/4" at birth, %ile stayed pretty similar), his head is 34% (also stayed consistent).

    My doc recommends supplementing with 1-2 oz formula after each feed, as she said based on my pumped amounts after a pump-test (morning and evening, only 2 oz each time- but it was only after 2 hours since that's how often he eats). But she said he's not getting the 37 oz he needs per day. She also recommended pumping after each feeding to stimulate increase in my supply.

    His diapers hadn't been soaking wet, though I did change him with wet and dirty diapers about 5 - 8 times per day. The fact that they weren't soaking, heavy, wet made me worry. I started the formula, and the diapers were more wet and he gained 7 oz in the last 2 weeks. However, I detest using formula.

    Regarding my supply, I did notice a less full feeling and had reduced leaking when I started my period again in December, but it seems like it has since come back. I still don't leak like I did the first 3 months of his life.

    Since I've started the extra pumping, I have sometimes just pumped and bottle fed him to see how much I can pump. I get about 4 oz in 3-4 hours.

    My questions are:
    - Should I just try EBF for the week and see if he gains?
    - Should I do as my doc recommends and supplement and pump?
    - Are some babies just leaner? He was big at birth, too, so maybe his body is just evening out?
    - Are soggy, heavy diapers necessary, or how wet is GOOD wet?
    - If he doesn't seem unhappy or hungry, and has good energy, chunky thighs, and is meeting milestones, can I just disregard these concerns?
    - Should I keep pumping to increase supply, or can I trust my body will deliver what he needs?
    - Is feeding every 2 hours normal at this age? He goes longer, sometimes even 3 - 4 hours, but often is eating every 2. My doc said that is too often and another sign he's not getting enough.
    - I want to trust my instinct to just ignore the doctor on this one, but also worry maybe she's right.

    Hope that's not overkill, but I wanted to be thorough.
    Thanks for any guidance you can give!

  2. #2
    Join Date
    May 2006
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    20,808

    Default Re: Supply issue? Want to avoid supplementing.

    Welcome to the forum!

    Based on what you've posted, I think you need to see a different pediatrician. First, there's the percentile thing. Yes, your baby has come down some percentiles, but that doesn't necessarily mean that something is wrong. It is normal for healthy babies to shift percentiles, particularly as they get into the middle of the first year and start getting mobile, putting increasing amounts of calories into action and packing less on as fat. Both my kids went from the 95-99th %ile at around 2 months to the 75-80th %ile at around 4-6 months. There's also a phenomenon called "catch-up/catch-down" growth, which means that the baby can follow a very different growth trajectory outside the womb than he did inside the womb. A baby can grow fast inside mom and much slower on the outside, or slower inside mom and much faster on the outside. Another factor which can affect the perception of weight gain is inflated birth weight: since so many moms now receive IV fluids during birth, a lot of babies are being born with artificially inflated weights, which can make subsequent growth appear slow. Is that a possibility for your child?

    The second reason to look for another opinion is that your doc didn't give you good advice about supplementing, daily milk amounts, measuring your milk supply, or feeding frequency. If you're going to supplement, you should supplement with your own milk, not formula; breastmilk actually contains more calories per oz than formula. A breastfed baby typically eats 19-30 oz per day, not 37. 37 oz is daily intake for a formula-fed baby, not a breastfed one. And pump tests are NOT an appropriate measure of milk supply! Babies typically extract more milk from the breast than the pump, and not all moms are able to pump much, if anything, even when they have great milk supplies. Pump output varies based on time of day, experience with pumping, make and model of pump, shield fit, stress level. That being said, 2 oz is a totally normal amount to pump at a sitting. Again, the average intake for a breastfed baby is 19-30 oz of milk per day. So let's say a baby takes in 2 oz at a time and nurses every 2 hours for a total of 12 times a day. That adds up to 24 oz of intake per day, right in the middle of the range for daily intake. But the baby is probably better at getting milk out than the pump, so let's say he takes in 3 oz, just a little bit more than the pump can extract, and nurses 10 times a day: that's 30 oz, on the high side for intake! Finally, the feeding frequency you describe is 100% normal for a breastfed baby, and is in no way a sign of inadequate intake. My kids both fed every 1-2 hours throughout the day and night at 4 months, with the occasional 3-4 hour stretch of sleep- and they were both HUGE babies.

    Basically, the most important thing is to look at the baby, not the chart. If the baby is consistently growing in height, weight, and head circumference, seems healthy, and is mastering the appropriate developmental milestones, there's probably no reason to worry about what he's doing on the charts.

    In short, here's what I think you should do:
    - Find a different pediatrician, one who can look at your baby with totally fresh eyes.
    - Consider seeing a lactation consultant, preferably an IBCLC, for a professional assessment of nursing. I think this is especially important if you decide to stick with your current pediatrician.
    - Check out this kellymom.com resource diaper output: http://kellymom.com/bf/got-milk/supp...ughmilk-older/
    Coolest thing my big girl said recently: "How can you tell the world is moving when you are standing on it?"
    Coolest thing my little girl sang recently: "I love dat one-two pupples!"

  3. #3
    Join Date
    Oct 2012
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    Default Re: Supply issue? Want to avoid supplementing.

    Mama, it sounds like you are doing great, honestly.

    1) 37 oz is not a normal amount for a day. 24 oz is average, the range is somewhere between 19 and 30 oz, and 37 oz is really high.
    See this link:
    http://kellymom.com/bf/pumpingmoms/pumping/milkcalc/

    2) Based on the 24 oz average, 24 oz/24 hours = 1 oz/hour on average. So, if you pump after 2 hours and you get 2 hours, that is normal - especially keeping in mind that the pump is less efficient at removing milk than baby is - and that is one reason that a random pump does not tell you about overall supply.

    3) Nursing every 2 hours is perfectly normal for a breastfed baby. A typical meal at the breast is 2 or 3 or 4 oz. So if baby is getting around 2 oz at a sitting, he will need to nurse every 2 hours to get to 24 oz. It's also normal for baby to feed frequently at some times of day and go longer at other times - cluster feeding all evening long, then having a 4 hour sleep stretch, for example.

    4) It is also normal for breastfed babies to drop percentiles. All three of my babies went from being between 75th - 90th percentile at 4 months and then dropping down - for example, my middle baby was 90th percentile at 4 months and was 10th percentile for weight at her three year visit. She was also my biggest baby at birth yet is the smallest in the weight percentiles. I don't think there's a correlation between birth weight and subsequent weight.

    Of course I am not seeing and examining your baby, but from what you describe, it sounds like everything is normal and fine, and if that's the case all the extra pumping and formula is not only unnecessary, but actually could be harmful.

    ETA: Simultaneous post with mommal... we agree!

  4. #4

    Default Re: Supply issue? Want to avoid supplementing.

    Thank you both for your feedback and reassurance. I feel better knowing my supply if normal. I figured it must be if my little guy is never fussy/hungry, only fussy/tired. After he eats he's been happy and not wanting more from me, even when I wait a few minutes and re-offer.

    I am frustrated by the medical world and these percentiles. I know they mean well, but they're just creating doubt and fear among mothers that does not need to be there!

    I will check out your links today. Thanks again!

  5. #5
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    Default Re: Supply issue? Want to avoid supplementing.

    I forgot to ask- what chart is your doc using? The old CDC charts, developed using data from predominantly white, midwestern, formula-fed babies, or the new WHO charts developed using data from an ethnically diverse population of breastfed babies? The reason I ask is that the curves for formula-fed and breastfed babies tend to be quite different. In general, breastfed babies tend to gain weight relatively fast in the first half of the first year, and then slow down in the second half of the first year. Formula-fed babies tend to exhibit the opposite pattern, gaining weight relatively slowly at first and then speeding up in the second half of the first year. So if you measure a breastfed baby on the CDC charts, the breastfed baby will appear to gain weight "too fast" at first, and will then appear to gain weight "too slow" as he rounds the corner into the second half of the first year. As a result, a lot of nursing moms are chided for "overfeeding" their babies when they're young, and then blasted with concerns about slow growth and "underfeeding" as the babies get older.
    Coolest thing my big girl said recently: "How can you tell the world is moving when you are standing on it?"
    Coolest thing my little girl sang recently: "I love dat one-two pupples!"

  6. #6

    Default Re: Supply issue? Want to avoid supplementing.

    She uses the new charts, and even looked on the breastfed chart. Her concern is that he "crossed two lines" and that can signal failure to thrive. Which I thought was extreme, since my son is obviously happy, alert and thriving. She said she's more lax than a lot of doctors, though, and wouldn't want to put that label on him.

    But the other thing I forgot to mention is that I had possibly been unintentionally block feeding my son, since I would feed him on one side only at a time. He seemed satisfied, and usually disinterested in the second side. In hindsight, I think I should have been trying harder to wait for him to burp, and re-offer the second side. So he could have fallen a bit behind just because of that. Now that I'm doing both sides he usually eagerly takes both.

    Interesting about the gain patterns of BF babies, thanks for sharing that.

    My current plan is to BF him until his 6 month checkup and see how his weight is then, and if my doc is still pushing the supplementing, I may seek a second opinion. The lactation consultant idea is good, too. I'll check into that.

  7. #7
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    Default Re: Supply issue? Want to avoid supplementing.

    Crossing two lines on the chart is one possible indicator of FTT, but as this paper points out, using just one variable has poor predictive value when it comes to diagnosing FTT. So if "a lot of doctors" would label a baby as FTT using one variable alone, then they are doing it wrong.

    I think it's wonderful that you're now nursing on both breasts, and I think there's an excellent chance that it will make a difference in weight gain by the next appointment.

    Keep us updated, okay?
    Coolest thing my big girl said recently: "How can you tell the world is moving when you are standing on it?"
    Coolest thing my little girl sang recently: "I love dat one-two pupples!"

  8. #8
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    Default Re: Supply issue? Want to avoid supplementing.

    Quote Originally Posted by @llli*liinamaria View Post

    My current plan is to BF him until his 6 month checkup and see how his weight is then, and if my doc is still pushing the supplementing, I may seek a second opinion. The lactation consultant idea is good, too. I'll check into that.
    Sounds like a good plan!

  9. #9

    Default Re: Supply issue? Want to avoid supplementing.

    Ok, I'm back. And I should intro by saying my boy, now 7 months, has been gaining weight and growing, but my doctor is still not satisfied. He's 16# 6 oz as of this week. His weight percentile has dropped now in the 16%, but he doesn't look skinny. His length and head are consistent with his prev %iles. He's energetic and healthy appearing. Meeting milestones, babbling, etc. She thinks he may not be absorbing the nutrition he needs, based on his continual drop in weight percentile. I disagree, because if you look at him he is so obviously healthy.

    Since my doctor is still freaking me out, I am getting a second opinion next week.

    I'm super anxious and frustrated by all of this. Every doc appt leaves me more worried, when I feel like it's unnecessary worry. I know, I know. I should have switched MD's right away. The one I'm seeing next week is a pediatrician, while my current doctor is not. Perhaps my current doc is overreacting due to lack of complete expertise in pediatrics?

    If I could go back I would have switched docs right away, but knowing I'll get a 2nd opinion next week helps. That's the update. Any input?

    Oh, and my current doc is still calling it FTT. I'm so annoyed.

  10. #10
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    Default Re: Supply issue? Want to avoid supplementing.

    I'm so glad you're getting a second opinion. Fresh eyes are an asset! And having a pediatrician rather than a family doc is a good idea- though just because someone is a pediatrician, it does not necessarily follow that they understand normal growth patterns in breastfed infants. You might want to call your local La Leche League and ask for a recommendation for a good, breastfeeding-friendly pediatrician.

    Now that your baby is 7 months, have you started solids? Because when you have a small baby, solids offer you some fun new avenues for increasing his calorie intake. Instead of feeding your baby the usual fruit and veggie purees and cereals, you can start with more calorie-dense foods like avocado, beans, and meats. And if you offer fruits and veggies, you can give them a calorie boost by adding a little olive oil to them.

    Do you give your baby a daily multivitamin? It won't hurt and may help. Not that I think that there's a problem! But I know that when you have a small baby, you sort of want to cover all your bases.
    Coolest thing my big girl said recently: "How can you tell the world is moving when you are standing on it?"
    Coolest thing my little girl sang recently: "I love dat one-two pupples!"

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