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Thread: Help me (snif) I don't know what to do!

  1. #1
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    Unhappy Help me, I don't know what to do!

    This is not actually my dilemma, is someone else from the Spanish forum, she agreed with me to post it here so I could translate it for her. We get good help from the Spanish forum but there's only a handful of us. The original thread is linked if anyone speaks Spanish please post there, otherwise I'll translate it here and translate the replies for her.
    http://lalecheleague.org/vbulletin/s...2377#post32377

    Today I took my baby for her 10 months check up to the pediatrician. Her weight chart is as follow:

    month: weight: length:
    0 3.230kg (7lbs2oz) 49cm (19 1/4")
    1 4.100kg (9lbs) 53cm (20 3/4")
    2 5.000kg (11lbs) 57cm (22.5")
    3 5.400kg (11lbs14oz) 58cm (22 3/4")
    4 6.000kg (13lbs3oz) 59cm (23 1/4")
    5 6.200kg (13lbs10oz) 63cm (24 3/4")
    6 6.400kg (14lbs1oz) 64cm (25 1/4")
    7 6.800kg (15lbs) 65cm (25.5")
    8 6.700kg (14lbs12oz) 66cm (26")
    9 7.200kg (15lbs12oz) 67cm (26 1/4")
    10 7.300kg (16lbs1oz) 67cm (26 1/4")
    Head circumference is 42cm (16.5")

    My doctor insisted that I need to wean her. He said that a baby her age need around 1000 calories and because she prefers the breast she isn't going to gain the weight that way. I've been trying to get her to eat more solids but she doesn't seem too hungry. I nurse her on demand and try to give her a variety of foods to see if she would get a few bites...
    I expalined my ped that I wish to follow WHO guidelines and asked why he didn't agree with that, if it could be something else causing the slow weight gain because I think my baby is very healthy otherwise. His answer was that he agree with WHO but in this case he isn't seeing any results and that according to the weight chart from the sixth month things have been going bad, and that we can't generalize and this is a case of malnutrition, that is not that she's sick but that she'll be behind on her development because if she doesn't grow her brain wouldn't grow either and that's a serious damage and irreparable, that he was sure it wasn't a physical problem like an infection or something like that. "Wean that baby so she can eat and get better, think about it" His words.
    There's a part of me that believe him, but won't convince me...there should be another way to resolve this, without weaning her, or am I doing wrong and damaging with my obstinacy??? What do I do??

    Thanks a lot for your time and attention.

    More about her:
    This is her second ped, she have no access to a LC or any LLL group, her only support is this forum. She scheduled an app. with a nutritionist to see if they can find something. From what she has told me her daughter has reached her milestones fine and is a very happy baby, she got sick recently with fever and the ped ASSUMED it was an infection but didn't run any test or cultures, and he still don't want to do any.

    I'll add my two cents to this later as well as tell a bit more about her situation.
    Last edited by @llli*mami.kathy; July 26th, 2006 at 07:25 PM.

  2. #2
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    Default Re: Help me (snif) I don't know what to do!

    Oh this poor woman...

    As I am looking at the weight chart, the baby IS growing, gaining significant amounts at different times. Obviously her milk is fine! Is the baby weighed on the same scale every time? How does she feel about going against doctors wishes? I think people put doctors on a pedistal, where they really need to be down with us. I listen to my doctor, but I do not do everything they tell me. I look at them as an outside opinion. Obviously if my children are sick, I would listen, but just because this baby is not creaping up on the scale quickly means NOTHING! She may just be small! If she is happy, meeting milestones, and continues to grow, even if slowly, then the mama should just smile and nod her head to the doctor and continue to BF that baby!

    Just my 2 cents!

  3. #3
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    Default Re: Help me (snif) I don't know what to do!

    Her child is gaining fine, she just has growth spurts. My neighbor's baby grew this way, the ped called it "stair stepping" Every 3 months he would gain alot but in between times he didn't gain at all, and this started right from newborn on up, 2 months he was fine, 4 months he was too small, 6 month check-up he was fine, 9 month check-up he was too small, 12 months he was fine. He is now almost 5 and a lanky thing, but taller and heavier then my 5 year old-who is healthy! Once he was weaned he didn't "take off" and grow fast, no, he was still a skinny, but healthy little boy. Infact, most of the people I know who weaned bc of having skinny kids, thier babies lost weight after weaning. This lady, her breast milk is fine, she needs a new Dr not formula. I wish she lived in MN, I'd refer her to a GREAT BFing friendly Dr!
    BTW, both my sons have malabsorbtion of sugars and are TINEY, my 1st DS was 14pds 7 oz at 1 year, and his brain development has been fine, he is a normal 3 year old now-just REALLY REALLY small!

  4. #4
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    Default Re: Help me, I don't know what to do!

    I don't have the new WHO growth charts handy (and anyway, I'm not trained in their proper use, for that matter), but to my untrained eye, this baby's curve looks quite typical for a breastfed baby. Rapid growth in the early months that gradually slows. There is one dip in weight here:

    Quote Originally Posted by Mami_Kathy
    month: weight: length:

    7 6.800kg (15lbs) 65cm (25.5")
    8 6.700kg (14lbs12oz) 66cm (26")

    But you'll note that even with the slight weight loss, baby continued to grow in length -- was that the month she started crawling or scooting around a lot? And anyway, she makes up for it the following month:

    9 7.200kg (15lbs12oz) 67cm (26 1/4")
    It's just this most recent check that shows a gain of only a few ounces and no increase in length -- but either of those measurements could be off, and one appt does not make a trend.

    10 7.300kg (16lbs1oz) 67cm (26 1/4")
    Head circumference is 42cm (16.5")
    IMHO, it is the doctor's insistence that the mother WEAN that marks him as ignorant and incompetent. We can't see the baby to know for sure whether there is some problem with her growth or health. But whether there is or not, the mother can be assured that weaning is NOT the best answer. There is no food superior to breastmilk in its nutritional make-up. Solid foods in the first year are for fun and experimentation, not primarily for nutrition, because every last one of them is inferior to breastmilk.

    I hope some of the moms here who have had 16-pound 1yo's will see this thread and chime in with their experiences.

    I just abhor the way the doctor attempts to browbeat the mother into compliance with this line:

    this is a case of malnutrition, that is not that she's sick but that she'll be behind on her development because if she doesn't grow her brain wouldn't grow either and that's a serious damage and irreparable

    What any decent mother would hear in those words: Obey me or your child will suffer mental retardation! Ugh.

    Could the mother switch doctors -- not to another pediatrician, perhaps, but to a general family practitioner? I think some peds are so skilled in the pathologies of childhood that they can't always recognize "normal" when they see it. Someone who is trained in working with families and who deals with a wider range of "normals" might be able to look at this situation with some perspective, and either put this poor mother's fears to rest, or give her some constructive advice instead of browbeating her.

    I am just now reading My Child Won't Eat! by Carlos Gonzalez, and I notice that it was originally published in Spanish, under the title Temas de Hoy. I wonder if this mother knows about this book; from the little I've read so far, I suspect she would find it tremendously reassuring.

    --Rebecca

  5. #5
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    Default Re: Help me (snif) I don't know what to do!

    I'm going to look up how many callories it says a baby needs on sears website..
    I would think that 1,000 sounds high...

    heres a link that might help... is your child getting enough to eat?
    http://www.askdrsears.com/html/3/T031100.asp

    he says to keep a diary of all the food the baby is eating..
    I got that advice when my baby had low iron.. The doctor basicly said that my milk was no good for a 12 month old and she was drinking too much of it and if I didn't wean her and get her onto more food she was going to die..
    Well at 3 she is as healthy as a horse and not even weaned now.
    I think maybe the doctor is missimformed about the benifits for older bAbies.

    heres a chart that compaires breastmilk to other milks
    http://www.kellymom.com/nutrition/mi...kcalories.html
    if I figured right he would be telling a formula feed baby that the baby needed to have more then 45 oz of formula? That seams like alot of milk.
    uggg!
    this is a good book I don't know if you can get it in spanish
    http://store.llli.org/books/product/91
    she could try high calorie foods..Avacado meats cheese eggs skip the cereals and pastas just for a while to get the doctor off her back.
    Ask too if she is a smaller person? Sometimes doctors don't think about that.

  6. #6
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    Default Re: Help me (snif) I don't know what to do!

    SPEAKING FROM PERSONAL EXPERIENCE:

    My dd is smaller than this baby, she is in the 10th percentile for weight, and my ped says she is fine!!!!!

    She is in the 90th percentile for length and head circumference.

    There's nothing wrong with this baby. Maybe it's time for a 3rd ped that is more supportive of bf.

  7. #7
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    Default Re: Help me (snif) I don't know what to do!

    I expalined my ped that I wish to follow WHO guidelines and asked why he didn't agree with that, if it could be something else causing the slow weight gain because I think my baby is very healthy otherwise. His answer was that he agree with WHO but in this case he isn't seeing any results and that according to the weight chart from the sixth month things have been going bad, and that we can't generalize and this is a case of malnutrition, that is not that she's sick but that she'll be behind on her development because if she doesn't grow her brain wouldn't grow either and that's a serious damage and irreparable, that he was sure it wasn't a physical problem like an infection or something like that. "Wean that baby so she can eat and get better, think about it" His words.
    I don't get how someone with that line of thinking could be a doctor. If a baby is totally happy and healthy, how can she be suffering malnutrition? He said that isn't about being seek but being malnourished is being sick!! What's up with that! He's talking about her brain isn't growing, so how in the heck is she meeting every single milestone on time? How is he sure about not being something else if he won't run any type of labs? He doesn't make any sense AT ALL!!

    And if he wants to pull the "the charts shows" line he still wrong! Look at the chart http://www.who.int/nutrition/media_p...irls_z_0_5.pdf , she might be below average but still in there. What chart is he looking at? does he think they're a test and the baby should be close to the 100%.

    His license should be revoke! If the baby don't want to eat solids food, imagine if she stop nursing, then what would be left, NOTHING! Then the poor baby will get malnourished.

    You know what make this even more sucky? He is her neighbor! So she has to see him constantly. The good news she made up her mind and she's not going to use his services again. Another thing that sucks for her is that according to the online directory there's only one Board Certified Lactation Consultant in the entire country of Mexico, and the LLL groups or Leaders are hours away from her.

    Anyway, update on her situation. She saw the nutrionist and was told there's not malnutrition, figures! That the baby is just small and gave her ideas on how to up her calorie intake. So if anyone know about high calories age aproppiate foods let me know. I know about using olive oil, meats, cheeses, avocados, and still looking.

    Thanks everyone for your support, I'll let her know about your recommendations, ideas and feelings about this matter. I know she'll be so happy to hear them.

    Ask too if she is a smaller person? Sometimes doctors don't think about that.
    Totally agree. I don't about weight but she's short and her husband is not that big either.

    I am just now reading My Child Won't Eat! by Carlos Gonzalez, and I notice that it was originally published in Spanish, under the title Temas de Hoy. I wonder if this mother knows about this book; from the little I've read so far, I suspect she would find it tremendously reassuring
    I'll let her know about this book.

  8. #8
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    Default Re: Help me (snif) I don't know what to do!

    According to The Breastfeeding Answer Book (LLL pub), for a breastfed baby, "Average weight gain for the first three to four months is about six ounces per week, though it is considered acceptable for some babies to gain four or five ounces per week. Weight gain should always be figured from the lowest point rather than from birth weight. Growth in length average one inch (2.5 cm) per sonth and growth in head circumference is about one-half inch (1.27 cm) per month during the first 6 months, and about half that during the second 6 months. The very rapid growth a baby experiences during the first three months typically slows down during months four to twelve...an average weight gain for a breastfeeding baby four to six months is about four to five ounces (113 to 142 grams) per week. An average weight gain for the breastfeeding baby six to twelve months is two to four ounces per week. Growth in length average about 1/2 inch (1/27 cm) per month and growth in head circumference is about 1/4 inch (64mm) per month. The average breastfed baby doubles his birth weight by five to six months. At one year, the typical breastfed baby weighs about 2 1/2 times his birth weight, has increased his birth length by 50 percent, and his head circumference by 33 percent."

    Here are my thoughts:

    Based on above info, it looks like the baby was growing at a pretty typical rate from 0-6months, as she was just shy of doubling birth weight. Overall, her weight gain has been below average from 6 to 10 months, BUT that looks like its only because of that one month where she lost weight. The month before she gain nearly a full pound, and the month after a full pound. If not for that one month I think she'd be pretty much on track. I'm wondering if maybe she had an illness or something that month that caused the weight loss and now she is just still catching up???

    I would also be interested to know what the baby's nursing patterns are. Does she act hungry (wanting to nurse constantly)? Or, maybe she's so busy learning to crawl, walk, communicate, etc. that she forgets to nurse?

    Even if there IS an issue of not enough calories, I don't think weaning is an appropriate intervention. In my opinion a better approach would be to try to INCREASE intake of breastmilk (either by encouring more frequent nursing or taking steps to increase milk supply if that's an issue) and at the same time try to introduce some calorie dense solids in addition to nursing. Ideas for good solids to choose would be avocado, bananas, and sweet potatoes. My son likes mashed avocado mixed with mashed bananas. Also, after 12 months a good choice is whole milk yogurt (as long as baby tolerates dairy). I'm not sure what's available in Mexico, but in the States Stoneyfield Farm and Dannon both make whole milk yogurts (they have about 8-9 grams of fat per cup).

    I hope some of this is helpful. I think I would also try to find a new doctor.

  9. #9
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    Default Re: Help me (snif) I don't know what to do!

    Excellent post, llowe -- thanks for sharing the Breastfeeding Answer Book passages.

    Just one aside about the yogurt -- I remember my son eating a lot of yogurt well before the age of 12 months. I've heard that the fermentation process that turns milk into yogurt breaks down the proteins that could otherwise cause trouble. Anyone know if that is correct?

    It's also pretty easy to make yogurt yourself at home -- especially in warmer climates. Just something to maybe pass along to the OP on the Spanish-language board.

    --Rebecca

  10. #10
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    Default Re: Help me (snif) I don't know what to do!

    Quote Originally Posted by quakerm0mma
    Just one aside about the yogurt -- I remember my son eating a lot of yogurt well before the age of 12 months. I've heard that the fermentation process that turns milk into yogurt breaks down the proteins that could otherwise cause trouble. Anyone know if that is correct?
    I do know that yogurt is generally much easier to tolerate than fresh milk or some other dairy products, and therefore is a good first dairy to offer. So, yes, it might be ok to go ahead with some before 12 months if there is no previous history with dairy allergy. If this is an option--I mentioned before that my son likes avocados and bananas mixed together--he's even more fond of avocado, bananas and yogurt ALL mixed together. Actually tastes a lot like a banana blizzard in the right proportions.

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