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Thread: Advice needed re: EBF past 12 months

  1. #1
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    Default Advice needed re: EBF past 12 months

    Hi! I have been lurking and reading but haven't really jumped in to post yet. This is bound to be long, but I am a mess and upset and need some advice and hopefully some ammunition to arm myself against my current pediatrician.

    My daughter just turned one (1/23) and is exclusively nursing. She shows no interest in food. I started introducing purees to her at about 7 months, let her play in the food, used a spoon, made it different textures and different consistency...still no interest. I didn't push it.

    At about 9-10 months I let her start playing with finger foods, bits and pieces of what I was eating, while I was eating. I attempted purees about once a week, sometimes every 2 weeks, occasionally longer. She was still completely uninterested. Sometime around 11 months she started feeding ME her food. She knows that you are supposed to eat the food - she just doesn't eat it herself.

    I swear she has radar - she is happy as a clam chewing on a spoon or her fingers or whatever as long as there isn't food on it. The second even the tiniest bit of food is on the spoon, she won't put it near her mouth.

    All in all, she has had maybe a handful of small bites of food (sweet potatoes and applesauce were the ones that I had *some* success with). She has knawed on a few finger type foods (pizza crust, crispy bread crust, etc.) but if anything breaks off into her mouth she starts gagging until she can get it out of her mouth, or until I can sweep it out of her mouth.

    We also stopped attempting to give her oral medicine (tylenol, even oragel) several months ago.

    All in all, I just figured that she wasn't ready to start eating. She is 12 months old, well off the charts in height and weight and obviously thriving and not lacking nourishment.

    Fast forward to last week...

    Her pediatrician said that in order to get her to start eating solids, I should wean her - she will eat when she is hungry enough. That sounds like the dumbest thing ever to me.

    Then today the pediatrician called and said that if she doesn't start eating in the next few weeks, to get back in touch with him to set up occupational therapy for her.

    A few hours later, the nurse called and said that she had put my daughter on a waiting list (at the dr's suggestion) for an OT. I asked her if that wasn't a bit much and that I didn't think it was necessary at this point since she is not lacking in nourishment. She said that babies shouldn't be nursing at all at 12 months and should be eating whatever table foods they want. I told her that I had spoken with other mothers whose children nursed exclusively until 12, 15, 18, 20 months and they are just fine. She basically told me I was wrong (in a not-so-nice way).

    THEN, about 30 minutes after that, another nurse called and told me that I need to be giving her vitamins (tri-vi-sol) daily since she isn't getting enough from me. I told her that I had not been doing that, and she (rudely) told me that I need to be.



    So...now I am at a loss of what to do. I KNOW that I am not alone in this situation. I KNOW there are other babies out there who don't eat food and EBF for 12 months or longer.

    I am actively looking for a new pediatrician now (we just got new insurance, thank god!) and am trying to find one who is more supportive of AP style parenting and especially supportive of breastfeeding. I have contacted a local LLL leader and am trying to get in touch with some other local AP moms from a local message board to find out about their pediatricians. Is there a list or guide somewhere that would point me in the right direction to find a new pediatrician who is more on the same page as me and my beliefs/parenting ideals?

    I need reassurance. I need advice. I need some ammunition to help me support myself to my pediatrician. I need to know if there *could be* something wrong that an OT would help with.

    Thanks for reading, and thanks in advance for any replies. Sorry so long.

  2. #2
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    Default Re: Advice needed re: EBF past 12 months

    Hi Becky,

    Happy Birthday to your Daniela! What a frustrating situation! I'm off to bed, and I certainly don't have all the answers for you. But one thing I really thought you might want to arm yourself with is the "New Mother's Guide to Breastfeeding." This is a book published by the American Academy of Pediatrics, but there are some statements in it that you would think come from a La Leche League publication. I would check your library for it and pay particular attention to the chapters "Breastfeeding Beyond Infancy" and "Weaning Your Baby." Both of these chapters are very supportive of extended nursing (beyond 12 months) and even point out the many benefits of this practice. And since this book comes from the AAP, hopefully your ped would take notice.

    How sad and what lack of knowledge that the nurse told you babies should not breastfeed at all after 12 months. And how sad that the ped told you to wean. You are right, this is silly, you have a perfectly happy, healthy, growing baby and you are going to take away from her the entire nourishment that has brought her to this point?! That makes no sense.

    Obviously, you do want to encourage her to eat solid foods, and it sounds like you are trying. Ooops gotta run - I've got one awake! :-)

    Good luck, I hope other posters who have been through this will have more suggestions.

  3. #3
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    Default Re: Advice needed re: EBF past 12 months

    Hello,
    One thing I may be able to offer in way of support is that kids really do eat much less than we might think they would. Think of a meal as being about the size of your daughter's fist -- so, a few bits of pizza crust is not an insignificant amount.

    Also, I would suggest making sure you offer solid foods before you offer the breast at least 2-3 times a day. I know that even now (my son is 2 years old) I catch myself nursing him right before breakfast, and then of course, he doesn't eat anything! Also, my son still fils up a lot at nght (unfortunately) so he is picky during the day as well.

    Obviously, your ped suggesting weaning is off the mark, unless he can show evidence that your child is not thriving. What if she weren't getting all the good nutrition from you?? I am glad you are changing ped's and hope you get one more balanced/knowledgeable about bfeeding. I don't know about the OT, I can't see how that would be of benefit but if you get a ped you can trust then he/she could give you good advice on that one.

    Luck to you,
    Ingrid

  4. #4
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    Default Re: Advice needed re: EBF past 12 months

    Becky, I'm sorry you are struggling with this. But to be honest, I really think that you have answered your own questions. Do your best to trust your instincts and you do what you feel is right and in the best interests of your baby. There is very little research out there in regards to exclusive breastfeeding past age 1 so I think the medical community gets a bit up in arms when they see a 1 year old who's not yet eating solid foods.

    As a mother, I can tell you that one of my children wasn't ready for solid foods until he was 11 months old.

    As a LLL Leader, I can tell you that no matter how long you breastfeed for, your baby derives benefits from it -- both nutritionally, emotionally & immuniologically. As for the nurse who told you that babies should not be nursing past age 1, the World Health Organization (their recommendation is to breastfeed for at least 2 years) would probably disagree. Even the AAP recommends bf'ing for at least 1 year.

    Here are some articles on extended breastfeeding from New Beginnings - perhaps you'll find some useful "ammunition" in them http://www.lalecheleague.org/NB/NBextended.html

    Dr. Jack Newman says, "... eating food isn't just about nutrition. It's about achieving a milestone and starting to join in as a regular member of the family. Milestones are achieved, not forced."

    I think that you'll find lots of support and information by joining some AP groups. I don't really know anything about OT only that I suspect that if your baby has any oral aversions then this will help.

    Best of luck to you!

  5. #5
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    Default Re: Advice needed re: EBF past 12 months

    Hi Becky
    Good for you for listening to your instincts! It's so frustrating when our healthcare providers aren't up on the research in a area that should be part of their specialty.

    I encourage you to get a copy of "My Child Won't Eat!" by Carlos Gonzalez, MD. (La Leche League Int'l, 2005). He is a Spanish pediatrician who spoke at the LLL Int'l Conference last summer. Two points would be most relevent here:

    1. Babies have a tremendous growth curve in the first year of life. They don't grow so much so fast again until they hit puberty. He says that the phrase, "Eat this food so you'll grow" is wrong. It's really a situation of "you'll eat *because* you are growing." After the first year, children really don't require huge amounts of food (which is why it's important to make sure what they do eat is nutritious). As a mom, I could swear that for most of my son's second year he lived on breastmilk and air! (At least is seemed that way a lot of the time).

    2. Dr. Gonzalez included some interesting appendices in his book. In one, he relates how medical recommendations on starting solid food have changed over the past 100 years. Reviewing "baby books" written by doctors, he found that in 1906, "The introduction of solids took place very cautiously. Until twelve months old, ten at the earliest, Dr. Ulecia recommends exclusive breastfeeding. At this age you could start offering a clear gruel made with water and flour followed by breastfeeding." (p. 152 of My Child Won't Eat).

    He goes on from the same book: "At around thirteen to fourteen months, Dr. Ulecia recommends adding an egg yolk to the morning gruel, and adding another feeding of plain gruel in the afternoon. At fifteen months, add egg yolk to both gruels. At sixteen to eighteen months add broth, legumes, and crackers (once a day)......At three years old, whole egg is introduced and chicken croquettes made according to a special recipe. The amount of fish is specified as [about 1.5 inches]. Three 100g servings of milk were given per day (less than half a cup!).....At three-and-a-half, fruit was introduced....Vegetables are introduced when the child turns four.... (pp 152-153)

    Reviewing more books written later, he notes that in 1932, the recommendation is "At the *end* [my emphasis] of the second six months, it is good for the baby to taste salty food." Then, in 1936, the recommedation is "*In* [my emphasis] the second six months, it is good for the baby to taste salty food." (p156)

    Dr Gonzalez goes on to provide examples of how the time to introduce solid food got earlier and earlier as the century went on. His theory is that more and more children were given formula earlier and earlier-- and the formula was not nearly as nutritious as breastmilk, so the children required complementary foods just to get enough nutrients.

    I hope you can find a more baby-friendly pediatrician. When you hear things from your doctor that don't seem right to you, there is nothing wrong with asking him (or her) to back up what he's saying. ("Could you provide me with some written documentation on this course of action?") You can also ask what he thinks the consequences would be if you don't follow his suggestion. (And you can also ask, "is this your opinion or can you show me the documentation that you are basing this on?") You don't have to be rude, but if your health care providers are so sure, because of their medical training, that something terrible will happen, they should be able to back up their 'scientific' claims.

    As far as the occupational therapist, I don't have any experience in that area. Again, I would wonder why the doctor is recommending it. ("Do you feel that my child has a physical condition that prevents eating solid food? What is this condition? Would occupational therapy help it? Are there alternatives or will my child outgrow it?) If your child is growing, healthy, meeting appropriate milestones, I would question why you need to do anything different. You can read numerous stories on the LLL website about medically compromised babies and children who thrive because they get breastmilk (I'm not saying your daughter has a medical problem, but if she did, then all the more reason to keep nursing!) Babies lose their tongue thrust reflex at different ages-- it sounds to me like your daughter just isn't ready *yet*.

    Well, this post has gotten really long. I hope it has given you some useful information and things to think about. You are responsible for your child and you need to do what you think is best for her and your family.

    Dawn

  6. #6
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    Default Re: Advice needed re: EBF past 12 months

    Quote Originally Posted by tabs416
    Hi! I have been lurking and reading but haven't really jumped in to post yet. This is bound to be long, but I am a mess and upset and need some advice and hopefully some ammunition to arm myself against my current pediatrician.
    Welcome to the boards! La Leche League Leaders do not give "advice", but we do give information and support. Everyone is welcome to share their experience and opinions. Take what works for you and leave the rest!

    Quote Originally Posted by tabs416
    My daughter just turned one (1/23) and is exclusively nursing. She shows no interest in food. I started introducing purees to her at about 7 months, let her play in the food, used a spoon, made it different textures and different consistency...still no interest. I didn't push it.
    Sounds good.

    Quote Originally Posted by tabs416
    At about 9-10 months I let her start playing with finger foods, bits and pieces of what I was eating, while I was eating. I attempted purees about once a week, sometimes every 2 weeks, occasionally longer. She was still completely uninterested. Sometime around 11 months she started feeding ME her food. She knows that you are supposed to eat the food - she just doesn't eat it herself.

    I swear she has radar - she is happy as a clam chewing on a spoon or her fingers or whatever as long as there isn't food on it. The second even the tiniest bit of food is on the spoon, she won't put it near her mouth.

    All in all, she has had maybe a handful of small bites of food (sweet potatoes and applesauce were the ones that I had *some* success with).
    So far, so good...

    Quote Originally Posted by tabs416
    She has knawed on a few finger type foods (pizza crust, crispy bread crust, etc.) but if anything breaks off into her mouth she starts gagging until she can get it out of her mouth, or until I can sweep it out of her mouth.

    We also stopped attempting to give her oral medicine (tylenol, even oragel) several months ago.
    Is she unable to swallow the food or medicine? Does she gag on all food that goes into her mouth? Does she fight anything that goes near her mouth (other than your breast)?

    Quote Originally Posted by tabs416
    All in all, I just figured that she wasn't ready to start eating. She is 12 months old, well off the charts in height and weight and obviously thriving and not lacking nourishment.
    Sounds like she's steadily growing and gaining.

    Quote Originally Posted by tabs416
    Her pediatrician said that in order to get her to start eating solids, I should wean her - she will eat when she is hungry enough. That sounds like the dumbest thing ever to me.
    Remember: The first rule ALWAYS is feed the baby.

    Quote Originally Posted by tabs416
    Then today the pediatrician called and said that if she doesn't start eating in the next few weeks, to get back in touch with him to set up occupational therapy for her.
    What reasoning did he give for advising you to seek an Occupational Therapist for your dd? Did he explain what an OT could do?

    Quote Originally Posted by tabs416
    A few hours later, the nurse called and said that she had put my daughter on a waiting list (at the dr's suggestion) for an OT. I asked her if that wasn't a bit much and that I didn't think it was necessary at this point since she is not lacking in nourishment. She said that babies shouldn't be nursing at all at 12 months and should be eating whatever table foods they want. I told her that I had spoken with other mothers whose children nursed exclusively until 12, 15, 18, 20 months and they are just fine. She basically told me I was wrong (in a not-so-nice way).
    ((((hugs))) That must have been so difficult to hear. It certainly sounds like the nurse was uninformed about breastfeeding. The AAP (American Academy of Pediatrics) would disagree with her statement that babies shouldn't be nursing at all at twelve months.

    Quote Originally Posted by tabs416
    THEN, about 30 minutes after that, another nurse called and told me that I need to be giving her vitamins (tri-vi-sol) daily since she isn't getting enough from me. I told her that I had not been doing that, and she (rudely) told me that I need to be.
    Here is some information about vitamins:
    www.lalecheleague.org/FAQ/vitamin.html
    These are NOT LLL resources, but you might find the information helpful:
    http://www.kellymom.com/nutrition/vi.../vitamins.html
    http://www.askdrsears.com/html/4/T045500.asp

    Quote Originally Posted by tabs416
    So...now I am at a loss of what to do. I KNOW that I am not alone in this situation. I KNOW there are other babies out there who don't eat food and EBF for 12 months or longer.

    I am actively looking for a new pediatrician now (we just got new insurance, thank god!) and am trying to find one who is more supportive of AP style parenting and especially supportive of breastfeeding. I have contacted a local LLL leader and am trying to get in touch with some other local AP moms from a local message board to find out about their pediatricians. Is there a list or guide somewhere that would point me in the right direction to find a new pediatrician who is more on the same page as me and my beliefs/parenting ideals?

    I need reassurance. I need advice. I need some ammunition to help me support myself to my pediatrician. I need to know if there *could be* something wrong that an OT would help with.
    I do not know of any list that would lead you towards the kind of Pediatrician you're looking for, but sounds like you're off to a good start to finding what you want simply by networking!

    I would like to remind you that LLL Leaders are NOT medical professionals, nor should you take any recommendations you find here in the place of medical advice. That being said, I'm wondering how you would feel about doing some research (Google is your friend ) into your situation? There can be medical reasons for food refusal/gagging and there is help out there! Of course, you know your baby best. My best suggestion is to read up on the topic, and then follow your mothering instinct.

    Good luck to you! Please keep us updated. If we can help you locate further information or if you need support, do not hesitate to ask!

  7. #7
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    Default Re: Advice needed re: EBF past 12 months

    Not nearly as detailed as some other posts, but when discussing nursing with my pediatrician recently, is opinion (based on what, I don't know, but I really trust this practice and their opinions) was that "mothers typically have enough milk for 35 pounds of baby." I asked how much she should be eating (she's 8 MO) vs how much nursing, and that was his answer. His practice is quite progressive (or old fashioned, depending how you look at it), and he said they don't get concerned about what their patients eat until they're 2 or 3, so long as they're growing and developing normally. Of course, they encourage offering healthier selections to nibble on to help their tastes become accustomed to what's good for them, instead of the oreo cookies I like to eat!

    Sounds like a good idea for you to be looking for a new pediatrician. Remember that in many cultures outside the U.S. it's considered perfectly normal to exclusively nurse for years, so you're in good company! Good luck with everything!

  8. #8
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    Default Re: Advice needed re: EBF past 12 months

    I agree you should be looking for a new doctor. In my own experience, it sounds that professionals in the field are very quick to recommend an ot. My daughter was referred to one by a lc when she was only 3 weeks old for what the lc was a poor sucking reflex. A preschool teacher also recommended an ot at 7 months because my daughter wasn't showing interest in mouthing objects. Then again, a nurse suggested I see a ot at 9 months because she wasn't showing interest yet in solid foods.

    My daughter is exclusively bf and refuses the bottle. She is 75% consistently for height and weight. She obviously is not lacking nourishment.

    Trust your instincts. If I had listened to others, my daughter would have been formula fed from 3 weeks on. You know what is best for your own child.

  9. #9
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    Default Re: Advice needed re: EBF past 12 months

    Out of interest- will your baby take expressed breastmilk of a spoon??
    My daughter was also very reluctant to try solids, so I began with just EBM from spoon- v. slowly thickening it with baby rice, then mixing to create other runny purrees. I found that with the familiar taste of breastmilk- she was a little more encouraged to eat

  10. #10
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    LLLJacqui is offline Shares Widely And Frequently
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    Default Re: Advice needed re: EBF past 12 months

    I don't think I have much to offer by way of resources beyond what has already been offered, but I do know that as a LLL leader I have come across many mothers who were in your situation... they had babies/toddlers who just weren't into solids no matter how often they were offered them... and then, around 18 months, they suddenly thought they were GREAT! None of those children have any problems with food aversions or eating or anything now.

    I agree that so long as your child doesn't seem to have a problem swallowing, then this is not something to get too uptight about... Just keep offering solids... maybe have a little food plate around during the day with cheerios and some other little bites so that your toddler can pick at it if she feels like it. This helped my DD a lot. She really wasn't into solids that much and really didn't like eating when my DH and I ate a meal... she just wanted to touch food when she wanted to... there was no real pattern to her eating. She's now 3.5 and will eat about anything put in front of her.

    So, there is hope. I think if you feel you need to find a new pediatrician, then you should. If you are not feeling encouraged and understood in your parenting choices, then you need to find a place where you are.

    Good luck to you and know you are not alone.

    Jacqui

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