<<Do we ever see slow gain in bottle-fed / formula-fed babies when offered
ample milk? Or is it a phenomenon related to breastfeeding? >>
I think I've seen more cases of FTT in formula fed infants...(and we
have a 85% breastfeeding initiaion rate in my program,) so its not
because we have more "exclusively" formula fed infants.
During my "More years than I want to admit" at WIC,
the most severe cases of failure to thrive I have seen have been in
formula-fed babies. Three times I have sent parents directly to the ER
with severely dehydrated babies. Once was from failure to dilute
concentrated formula and feeding it like ready to feed. (The ped kept
changing the formula, but never asked how she was mixing it...it was
her third baby, the first two were breastfed and never drank formula
and breastfeeding never got initiated with the third child). The
second was mixing powdered formula at double strength. (She thought
the dilution was a scoop to one oz of water, when in fact it is 2 oz
and 1 scoop). This was a very educated mom by the way.
Another baby I sent to hospital from the WIC office was hospitilized a
month with severe formula intolerances/food allergies and nearly died.
The baby presented to us as a listless. thin, pale limp infant, and
the family was oblivious to the baby's dire medical situation. We
nearly called an ambulance for that baby, but the family had a car and
drove directly to the ER. (After I had to explain to them that their
baby was VERY sick, sigh)
I have never had to send a baby only getting breastmilk to the
hospital for emergency treatment, although I know it might happen
someday.
I regularly have cases of supposed formula intolerances being a case
of caregivers not mixing or handling formula correctly. I always ask
how formula is being diluted, and what I hear is amazing. It's not
uncommon for me to see a parent pull out one of those new plastic
quart bottles with the twist cap of ready to feed from the diaper bag,
and poor it in a bottle to feed the baby. They are often shocked to
learn its only good an hour unrefridgerated after opening. Other
mothers tell me that they mix the formula by adding the powder to the
water until it "looks right". (whatever that may be).
Not all formula mixing errors are accidentaI. I once had a mother
deliberately feed concentrated formula without diluting it because
"the baby sleeps longer when I do that". This baby was terribly
obese by 1 month old, no doubt because the amount he drank to meet his
water needs was far too many calories, and amazingly this baby never
threw up. Mom was unwilling to dilute it and was very angry with me
for issuing her ready to feed formula from WIC. (In the old days when
it was still possible to do that-now giving ready to feed formula is
really difficult)
I had at least one mother who did recognize when her baby needed an
increase in formula, but delivered the "extra" ounces by adding more
water to the bottle without adding more powder! (And not realizing
that it wasn't really more formula until it was carefully explained.)
I also think some of the causes of breastfeed babies being slow
gainers is because mom is following formula feeding advice. Just
today I had a woman breastfeeding every 4 hours because some nurse at
the hospital told her that was the proper schedule to avoid
overfeeding! This baby was gaining fine because luckily (or not) the
mother was topping the feeds with formula because "my milk is drying
up and she's not satisfied with just breast".....it's no wonder with
that feeding schedule. Hopefully my advice to her will help remedy
the situation, and I refered her to our talented peer counselours for
close followup.
I also think that many cases of failure to thrive are from the
inability of the baby to co-ordinate breath, swallow and suck and
therefore feed poorly.(And yes, I have seen it in bottle fed infants
too!) And I think that many of those feeding difficulties are because
of inteventions done to the mom/baby in the hospital.
Regards,
June Eastman, BS, M.Ed., IBCLC
Lawrence Masaschusetts WIC Program
Lisa asks:
<<Do we ever see slow gain in bottle-fed / formula-fed babies when offered
ample milk? Or is it a phenomenon related to breastfeeding? >>
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