It seems we all had a bad day yesterday; maybe the planets are in the wrong
alignment for pediatricians to use their brains when dealing with
breastfeeding moms, or something . . .
I have another one for Coach Smith's "Absurd Advice" book:
Mom of an 11-week-old came to see me upset about what the Ped GI doc had
said. Seems she was sent there by her Ped for "reflux" BW 8#4oz, current
weight 15#6oz. Babe is exclusively breastfed, happy, smiling, thriving.
GI doc was "concerned" because wt was 80th%ile! Told mom she was
"overfeeding", should pump her milk to give in a bottle 3 times a day and
mix with rice cereal to thicken, and if she "insisted" on continuing to
breastfeed directly the rest of the time, she must limit to 6 minutes per
side, and gave a script for high-dose Zantac.
My hunch from watching them feed and hearing the whole story, is that this
mom has the happy problem of slight oversupply causing a little fore/hind
imbalance. I.e., there is more than usual amount of foremilk being made,
which is what babe initially fills up on, doesn't gets the hindmilk satiety
signal, foremilk gets digested fast and/or spit up, so babe stays hungry
and keeps eating all the time, which makes mom's supply go up more, thus
producing more foremilk, and it's a cycle.
Explained all the physiology of this to mom, as well as my recommendation
to do just the opposite of what Ped GI said, which was to feed on only one
side per feeding, and pump only for comfort and freeze the leftovers. She
really didn't want to do cereal, because she's read the AAP statement about
not starting solids until 6 mos. She also stated it hadn't done anything so
far in two days, except make the spit-up harder to clean up. I also
questioned the pumping, because if foremilk and hindmilk are mixed in a
bottle, then babe still won't get satiety signal.
My observation of trying to thicken expressed breastmilk with cereal is
that it doesn't work anyway. Used to notice when I was mixing my kids'
cereal with breast milk that if it sits more than 5 minutes, the enzymes in
the milk digest the cereal while it sits in the bowl, and the whole thing
becomes thinner anyway.
Any other thoughts? Why does this baby need treatment anyway, with
adequate weight gain? Told mom he probably didn't! One option was to just
keep doing laundry. (I think she's sorry she ever mentioned it to the Ped
in the first place.)
No, I don't think this Ped GI would read anything I sent him; he thinks
he's God's gift to pediatrics in our town. :(
Feeling like a salmon in spring,
Becky Saenz, MD, IBCLC
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