Dear Pam,
Where do I start?!
First, let's look at the big picture.   Here is a baby with slow weight gain
(not NO weight gain, SLOW weight gain), who is active, crawling, pulling to
stand and cruising (an 8-9 month milestone), happy, smiley, normal stools,
taking 3 oz at an observed feeding along with solids appropriate for age, good
color, no illnesses, and I'm guessing wet diapers are qs.....and the docs want to
force feed him based on ONE parameter of health measurement?    Are his
parents slim or short?    Is there something I'm missing here?
Take a look at this child's activity level.   Most kids his age are just
learning to sit unassisted.   The calories are getting burned off as fast as he
takes them in!   The only other thing that might come in to play is the spitting
up, which is not unusual for kids with weak gastro-esophageal sphincters.
It often resolves around the time they are able to pull to stand...usually well
before their first birthday.   There are ways to minimize post-feed spit-ups
(feed in upright position, minimize activity immediately after feedings).
Unless there is a problem which would give other obvious symptoms, some babies
simply are slow gainers, normal for their own needs but slow to the rest of the
world.
Growth charts are based on both formula-fed and breastfed babies, unless the
docs are using the new ones for breastfed babies.   Regardless, growth charts
give the average measurements of where MOST of the infants lie.   But, of
course, there has to be babies on both ends of the bell curve, yes?   How else do
you get averages?   Remember mean, median and mode from our middle school math
classes?   There will always be weights on both ends of the fringe.   He is
not alone.
Force feeding creates food issues that can last a lifetime.   Hints of food
allergies can often be the reason why children often refuse new foods until
they are ready.   Healthy breastfed babies are self-regulating.   He's nursing 7x
a day PLUS all night long, plus solids?!!!   Sounds adequate to me!   If she
wants to increase his fat intake, try breast compression (to keep him
interested as he falls asleep toward the end of the feeding) or one sided nursing
(going back to the same breast instead of switching for one feeding.)   This way
he gets more fatty hindmilk per feed.
He is healthy because of the breastfeeding, so why would we want to disturb
that by adding formula?   Ounce for ounce, ABM has the same number of calories
as breastmilk, with NONE of the protective factors.   We all know that babies
can lose weight when they get sick, right?   I'll never understand why docs
think that ABM is better than the real thing!
I had a client with a 6 lb, 9 oz baby girl who grew slowly but consistently
under the 5%ile, refused anything but breastmilk for 13 months, despite her
tall-and-thin parents' best efforts to offer solids.   She hit all her milestones
at the right time and is now a 50 lb 8-year old, small in stature and weight
but bright, athletic and above normal in every other way.   She is my
daughter.
Annie Brown, LLL Leader, IBCLC

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