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  1. #1
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    Default Milk quality question - update page 3

    And I needed to do it, like, yesterday.

    Jack is now 5.5 months old. He has hardly gained any weight in the past 3-4 months so we were referred to a pediatrician for failure to thrive and that's where I've been today.

    He says he looks and acts fine, which he does. However, he is concerned over the lack of weight gain, and I've been told to supplement with formula twice a day (and the formula is made to be more concentrated than it says on the can) and also add cereal twice a day. I have no problem with the cereal because I was planning on doing that in the next couple of weeks anyway, but I'm very upset over the formula, for reasons that have nothing to do with whether I think formula is good or not, but because he is my last baby. All the others were breast fed until they self-weaned, which they all did at around a year. He is my last breast fed baby and I wanted to prolong the breast feeding relationship as long as possible and now it feels like the whole thing is being stopped right now. Which obviously it isn't because he didn't tell me not to breastfeed, and I realize that is all to do with how I feel and not with what's best for Jack.

    Anyway, I am considering doing the cereal but not supplementing, but in the meantime was also wondering if there is something I can take? eat? do? to improve the quality of my milk.

    The pediatrician's arguments for supplementing are as follows:
    If he were a two year old and came in with the same problem, then he would suggest feeding higher calorie food to the two year old, and formula is the equivalent for babies. He can't do anything about my milk quality, so formula is the only option. He says he would now consider the situation to be an emergency because it has gone on for a few months. He says he is not anti-breastfeeding, but he is anti "breastfeeding at all costs", and at this point the lack of growth could be affecting brain development so Jack would be paying the price. I couldn't think of anything to argue against any of that. He even gave me three cases of formula so I wouldn't have to buy it.

    I have to go back in a month to see how we're getting on, and I dread to think what would happen if I don't do everything he says and then Jack's weight doesn't go up....

    I creid all the way home.
    Last edited by mum_of_four; 09-07-2007 at 12:18 PM.

  2. #2
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    There are probably some things you can try before adding formula. What is your supply like? Do you think Jack would nurse more if you put him to the breast more often? You could try taking fenugreek and blessed thistle to boost your supply, thus getting more calories into him. Also something to consider is if Jack is getting enough hind-milk - are you doing compressions at the end of the nursing session? If he's not interested any more, could you pump to get the hind milk?

    Breastmilk and formula are roughly the same, calorie-wise (20 calories per ounce). Cereal isn't anywhere close to that, so nursing more or adding formula is a better choice than cereal for helping him gain weight. By changing the amount of water used to mix the formula, you are upping the calorie count - but it's not doubling it, or anything, just adding a few calories per ounce. A similar effect can be gained by adding some formula powder to pumped breast milk, if you are concerned about the impact of a formula feeding session on your supply.

    I'm sure others will have better advice than that - so I'll give you a *hug* and wrap it up.

  3. #3
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    I wasn't able to breastfeed for more than a week with either child, but I hear you on the disappointment in "having" to turn to formula.

    I know how important breastfeeding is, for you and for baby. You are not harming him in supplementing, but I am not discounting your feelings. I don't think supplementing formula is "better" than breastmilk, so I'm kind of confused by that... cereal is just a filler, but it's also great way to teach them how to "eat" and maybe you could go straight to trying "real" food instead... there's no real reason to HAVE to do cereal first, unless that's how you want to add formula to ease your mind (it's in the cereal, not a bottle; not substituting a bfeeding).

    Can't you institute the high-caloric diet to yourself to eventually have that filter through the bm? I honestly don't know enough about what goes through, how much gets through etc. I'm not trying to play doctor here. Does he seem to eat enough/long enough compared to your previous children? These are just my own thoughts as I read your post.

    I do think that if it's that he's just getting enough from you to survive, without thriving, then you must do what is more important for his health (how beautifully generous for the ped to have given you formula, at least you have it on hand!), but I totally encourage ways to help you breastfeed before resorting to formula. I hope you can do what's right for you, your baby, and your peace of mind.

    Best of luck, and lots of hugs!!!

  4. #4
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    Well I'll start with {{{{{HUGS}}}}} to you mama for wanting the very best for your DC.

    I don't agree with the cereal recommendation because as a PP pointed out, it's just a filler that will not offer more calories than BM or formula. Why not start him right on real foods rather than cereal? We NEVER gave DS any infant cereal for the reason above. Avacado is very dense in calories and it just needs to be mashed with a fork or pureed in a blender.

    Make sure your DS is getting all the hindmilk available to him.

    If you don't mind, I will post your dilemna on another site I frequent and see what suggestions they might have to boost the quality of your BM - If it's at all possible, someone there will know!

    Depending how you feel about offering BM from other BF mamas, that might be an option??? Do you know anyone close to you who might be willing to donate EBM? I would be willing to pump what I can for you if you wanted

    If you MUST offer formula, do it via SNS that way baby will still be getting BM and BF while receiving the formula and thus not interfering as much with the BF relationship as just straight bottlefeeding.

    Finally, I would strongly suggest you contact Dr. Jack Newman. He answers all of his emails personally and fairly promptly. drjacknewman@sympatico.ca

    HTH

    MM
    *sigh*



    Breastfeeding Success Essentials:
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    Beat the "Booby Traps" to Breastfeeding Success!


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  5. #5
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    Definitely DEFINITELY get some other advice! (and I agree that Jack is probably your man here, and he'd be able to provide solid information to give back to your doc so you aren't fighting him alone, ya know?)

    If you *must* do the formula route, have you considered sips from a cup, or even from a spoon so that he doesn't end up preferring a bottle?

    I'm talking out my arse a bit here, sorry, I'm the farthest thing from a breastfeeding expert on this forum but I do feel for you and think that you'll get a ton of support here to help you out!


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    I am sorry to hear about what you are going through. Personally I would just give your DS the formula. You can always stop once he starts gaining. I do agree with using the lactation aid though. That way DS is nursing at your breast - no bottle involved - , getting your breast milk and the extra calories at the same time, and this also increases your milk supply because of the extra sucking. I have been there, done that and it really worked for me. Once everything was back up to speed I simply stopped using the aid (and the formula). My DD ended up breastfeeding until she self weaned near 2. I know how hard it can be to do but I personally would not ignore the doctor's advice. I just did a quick skim through Jack Newman's book and didn't find anything about improving the quality of breast milk. I would think (and just a guess) that the better you eat the better your milk will be. At any rate, do what you feel is right and hang in there. I don't know how many times I was told to put DD on formula for good. It is sooo stressful but just remember it doens't have to be all or nothing. Nor does it have to be forever. Good luck!

    ETA - the supplamenting advice (in my case) actually came from JN's book and saved my bf relationship.

    Also - Zoo... looks like we are disagreeing lately... at least we will always have RON! LOL!
    Last edited by thebarmybee; 08-31-2007 at 01:45 PM.

  7. #7
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    Sorry but since you didn't answer right away and time is of the essence, I hope you don't mind but I posted it on the other forum anyway... Already several replies! Here they are:

    Ack! Bad advice. Avoid the cereal of course, if she wants to offer solids offer a little fruits and veggies high in nutrition - avacado is great - after the babe hits 6 months. Never fill the baby up on that, nurse first then foods, nothing will digest and fill his needs like breastmilk can. Her milk is probably of fine quality, maybe not quantity. If she wants a list of things to try:

    Make sure mom is eating enough calories and a good variety of nutritious foods.
    An EFA supplement for her can't hurt (ex: flax seed oil) most people are low in those anyway and it does pass to milk.
    Oats can boost milk supply: oatmeal, cookies, oat bread
    Fenugreek and blessed thistle supplements.
    Mother's milk teas with fennel, nettle.

    Avoid OTC meds especially sudefed and stuff like that, avoid mint, sage, and oregano.

    A visit with a good lactation consultant is in order. I can't believe the ped would suggest formula and cereal instead of refering her. Well I can but it's sad and frusterating.

    If she does NEED to supplement with formula for low supply, first look for donor breastmilk instead, whatever the supplement is it shouldn't be given by bottle, that'll just reduce her milk production. Lact-aid or SNS, definately.
    Bad bad advice.

    No cereal. empty filler.

    I would be interested in the nursing schedule.

    My first suggestion would be to offer nursing at LEAST every hour while awake. Cosleep and nurse as possible at night.

    I wonder if this is scheduled nursings?

    -Angela
    Oh poor thing!!

    I'm by no means an expert but if I was in her situation these are the first things I would do.

    1. Contact the LLL in her area ASAP and surround her self with support and good advice.

    2. Get a really good pump and pump off the foremilk so he only gets the high calorie hind milk.

    3. Add some Essential Fatty Acids to her diet to fatten up her milk, but at least with good fats. If she is already taking EFA's then start taking more. For example a few good tablespoons of flaxseed oil in smoothies, fish oil capsules (Carlson's, Nordic Naturals, Natural Factors are all good reliable safe brands), hemp seeds are also high in EFA's and have tons of other awesome nutrients in them too and can be blended into smoothies or tossed on yogurt, cereal etc.

    Someone mentioned on another post in here that their child/baby had a dairy allergy and if she (mamma) was consuming any dairy her baby stopped gaining weight, when she stopped the dairy, baby started gaining again.

    Food sensitivity might be something to look into as well. I would cut out the obvious dairy and wheat and see if that makes a difference?

    {{{hugs}}} to her. Keep us posted if you can!
    I'd be interested in seeing if she's tried cutting out dairy. My daughter stopped growing, and it was due to the reintroduction of dairy in my diet. She's sensitive to it, and even though she wasnt showing any external signs, it was hindering the absorption of nutrients. It's worth thinking about.
    Is he growing in head circumference and length? Those are important in FTT.

    There are two possibilities, that he's not getting enough, or that he's getting enough ans is not using it properly. Not getting enough is easily fixed, really, but not using it well is serious. If the child needs super concentrated formula, there's something seriously wrong. I would ask for a referral and see a specialist before doing it. I've never ever heard of anyone advising to give concentrated formula, it seems insane, because of the stress on the kidneys with not enough water for the protein they're being given - I would want to know NOW if there's a metabolic problem, rather than follow some weird scheme.

    Cereal is lower calorie than breastmilk or formula. I would delay cereal in this case (and I was told by my paed to cut back on solids when we had weight gain issues).

    While I was waiting for the specialist I would start offering the breast twice as often as before, at least every hour and a half during the day. If the baby's sleeping through I'd start waking him around ten for another feed. At each feeding I'd use breast compressions and switch back and forth between breasts until the baby refuses any more. I'd go and see an LC and have test weighs done to see what sort of milk transfer is happening. No pacifiers, the baby needs to do all of his sucking at the breast to get milk.

    HTH
    *sigh*



    Breastfeeding Success Essentials:
    SUPPORT ~ EDUCATION ~ DETERMINATION

    Beat the "Booby Traps" to Breastfeeding Success!


    ~The plural of 'anecdote' is not 'data'~

    ~Do or Do Not. There is no try.~
    Yoda

  8. #8
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    Here's a list of baby appropriate foods with the calorie and fat content:
    http://kellymom.com/nutrition/vitami...dcalories.html

    Avocado is the only food that's better than breast milk, both calorie AND fat wise - and the fat is really important.

    If you don't have a pump, you can rent one - I know Cheeky Monkey has a rental program.

  9. #9
    Zoo
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    Quote Originally Posted by thebarmybee View Post
    Also - Zoo... looks like we are disagreeing lately... at least we will always have RON! LOL!
    Whatever you do, don't bring up Jack when we're having a lovely evening out, that's all I'm sayin'.... lol

    No, I actually totally agree with you, I just don't know how the supplement thingy works and figured if it was an option The Jack would tell her.

    Oh and PS, piggins is playing tonight at the wick...


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    Wow, MilkyMama, those are great suggestions, thanks for posting it elsewhere.

    A few thoughts on what others have said...I don't think it's necessarily a "quantity" issue because he isn't screaming and yelling for more at the end of a feed. My other three at this point were screaming for food all the time so I knew they were ready for solids, but he isn't showing any interest in solids and isn't fussing as if he isn't getting enough. Also, I know for sure there is milk there because when he is feeding on one side there is milk leaking on the other, and if he hasn't eaten for a while I feel very "full".

    So I think it's a quality issue, or a lack of absorption issue on his part. I don't think that I'm doing anything different with him than I did with the other three. He is fed on demand. Obviously sometimes I can't always get to him right away if I am in the middle of doing something but I go to him as soon as I can. He has slept through the night since he was about a month old. One of my "strategies" over the past few months has been to wake him up for more food before I go to bed (about halfway through his night) but he is more interested in playing than eating and at 1 am I am not interested in playing! He starts the night off in his own bed so that I can get things done knowing he is safe, but when/if he wakes in the night he comes into bed with me and feeds when he likes. I *think* that he feeds initially and then drifts off back to sleep and that's it until the morning, but obviously I'm sleeping so not really sure.

    He doesn't have a pacifier but he does suck his thumb, and has done since birth. I can tell when he is done eating because he pushes me away and "plugs himself in" (puts the thumb in). Once he has pushed me away he really is done because he won't go back on that side, or try the other side.

    My feeling is that if he wasn't getting enough milk I'd be hearing about it, and I'm not. He is the easiest baby I have had.

    thebarmybee: are you talking about one of these tubing systems where the tube lets out right at the nipple so that when they suck the nipple they also suck the tube? I was rigged up to one of those when my first was still in the hospital but I'm not sure where I could get something like that now. I definitely prefer that idea to a bottle. I bought a sippy cup today and figured I would try that if I had to.

    I think I will try the wheat free millk free thing for me for a few days and then go to a well baby clinic to get him weighed a few times. And I will e-mail Jack Newman (I know he's the guru but I hear some scary things about him and I don't need any more scaring today, thank you very much!).

    amyunicorn: I love the high fat diet for me idea, unfortunately, I don't think I have any problems in that area already!!

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    Yes, I'm talking about those tubes. I got mine at the hospital (St. Joes). They tried to tell me that they couldn't sell them without a lactation consultaion. I told them what I thought about that and left with my tubes. I don't know if it would work for you but I really liked the idea that the baby was still "nursing". I am so pro-breastfeeding but sometimes we all need a little help. If you have any more questions plesase let me know.

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    Just a few things... I've heard with the elimination diet that it can take *up to* a month off the allergen foods to see a result in *some* babies. So just incase you don't see immediate results, don't rule it out either. Can your doctor refer you to an allergist for the baby?

    You can buy an SNS (the tubing thing you described and that BB and myself suggested) locally here ---> Positively Breastfeeding

    There are several Specialty Feeding Devices that Tess sells. SHe is a Lactaion Counselor so she might be able to help guide you if you go see her.

    Other Specialty Feeding Devices

    I believe it is recommended that you use the smallest tubing available with the unit so the baby has to continue to "work" for his food.

    HTH

    MM
    *sigh*



    Breastfeeding Success Essentials:
    SUPPORT ~ EDUCATION ~ DETERMINATION

    Beat the "Booby Traps" to Breastfeeding Success!


    ~The plural of 'anecdote' is not 'data'~

    ~Do or Do Not. There is no try.~
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    oats really do boost supply if it is an issue, though it doesn't sound to me like it is. I had an oatmeal to go bar on the way to work the other day and was leaking ALL day!

    I hope you can find something that works for you Alison, Jack is so lucky to have a mama like you to make sure he is thriving.

    Maybe try one of the mesh feeder systems (I've seen a few brands, such as baby safe feeder) with an alvacado in it to keep him occupied and getting fat in him when he isn't attached to you.

    I agree the cereal thing is dumb, it's just fluff that'll fill his belly. If you need to bulk him up that seems couterproductive.

    If you are going to try formula I'll second some advice given to me- buy the smallest can that you can find so you don't end up throwing a ton out. It was really hard to wrap my head around the idea of giving the twins formula, especially because Bryce never did and breastfeeding, really, is going fine. I am feeling fine about it now, but boy those first few times giving them bottles were VERY emotional (for many reasons, not just what was IN the bottles).
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  14. #14
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    More replies from the other board:

    I have an older brother who was exclusively bfed and didn't grow much for a few months. He was called failure to thrive and they prescribed growth hormones. My mom refused them and he is just fine and healthy. He just happens to be a small person(5'2")
    I'd actually offer formula in a cup at this age, rather than an SNS. If she is going to use cereal (which IMO ins't a great idea for a baby with weight gain issues) then I'd mix the formula into the cereal, but maybe not offer it separately as a beverage. Whatever solids she does offer need to be calorie dense foods. Cereal by itself is pretty filling without many calories, but with enough powdered formula mixed in it wouldn't be a bad choice, from a weight gain perspective.

    She could also try giving fish oil directly to the baby- get him the good fats directly PLUS increase his overall fat and calorie intake.
    *sigh*



    Breastfeeding Success Essentials:
    SUPPORT ~ EDUCATION ~ DETERMINATION

    Beat the "Booby Traps" to Breastfeeding Success!


    ~The plural of 'anecdote' is not 'data'~

    ~Do or Do Not. There is no try.~
    Yoda

  15. #15
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    Hi! You seem to have lots of suggestions and I'm not an expert.

    Wanted offer offer you a HUG.

    I was reading through all the suggestions and remembered Jack Newman's book talking about this a little (or tangentially) and about feeding baby on one side for more than one feeding in a row. I could be getting muddled, but I'm pretty sure this was to improve the 'quality' by having less fore-milk produced and more hind-milk available if you're feeding from the same breast at feedings close together. I'd double check it in his book if you can to make sure I'm getting that right.

    Maybe it was already suggested and I glazed over it I think this goes with the other comment above about pumping to get the fore-milk and then nursing so they get more of the hind-milk. The bottles that I pump seem to vary in the amount of fat/colour depending on if I'm pumping after recently nursing or in the morning after a long time of not nursing, so it seems to fit with that.

    Good luck! Hope it works out!

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