I wanted to write about my experiences with “underweight” (according to the CDC’s growth charts) kids, in hopes that it may help another mom. Lots of disclaimers are necessary!
First, I’m not a doctor, nor do I play one on the internet. My experiences and opinions should not be taken as medical advice. The closest to medical advice that I will offer is this: if a doctor suggests that you should supplement/discontinue breastfeeding solely based on your child’s place on the growth chart, in the absence of any symptoms or medical conditions…seek help from a lactation consultant (or three) and get a second opinion.
Second, this post talks about babies not on the growth charts and how it can affect a breastfeeding relationship. I realize that formula fed babies aren’t necessarily “big” and can have growth chart issues too. However, this post is about my personal experiences.
Last, there’s no judgement from me if you switched to formula at your doctor’s advice (or for any reason.) Just like some c-sections are necessary, there are situations where formula is necessary too. (Hypoplastic breasts, prior breast surgery, chemotherapy etc.) However, so many women are “booby trapped” by being given inaccurate information by the medical providers they are supposed to be able to trust. The rate of women who are told “you’re not making enough milk, your milk isn’t enough, your milk isn’t fatty enough, your pelvis isn’t big enough” and so forth is far higher than the number of women for whom this is true! Finding out that your switch to formula wasn’t necessary is about as hard a pill to swallow as finding out your “emergency c-section” was because your OB wanted to go home. Just like I don’t assume all c-sections are unnecessary, I’m not assuming that all formula use is unnecessary. That said, I also respect a woman’s right to choose, even if that choice isn’t one I’d make. So if you had a scheduled c-section or formula fed from day 1 by choice, I am not judging you (not my biz-ness!), and that’s not what this post is about, ok?
I’ve remarked before that I don’t know how our mothers did it without the internet. I don’t mean listening to what some schmuck (me) says, but having actual medical journals and details of studies right at your fingertips. It’s amazing and I don’t know what I’d do without it! Back in 2005 when I had my daughter, I was a member of a breastfeeding group on Parents.com. I credit those women (along with my stubbornness) for my breastfeeding success. Without them, I would have failed, as I was set up to by pediatricians and hospital staff.
This story begins with my miserable first birth experience, which culminated in an epidural, and me so swollen, I was sure I would pop. IV fluids given during labor can artificially inflate baby’s birth weight, leading to “alarming” weight loss in the first 24 hours. A loss of 5-7% of birth weight is physiologically appropriate for a newborn, sometimes up to 10%. When my daughter had lost about 5% in that first day, I was immediately bullied to give formula. I was even told by a nurse that “the doctor would make” me if I didn’t. We tried, she wasn’t interested. The only photo I have of my husband with her in the hospital is the one where he is trying to feed her formula. I can’t stand to look at that picture to this day, 7 years later. Not because I think formula is “evil,” but because it represents my complete failure to stand up for myself and our daughter during that entire experience.
Whether the baby loses 1% or 10%, it’s important to use the lowest weight when assessing subsequent weight gain. Depending on the source, it’s expected that a breastfed baby will gain between 4 and 8 ounces per week in the first few months.
Dr. Jay Gordon urges parents and Doctors to “look at the baby, not the scale,” which I will talk about more in a bit. Even if your baby is gaining “enough” weight per week, he or she may not be on the CDC’s growth charts, as mine weren’t. Interestingly enough, even the CDC recommends that health care providers use the WHO growth standards for children up to age 2.
The WHO standards establish growth of the breastfed infant as the norm for growth.
Breastfeeding is the recommended standard for infant feeding. The WHO charts reflect growth patterns among children who were predominantly breastfed for at least 4 months and still breastfeeding at 12 months.
The WHO standards provide a better description of physiological growth in infancy.
Clinicians often use the CDC growth charts as standards on how young children should grow. However the CDC growth charts are references; they identify how typical children in the US did grow during a specific time period. Typical growth patterns may not be ideal growth patterns. The WHO growth charts are standards; they identify how children should grow when provided optimal conditions. [Emphasis mine. Imagine using the “typical” American as the benchmark for health.]
The WHO standards are based on a high-quality study designed explicitly for creating growth charts.
The WHO standards were constructed using longitudinal length and weight data measured at frequent intervals. For the CDC growth charts, weight data were not available between birth and 3 months of age and the sample sizes were small for sex and age groups during the first 6 months of age.
Edit: about a week after I posted this, the AAP came out with a new, more strongly worded statement about breastfeeding, in which they say “infant growth should be monitored with the World Health Organization (WHO) Growth Curve Standards to avoid mislabeling infants as underweight or failing to thrive.” YAY!
So what happened to us was what happens to so many other families. My daughter was meeting all expected milestones, was healthy, nursing well, having tons of wet and dirty diapers, but fell off the CDC’s growth charts. We were going to one of those offices where a dozen or more pediatricians practiced, and you saw whomever was available, for the most part. If you needed a last minute appointment, you usually got the most rotten doctor, since they were the only one not booked solid. We saw a doctor who graduated med school in 1972 (I looked it up) and probably hasn’t read a study or paid attention at a seminar since then. He immediately told us to stop breastfeeding, give formula and oh, put some cereal in the bottle too. Believe it or not, DH & I both went to this same practice as kids & saw this doctor!
What did I do? Smile, nod and get the heck out of there. Over the next several months, though she had no symptoms aside from being genetically small (her dad is around 5′ 7″ max and I am not quite 5′ tall, hovering around 100 lbs or less when not pregnant/postpartum) she was put through a battery of blood and urine tests. All are normal. Surprise.
We eventually got an appointment with the doctor who is now our current pediatrician (he left the practice & we followed him…cue creepy stalker music.) Though he graduated med school in 1980, just 8 years after jerk-o/idiot doc, he has kept up on AAP guidelines (which are unfortunately usually behind) and reads studies and attends seminars regularly. He is pro-breastfeeding & conservative in treating patients.
With his help, we did additional testing for things that may have been causing slow weight gain, without showing symptoms, and fortunately she was fine. We did some extra weight checks and tracked her individual growth curve (you can do this too by creating an interactive growth chart.) Aside from one visit where she appeared to “dip,” she rode her own curve just under the growth chart. The doctor wasn’t too concerned about the dip, since a few ounces makes a big difference, and a few ounces is easy to gain or lose with drinking/urination.
All along, he told me he had the feeling it was simply genetic, but of course, he doesn’t want to miss something, hence the testing.
Finally, at age 2 1/2 she barely got on the growth chart & has been hanging around the 3% ever since. He has told me that he’d “take IQ over weight any day,” referring to my daughter’s impressive verbal/reading/writing skills. (Proud mama here.)
When my son was born around 8 pounds, we were hopeful that he would stay “big”, and we could avoid all the weight checks. Unfortunately, he followed exactly the same patterns. Fortunately the doctor was quite conservative in tests & weight checks and he finally got on the chart at age 2!
When I was still expecting baby #3, we discussed the issue and he said that at this point, with the history, he’s convinced it’s genetic. As nice as it would be to have a baby “on the chart,” he wasn’t expecting it. My son was born at 6 lb 12 oz, down to 6 lb 5 oz at 3 days old (we’re not completely sure on all this because of some scale issues!) then up to 7 lbs at a week, 8 lbs at a month and 9 lb 10 oz at 2 months, or…the 25%, yay! He told me that he doesn’t necessarily expect him to be a big baby, and I don’t think he’d be surprised if he started falling down on the charts, but for now it’s a victory.
Even though I eventually found a supportive doctor, the doubt always crept in, and as great as he is, he said several things that contributed to that. First, he often asked an open ended question along the lines of “how do you feel about your milk supply.” Uh, well I felt fine until you asked, now I’m paranoid! He mentioned pumping output (a baby extracts milk much more efficiently than a pump, and some women simply can’t let down for a pump at all.) He also asked about feeling letdown. Not all women feel their letdown, and it often becomes less pronounced as baby gets older. Even questions of “does baby seem satisfied” can be a slippery slope, since a baby may nurse constantly and get a bit fussy while working on increasing supply during a growth spurt.
So what should be asked? Initially, make sure the baby is latched well. Is there pain? Has the mother seen a lactation consultant? Once milk has come in, can you hear the baby swallowing? Is the baby having wet and dirty diapers appropriate for his/her age? Is baby alert (as appropriate for age) and meeting milestones?
I knew my daughter (and son too) was fine, but I was still paranoid and wanted to get her on those gosh darned charts!! We tried Pediasure when she was a toddler (just filled her belly so she didn’t want to eat and whew, made nasty diapers.) We tried high fat foods like avocado, cream cheese etc. It didn’t help. Dr. Sears says “Active babies with persistent, motor-driven personalities who always seem to be revved up usually burn more calories and tend to be leaner.” We have videos of our daughter at just a few weeks old, constantly moving as if she were swimming in an invisible pool. Even now at age 7, she does.not.stay.still.
He also says “Various studies have shown that breastfed infants consume fewer calories and a lower volume of milk than formula-fed infants. This doesn’t mean that their mothers aren’t producing enough milk. Instead, it’s an indication that breastfed infants have an amazing ability to self-regulate their calorie intake according to their individual needs. This ability to determine for themselves how much they eat is probably one of the reasons that infants who are breastfed are less likely to have problems with obesity later in childhood.” (Emphasis mine.)
She weighs the perfect amount for her. She looks an awful lot like my husband did at that age; all knees and elbows! She has always been “tall for her weight,” which made her look even more slender. My son is more proportionate, so he looks chubbier.
For some reason, people think it’s OK, or appropriate to make rude remarks about a baby’s size. I’ve had strangers ask how much they weighed at birth, asked if they were preemies, implied that I was starving them and so forth. It’s so fun to hear “she’s so small” said with a look of disgust (not.) People still make remarks about my daughter being “so skinny” which infuriates me. It wouldn’t be OK to say something like that if she were overweight, so why is it OK to damage her self-esteem and body image with “too skinny” comments? She has always been a great eater, except when there was something more interesting going on. Therefore, any time we would have visitors (or visit someone) she would want to play, not eat. That meant more lovely comments about “no wonder she’s so skinny, she doesn’t eat.” I’d try to explain that she ate great at home blah, blah but no one believed me! (We also eat a diet that’s far healthier and more balanced than the average American diet. I’m sure I could fatten my kids up if I overfed them fatty ground beef, fast food, potato chips and Tastycakes instead of fruit, veggies, beans & lean meat!)
Though I’ve never had a “big” baby, I imagine people are similarly rude in that case. My daughter has been friends with a little girl since they were in 3-year preschool together. When I met her, she was a perfectly normal looking little girl, but her mom showed me a picture of her as a baby. No lie, she looked like the Michelin man. I have never seen a chubbier, more roly poly baby in my life. She was 100% breastfed, and slimmed down when she became mobile. She got equally rude comments when her daughter was “too big” and her milk must be “no good.” My BFF has “top of the charts” babies, but they look totally healthy & are proportionately tall. I thought it was ironic that she was stressing about her 90 whatever-th percentile breastfed baby gaining “too much”, while I was worrying about my <3% breastfed baby!
In conclusion, before you turn to formula, look at the whole picture, not just the chart. I wish I could clone my pediatrician and send him to all of you. He isn’t perfect, but he is fantastic. When he told us he was leaving the big practice, I was terrified that he was going to tell me he was retiring! (He’s not allowed until all my kids are grown up.) He is fairly supportive of breastfeeding (I keep extended bf’ing and night nursings to myself, LOL) and has made comments about how great breastfeeding is, that it’s the best thing I can do, keeps them healthy etc. He’s open to alternative vaccination schedules, was wonderful about my home birth, and continues to educate himself. When we were concerned about my son’s verbal skills, he suggested a baby sign language class, adding that 10 years ago, he would have told me that signing would hinder his verbal development, but recent studies show the opposite! He was even telling me about a seminar he attended about how they do the PKU testing.
At the same time, he’s very diplomatic. If you formula feed by choice, he won’t make you feel inferior. We didn’t even know his stance on circumcision until we asked. (We’d already researched & made our choice, but thought it was important to have a doctor on the same page.) He passed along the AAP’s stance on vitamin D supplementation in breastfed babies, but tells us not to sweat it if we choose not to. He doesn’t think babies or children with balanced diets need multivitamins, but will support you if you decide to use them.
So, phew. This ended up a mile long but I sincerely help it helps someone! I’m not a “militant” lactivist, but I do wish that women had all the information about breastfeeding and formula and had the support to succeed.
Has anyone else dealt with a top or bottom of the charts baby? How did your doctor handle it?
When we were expecting my daughter in 2004, we searched high & low for a glider rocker. My in-laws were visiting from South Carolina, and wanted to help buy one as a gift. I swear we went to every store in two counties trying to find one. Most stores only had one or two; they were usually ugly, often uncomfortable and always outrageously expensive. Since I am pretty short, chairs with back or neck padding hit me all wrong!
We ended up in a third county (LOL, really) at a bigger baby store that had a good half dozen or more. You had to choose the wood color, fabric, options, and order it. We were only about 2 months away from the due date and not sure if it would make it on time, but we ordered one made by Dutailier. (My water broke the morning we were supposed to pick it up!) It has served us well, and my 2 1/2 year old is still using it. We rock and we read stories, and really didn’t want to snatch it away from him. Plus, it doesn’t match the baby’s crib which we bought to match the “spare bedroom” furniture we already had. (The new glider is in our bedroom for now since we are still co-sleeping!)
So, we wanted a new one, but we didn’t want to spend hundreds. I looked up the original glider/ottoman purchase (thanks Quicken!) and it cost nearly three times as much as the Stork Craft Tuscany glider and ottoman
we just bought.
Anyhoo, I had been poking around and found a couple inexpensive gliders. Wal-Mart (ptooey!) has a really nice selection of glider/ottoman sets in the under $200 range on their website. It’s a shame they don’t have them in the store to see & try. I really wanted black wood & beige cushions which eliminated a few.
Which reminds me. The jerky salesperson when we bought the glider in 2004 acted like I was a big idiot for wanting it to match the nursery furniture. Apparently I was supposed to buy it to match our crappy family room furniture since that’s where it ends up in most people’s houses. I’d hoped to be rid of this (what’s a synonym for crappy?) furniture by now (still using it, boo…) and oh look, 7 years later it’s still in the room with the dresser & crib we bought it to match.
I also preferred the clean look of the Tuscany over some with rounded, poofy, tufted cushions. We decided to take a chance and ordered it from Wal-Mart (ptooey!) for $179 with free site to store shipping.
They’re available in several wood/fabric color combinations.
There really wasn’t too much assembly required, and it came in a really big box that kept the kids entertained, LOL.
Our other glider has squishy, foamy padding in the back, seat and ottoman. The Tuscany has cushy padding in the back, but the seat, arm pads & ottoman are almost a memory foam. It took a little bit for the arm rests to relax & sit right.
I didn’t realize that the fabric is actually a synthetic suede-like material.
The ottoman’s fabric is three pieces seamed together, which I think gives it a nice, modern look. That indentation you see is where my heel was a few minutes before I took the picture!
I think the fabric on our old one is kinda ugly (yellow gingham check), but it was the best gender neutral option at the time! P.S. if anyone knows of a non-toxic scotch guard/stain protector type stuff, let me know. The new glider can be “spot cleaned” like the old one, but you can’t remove the covers to wash them. It’s looking kinda grubby by now, despite having been straight up washed when my son had a stomach virus and it was “be washed or be trashed!”
The old one has a locking mechanism and nursing stool, the new one does not. I really enjoy having the ottoman, since being short means my legs tend to dangle, but I rarely used the stool.
When I first plopped down on the Tuscany, it was kind of shocking, since I felt like I’d just sat on a pile of bricks. It’s not very thick, but I did kind of “sink’ into it a tiny bit like you would a Tempurpedic mattress. Not much, but a little bit. If I’d sat on it in a store, I probably would have hopped right back up and said “next!” but it really wasn’t uncomfortable once I’d been sitting there a minute. It was just different. The back is nice and soft though!
Overall, I don’t miss the lock/stool, it glides just as smoothly as the expensive glider, and feels just as sturdy. This surprised me, since I was expecting it to seem “cheap.” The seat & ottoman aren’t soft and squishy, but considering you can buy 2.9 of these glider/ottoman combos for the price of 1 of the Dutailiers (in fact, the ottoman cost almost as much as the Storkcraft set) I wish I had 2 Tuscanys and $160 instead, LOL.
EDIT: After using this for a while, it clicks when I rock. I can’t figure out why. I do still like it though but wouldn’t have with a newborn!
FTC compliance: I purchased the pictured items at normal retail prices. I was not asked to write, nor was I compensated for this post, and all opinions are my own. This post contains affiliate links.
Looking for cloth diaper help? Ever week, on Monday, I’ll answer a user submitted question.
Questions don’t have to be cloth diaper related, just email maria at change-diapers.com with “Mailbox Mondays” in the subject, or fill out my contact form for readers, which you will always be able to find on my Contact Page.
This (or similar) is a common question:
Which diapers are the easiest for the daycare providers?
Daycares would be most likely to accept a pre-stuffed pocket diaper or AIO with velcro since they are most similar to disposables. That said, there are daycares that accept prefolds & covers. I’d suggest bringing one to show them, since when you say “cloth diapers” they may be thinking pins & plastic pants!
In October I received a PaigeLauren Baby (PLb) bodysuit for our new baby and I’m so sad that he is close to growing out of it. The 0-3 month size fits 10-12 lbs and 20-23 1/2″. My guy isn’t quite 10 lbs yet at 9ish weeks old, but he’s somewhere in the range of 23″ and that extra fluff from the cloth diaper is making it hard to snap!
PLb is luxury clothing for infants, so it’s a little pricier, but it’s amazing. It is luxuriously soft and silky, and has held up fantastically. My son’s onesie is the Ruby color, so he wore it for Christmas, and I’ll squeeze him in it one last time for Valentine’s day!
PaigeLauren Baby has put their Ruby (red) and Quartz (pink) clothing on sale, so your cutie can be stylish for Valentine’s day. Through February 29th, all Ruby or Quartz items are 30% off! No coupon code necessary; you will see the discount reflected in the product selection drop down.
Will you wear red (or pink!) on Valentine’s Day?
FTC compliance: I was not compensated for this post, and all opinions are my own.