Healthy and Petite
Joyce Schaal
Vienna, VA USA
From: NEW BEGINNINGS, Vol. 15 No. 1, January - February 1998, p. 8-10
We provide articles
from our publications from previous years for reference for our Leaders and
members. Readers are cautioned to remember that research and medical information
change over time.
My second daughter, Emily,
was born at home weighing seven pounds, nine ounces. She had sucked
her fist in utero and had difficulty opening her mouth wide enough to
latch on well at first. However, that was soon overcome and we were
nursing beautifully—or so we thought.
Emily's lowest recorded weight
after birth, on day two, was seven pounds. At her two-week checkup,
she weighed nine pounds, two ounces—a very respectable gain in two weeks.
But something happened between two weeks and eight weeks. She gained
only two more ounces. Our doctor said there were three possible explanations
for the measurement:
- The scale could be wrong;
- Emily could have an infection;
or
- Emily could have a physiological
problem such as malabsorption.
Of course, I believed that
the scale was wrong. Emily showed no signs of having an infection—no
fever, vomiting, irritability, or unusual fussiness. She was nursing
frequently and had an adequate number of wet and soiled diapers.
The doctor wanted to see
Emily again in two weeks. If she did not show appropriate weight gain,
he would want to do a urinalysis and blood tests. She was bright and
alert with good skin tone and color, and she was smiling and becoming
more social. I was not prepared to submit my baby to tests that seemed
unnecessary.
My co-Leader and other LLL
friends gave me much-needed moral support to trust my intuition and
boost my confidence. During the next two weeks, I paid more attention
to Emily's nursing habits. I discovered that she had good nursing technique
(latch-on and suck), but that she did not nurse for very long at each
feeding and she was sleeping for at least one four-hour stretch each
night. I trusted that she knew how much to nurse and was meeting her
body's needs.
In the next two weeks, Emily
gained only four ounces. Still, her weight gain averaged out to the
normal range of four to eight ounces per week if calculated from the
low point of seven pounds at two days. Averaged over the ten weeks,
she had gained four ounces per week. I wanted to believe that this was
normal for her—she was just going to gain differently from the average
and not conform to the charts. She seemed healthy—she was just petite.
The doctor disagreed and
suggested that I supplement Emily's nursing with formula. I objected,
since I did not believe that the problem was with nursing, and there
is a family history of cow's milk allergy. I told the doctor that I
would spend the weekend in bed nursing my baby to see if this would
increase my supply and her weight gain. He reluctantly agreed, but wanted
to see us back in one week.
My husband, Mike, agreed
to spend the weekend caring for our older daughter, Katie, while the
baby and I were in bed. I called upon my La Leche League resources.
I consulted my copy of THE BREASTFEEDING ANSWER BOOK, carefully reading
the entire section on slow weight gain. I armed myself with information
about normal weight gain and possible causes of slow gain. Still, none
of these seemed to fit our situation. Emily was not premature, her birth
had been unmedicated, she did not take a pacifier or bottle, we experienced
no separation, there were no signs of illness, she did not have a cleft
lip or palate, and my health was fine.
I spoke with a lactation
consultant who offered more information and support. The doctor's suggestion
of supplementation had jolted me and I needed reassurance that I was
making the right decision by continuing to nurse exclusively. The lactation
consultant and I talked about the nutritional qualities of human milk
and how unlikely it was that my milk lacked some important element necessary
to sustain Emily. She suggested that I pump for ten minutes after each
feeding so that I would be getting the hindmilk, which is higher in
fat.
Emily seemed to do better
that weekend in bed. I borrowed a baby scale from a friend, but after
a few weeks of daily weighings, it made me crazy not to see any appreciable
change and I returned it.
I offered Emily my pumped
milk in a cup and from a spoon. I even tried a bottle with several different
nipples. She refused to take it no matter how it was offered. I tried
giving her just the creamy hindmilk, to no avail. Finally, one day I
was able to get her to take three ounces from a rubber-coated spoon,
though much of it drooled back out and I could not guess how much she
actually swallowed. The next day, her nursing was noticeably less. I
stopped offering the supplement because I wanted her to nurse as much
as possible.
As I thought back on our
nursing history I realized that Emily had been highly distractible from
the start, nursing better at night than during the day. Once, during
her first week, we were lying in bed nursing when her older sister,
Katie, came into the room. Emily could not see Katie, but she heard
the noise and stopped nursing to listen. So I tried nursing her in a
quiet room or lying down. This seemed to help a little, but not enough.
At 12 weeks, I was worried
enough that I felt it was time for more drastic action. I scheduled
an appointment with a lactation consultant and asked her to fax her
findings to Emily's doctor. I contacted another local Leader, who had
presented a session on slow weight gain at our Area Conference, to see
if she had any ideas or information that might help us. I talked with
yet another Leader who offered to post my situation on LACTNET, an email
chat list for breastfeeding supporters around the world, and pass along
any responses she got. I contacted a Leader from LLL's Professional
Liaison Network. She gave me a list of possible medical causes for slow
weight gain from the book Breastfeeding and Human Lactation.
The list included 18 conditions, most of them very rare. The most likely
one was urinary tract infection, though even that seemed questionable
since Emily had no symptoms.
After many emotional discussions,
Mike and I agreed that some testing might be appropriate. The doctor
interviewed me for over an hour, asking dozens of questions about our
family health history. Finally, Emily had a chest x-ray and a catheterized
urine sample was taken. After a four hour office visit, I left with
the paperwork to have blood drawn and stool samples tested at the hospital.
I went home feeling exhausted and beaten. I was worried about what the
tests might find.
A few days later, the doctor
called. The urinalysis had found a very small amount of bacteria, indicating
a urinary tract infection. Much relieved, we began a course of antibiotic
treatment.
Concurrently, Emily began
nursing more frequently during the day and nearly all night long. I
was thrilled by this change, despite how little I was sleeping. I attributed
the change to the treatment of her infection and expected to see rapid
weight gain over the next few weeks. Instead, Emily gained only six
ounces during the two weeks. I asked the doctor if it was possible that
Emily was a "statistical outlier," meaning that she fell within the
very small area at one end of the bell curve. He responded that in his
19 years of pediatric practice he'd never seen a growth pattern like
Emily's and he was 99% sure that something was wrong. He wanted more
invasive tests—a barium swallow, renal ultrasound, renal scan, and a
nuclear cystogram. If the tests were all negative or if Emily did not
gain at least seven ounces, he would put her in the hospital for observation.
I went home in tears. How could this be happening? My beautiful baby
was so alert, pleasant, and content. How could anything be so drastically
wrong as to require hospitalization?
Reluctantly, I scheduled
the test for the following week. For the next six days, I told Emily
that she needed to gain some weight—or else! She must have understood
because she responded beautifully. During those six days, she gained
seven ounces! I canceled all the tests except the renal ultrasound,
which found nothing abnormal. I scheduled the next doctor's visit for
two weeks after the ultrasound.
Emily's weight gain during
those two weeks returned to what I was coming to see as normal for her—she
gained about four ounces.
I took my husband, Mike,
with me to see the doctor this time. I wanted the moral support and
I wanted Mike to hear for himself what the doctor had to say. This turned
out to be a very different office visit from what I'd experienced previously.
The doctor asked me why the tests had been canceled and then acted as
though I was not even there. He placed a growth chart in front of my
husband and, for the first time, plotted Emily's previous four weight
measurements. The doctor had determined inadequate growth based on his
impression that the incremental change was not large enough. Looking
at the curve he had plotted, he noticed that Emily was still on the
chart. The doctor turned to my husband and said, "I can live with this
growth pattern as long as she does not fall below the fifth percentile."
This man had threatened to put my baby in the hospital just two weeks
ago, and was now telling us that this growth pattern was okay! I was
glad that he had kept a close eye on my baby's health, but I was also
furious!
On the drive home, I told
Mike how enraged I was and he agreed that the doctor had ignored me.
We immediately changed doctors. Our new doctor, a family practitioner,
has examined Emily and found her to perfectly healthy. She is developmentally
right where she should be, if not ahead. He was shocked that the other
doctor had wanted to put Emily in the hospital. He said Emily was perfectly
healthy—just small. He'd seen lots of small babies and we had nothing
to worry about. He did not even suggest starting solid foods, even though
Emily was six months old. What a difference it can make to have a supportive
doctor!
Many thanks to La Leche League
for giving me the knowledge, experience, and support I needed to follow
my heart and continue nursing my baby.
Reprinted from LLL of
Virginia's Area Leaders Letter, Visions, June 1997.
Last updated 11/12/06 by jlm.
Page last edited Sun Oct 14 09:30:58 UTC 2007.
