Healthy and Petite
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.