Update: Failure to Thrive

[JennyB]

The good news is that his cardiologist appointment went well. He does have problems with his heart but all minor and not contributing to the failure to thrive. The bad news is that he still hasn't gained any weight. He is 10 weeks old and is only 8lbs. 3 oz. (Birth weight was 81/2 lbs. ) But he hasn't lost any either. That's good right?!!!

 

The doctor ordered blood tests and we have been to the quest center twice to get blood drawn and he keeps blowing out his veins. I found out from the second center that they can only take 5 mL out of a baby under 15 lbs any more would cause damage to the baby. I am wondering why the first place I went didn't say anything and if his veins hadn't blown would have taken at least 10 mL out of him. That to me is such incompetence. I expect them to know how much blood can be drawn from an infant. So I am going to write a letter to management because they could have done serious damage and I would want to know if I were in charge. I am just grateful that his veins didn't cooperate the first time.

 

Does anyone know of anyway to help facilitate blood being drawn? They have tried both arms and 1 wrist even warming up the veins and she was barely able to get enough for one test. So we are going back every 3 days to keep trying until they get enough blood for all the tests.

 

The doctor also wants me to supplement every other feeding with formula. She stated it was because formula has 22 calories and breast milk only has 20. I just stared at that formula can with the second ingredient being corn syrup and couldn't do it. So my plan of action now is to try and get blood work finished, I cut out all junky food from my diet and am downing large quantities of healthy food. I decided to cut out dairy because he has had large amount of mucus since birth and he also was throwing up 3-4 times a night. He hasn't thrown up since but it is really, really hard to not have dairy. We ate at a friends house and I ate a cupcake thing without icing so thought I was safe and he was throwing up last night. So that is part of my formula dilemma. I know they make formula that is soy based but is it any more calories than breast milk?

 

I decided that I would wait until we got all the blood work back and if we didn't find anything out from that then I would give formula a shot. I just hate to put artificial stuff in his body when he is already having a hard time. Does that even make sense? It seems very logical to me but sometimes when you are in the midst of a situation you can't "see".

 

Thanks for reading if you've made it this far and thank you so much for the comments on my first thread. That helped to solidify my courage to wait on adding formula. I am not sure what I am going to tell the doctor though. Any ideas?

[shannatheshedevil]

Breast milk is best, period. If you are producing enough milk to sustain him (he's not crying with hunger after feeding, is he?), I'd stick with the breastfeeding. You seem to know dairy is a problem, so you'll just have to make a bigger effort to avoid it and eat larger meals with more whole foods. And seriously, 20 calories vs 22 calories? 2 calories isn't going to make a massive difference in weight gain- not even in a baby that small. I think you're doing the right thing.

 

Not to mention, formula is expensive!

[FaithManor]

My second boy was lactose intolerant and vomitted persistently (not spitting up but actual projectile vommiting). No one ever suggested it was dairy in my diet and so I didn't know what to do. He threw up formula as well. We stumbled onto a lactose free formula which got me to thinking that since I had two grandparents that were lactose intolerant (which is different from an actual dairy allergy) that maybe that was the problem. Unfortunately, I had already heeded the bad doctor's advice and given up nursing. The good news was that he was right as rain on the lactose free formula and started gaining weight quickly.

 

I know this is going to sound a little odd but there are homemade formula recipes and they are much healthier than the commercial formulas which are pretty much now made in China and shipped over here. Plus, soy is a heavily pesticide sprayed crop and there isn't any restriction that soy intended for formula cannot be sprayed. So, you could make your own. If you google the Weston Price Foundation you should find a link to a homemade dairy free formula recipe. It will look weird to you and you might think that it isn't palatable. But, I actually know a doctor in the Middle East who is using a version of this recipe in a hospital setting and it is saving babies lives. They do drink it. The formula is very, very high in necessary essential fatty acids.

 

That's just a suggestion. I am so sorry you are facing this. I remember those days all too vividly. For what it is worth, Ds is now 12, healthy as a horse, and eats like one too!

 

Faith

[HayesW]

IF you want to up calories, you can pump and let the milk sit. Then you can skim the fattier part off the top and spoon or cup feed him that.

 

Hugs, mama.

[Lightly Salted]

Unless your doctor has tested YOUR breastmilk, he can't know for sure that any formula has more calories. FWIW, I think he has his numbers backwards, but either way, I wouldn't go for formula either. Any malabsorption issues would only be made worse by introducing formula to the virgin gut. I'd look for a lactation consultant who can help you.

 

This compares calories in formula and breastmilk

 

http://www.kellymom.com/nutrition/milk/milkcalories.html

 

This has good suggestions to help up baby's weight gain

 

http://www.kellymom.com/babyconcerns/growth/weight-gain_increase.html

 

going off dairy/soy might help; I had to go dairy-free for about 6 months with DD. Are they absolutely sure of baby's weight gain - ie, are they measuring on the same scale under the same conditions EVERY time? Have they weighed before/after nursing to see if he's actually transferring milk adequately?

 

:hug:

Edited August 18, 2010 by Lightly Salted

[Chris in VA]

:grouphug:Has he been tested for cystic fibrosis> The mucus and lack of weight gain are concerning in that direction.

Don't mean to add anything to your plate.

[Dobela]

My dd was 1 lb 14 oz at birth and 4 lb when she came home. She didn't weigh 8 pounds until she was nearly 8 months old. When they had to draw blood, they would do it from her heel. It took longer, but it worked much better.

 

As far as the food and weight gain, that one is tough. They do make prescription formulas that has as much as 36 calories per ounce. We had to use this since she was so small and took way more energy to gain weight than other babies. On regular formula she was burning almost as many calories to drinkit as she was taking in.

 

How does he respond to foods without dairy? I m assumming ok??

 

Our dd did not gain much weight and the doctors were fairly anal about it at times honestly. Even after we changed formulas, bottles, nipples, added stuff to it to add calories, and more, she still didn't gain what they thought she should. One pointthey threatened me with a feeding tube because she didn't gain another 0.5grams per day. Finally one day I just lost it in the clinic and fired both guns at one of the doctors. :mad::angry::smash: In response to my outburst he started ordering other medical tests. Low and behold she was suffering from 'silent aspiration' . Any food or drink we gave her was first going into her lungs before going back down her esophagus. But she wasn't having lots of infection, or coughing during feeding, or any other usual sign of a problem other than lno/low weight gain. Only by the grace of God did she not develop pneumonia or some other serious infection because of it. The reason for her aspiration was linked to her mouth - as we found out at a feeding specialist referral. She didn't have the correct tongue movement needed to suck properly. Yes, she was sucking, but very inefficiently. Which is why she was burning all her calories just by eating. Another appointment showed that she also had reflux - again without the usual symptoms. We began some medication for the reflux, began using thickener with liquids, and began working with an SLP that specialized in infants and my dd had a dramatic turnaround. Amazingly she 'suddenly' began gaining so much weight another dr warned me that she was going to be obese if her rate of growth continued. :001_huh:

 

Ihope you find the answers you need soon. :grouphug:

[ktgrok]

How many wet and poopy diapers? Does he nurse on one side or both sides each feeding? How often does he feed? Do you hear swallowing when he feeds? How is his latch? Could be a supply issue, but could also be a transfer issue...have you seen an IBLC to evaluate if he is transfering milk? Any other issues, like extreme fussiness that could lead him to burn more calories than he should? I'd be wearing him non stop, and sleeping with him, and trying to minimize any stress he has...these things have proven to help weight gain. Also breast compressions.

[HeathenMom]

i have a close friend who had a very similar situation...her baby was losing weight, at 6 months old he weighed less than a pound more than when he was born. there were some minor (self correcting) heart issues, but when she started feeding him formula he started growing. she is very pro-breastfeeding and fed her previous kids the breast until they were over 2 years old...but for some reason her milk wasn't what it was when she was younger and the baby was not getting what he needed. he's just over 2 years old now and the cutest, chubby thing you ever saw!

 

breast is best, but you should really listen to the doctor in this case.

 

good luck!

[EKS]

My second boy was lactose intolerant and vomitted persistently (not spitting up but actual projectile vommiting). No one ever suggested it was dairy in my diet and so I didn't know what to do. He threw up formula as well. We stumbled onto a lactose free formula which got me to thinking that since I had two grandparents that were lactose intolerant (which is different from an actual dairy allergy) that maybe that was the problem. Unfortunately, I had already heeded the bad doctor's advice and given up nursing. The good news was that he was right as rain on the lactose free formula and started gaining weight quickly.

 

 

 

Human milk has lactose in it too.

[Quad Shot Academy]

:grouphug:

 

We went through this with my youngest and it was a horrific two year battle before they figured out what was wrong. If you switch to formula I would go right to a pre-digested, hypo-allegenic one like Nutramigen. Keep pumping though so you can go right back to nursing if it doesn't work. I did this to "prove" food allergies were not the cause of my son's failure to thrive. It took a few days of severe vomiting on the formula and needing a hernia operation for the doctors to start looking at something other than allergies. They got most of their blood after giving IV's, while under anesthesia and once put in a reverse IV in the hospital to take out blood. My son "just" ended up having gallstones and the surgery solved the problem. Feel free to PM me.

:grouphug:

[ChristineW]

How does he do when you don't have dairy? My DD2 wasn't able to tolerate the protein in cow's milk or soy. At three weeks old she turned from a sweet happy baby to a baby who cried nonstop and vomited a ton after every feeding. After two ultrasounds ruling out obstructions and being put on increasing doses of zantac, the doctor suggested I go dairy free. It took a couple of days for the protein to get out of my system but DD stopped vomiting and became a happy baby again. Anytime I slipped she would be extremely sick for a couple days. She is 15 months old now and is finally able to tolerate cows milk. She is still allergic to soy protein though.

 

It is tough, tough, tough to go completely dairy free. Cows milk (especially cassien and whey) is in everything from bread to spaghetti sauce to mashed potato flakes. I read labels on everything in the grocery store and we eat few processed foodsChristmas and Thanksgiving were especially hard, but it is doable.

:grouphug:

 

Christine W

[nrg]

My sons couldn't digest breast milk or any formula at all! They were lacking an enzyme. Nutramigen was brand new for the first, and probably saved his life. It took a while to figure out the problem with the first, and we experienced some pretty miserable, scary times.

 

I wish you all the best. Do consider predigested protein formula at least to see if it gives some relief.

[JennyB]

My second boy was lactose intolerant and vomitted persistently (not spitting up but actual projectile vommiting). No one ever suggested it was dairy in my diet and so I didn't know what to do. He threw up formula as well. He has a grandfather that is lactose intolerant and my husband has been having issues with lactose also. The doctor hasn't mentioned dairy allergies I just read up on failure to thrive and this was maybe one of the causes and so I went with it. He doesn't have all the symptoms of dairy allergy but enough that it isn't worth it to add dairy to the mix now. We stumbled onto a lactose free formula which got me to thinking that since I had two grandparents that were lactose intolerant (which is different from an actual dairy allergy) that maybe that was the problem. Unfortunately, I had already heeded the bad doctor's advice and given up nursing. The good news was that he was right as rain on the lactose free formula and started gaining weight quickly. This is good to know!

 

I know this is going to sound a little odd but there are homemade formula recipes and they are much healthier than the commercial formulas which are pretty much now made in China and shipped over here. Plus, soy is a heavily pesticide sprayed crop and there isn't any restriction that soy intended for formula cannot be sprayed. So, you could make your own. If you google the Weston Price Foundation you should find a link to a homemade dairy free formula recipe. It will look weird to you and you might think that it isn't palatable. But, I actually know a doctor in the Middle East who is using a version of this recipe in a hospital setting and it is saving babies lives. They do drink it. The formula is very, very high in necessary essential fatty acids. Actually, this isn't odd at all. OK purreeing the liver is odd but I am all for natural food going in. That is a fascinating site that I am going to be looking more into. Thanks.

 

 

 

Faith

 

going off dairy/soy might help; I had to go dairy-free for about 6 months with DD. Are they absolutely sure of baby's weight gain - ie, are they measuring on the same scale under the same conditions EVERY time? Have they weighed before/after nursing to see if he's actually transferring milk adequately? He is being weighed on the same scale. No they haven't weighed before and after nursing. Thanks for the sites above I will be reading them.

 

:hug:

 

:grouphug:Has he been tested for cystic fibrosis> The mucus and lack of weight gain are concerning in that direction.

Don't mean to add anything to your plate. I know. I saw that this could be the cause of FTT and so researched it and decided I didn't want that one and have tried not to think about it since. :001_smile: I made sure to tell the doctor about the mucus though so that she could draw her own conclusions. Thanks for sharing.

 

When they had to draw blood, they would do it from her heel. It took longer, but it worked much better. I am kinda hoping they will try something different but we will see tomorrow.

 

As far as the food and weight gain, that one is tough. They do make prescription formulas that has as much as 36 calories per ounce. We had to use this since she was so small and took way more energy to gain weight than other babies. On regular formula she was burning almost as many calories to drinkit as she was taking in.

 

How does he respond to foods without dairy? I m assumming ok?? He has been doing great.

 

Low and behold she was suffering from 'silent aspiration' . Any food or drink we gave her was first going into her lungs before going back down her esophagus. But she wasn't having lots of infection, or coughing during feeding, or any other usual sign of a problem other than lno/low weight gain. Only by the grace of God did she not develop pneumonia or some other serious infection because of it. The reason for her aspiration was linked to her mouth - as we found out at a feeding specialist referral. She didn't have the correct tongue movement needed to suck properly. Yes, she was sucking, but very inefficiently. Which is why she was burning all her calories just by eating. Another appointment showed that she also had reflux - again without the usual symptoms. We began some medication for the reflux, began using thickener with liquids, and began working with an SLP What's an SLP? that specialized in infants and my dd had a dramatic turnaround. Amazingly she 'suddenly' began gaining so much weight another dr warned me that she was going to be obese if her rate of growth continued. :001_huh: :lol: I am so glad that they were able to figure it out. He doesn't have any of the symptoms of reflux either. I am hoping that the blood work will tell us something.

 

 

 

How many wet and poopy diapers? He is pooping abt 3 x a day and wet at least another 3-5 Does he nurse on one side or both sides each feeding? I have been making a concerted effort to feed him on both sides. How often does he feed? It is about every 3-4 hours but the last few days about every 4-5. I am going to start making him eat about every 3. Do you hear swallowing when he feeds? Yep, I can hear him swallowing. How is his latch? Could be a supply issue, but could also be a transfer issue...have you seen an IBLC What is an IBLC a lactation consultant? to evaluate if he is transfering milk? Any other issues, like extreme fussiness that could lead him to burn more calories than he should? He is not fussy at all. My babies are generally mellow. They save all their energy for 2 and up.:D I'd be wearing him non stop, and sleeping with him, and trying to minimize any stress he has...these things have proven to help weight gain. Also breast compressions.I do sleep with him and have been trying to minimize his stress, he is the much loved youngest of 6. I just read about breast compressions and tried it next time I nursed and it worked so I will be keeping that up. Thanks for all your questions. It helps to clarify things for me.

 

i have a close friend who had a very similar situation...her baby was losing weight, at 6 months old he weighed less than a pound more than when he was born. there were some minor (self correcting) heart issues, but when she started feeding him formula he started growing. she is very pro-breastfeeding and fed her previous kids the breast until they were over 2 years old...but for some reason her milk wasn't what it was when she was younger and the baby was not getting what he needed. he's just over 2 years old now and the cutest, chubby thing you ever saw!This is my fear and my hesitation. I figure if I rule everything else out then I will definatley address the formula issue. Thanks.

 

breast is best, but you should really listen to the doctor in this case.

 

good luck!

 

 

I just changed his diaper and it was green. According to the breast feeding thread that means he is not getting the hindmilk right? It is usually yellow but has been green a few times the last few days.

 

Thanks.

[Renee in NC]

I just changed his diaper and it was green. According to the breast feeding thread that means he is not getting the hindmilk right? It is usually yellow but has been green a few times the last few days.

 

Thanks.

 

That is what I understand. I have had two babies who were not able to nurse hard enough to get hindmilk. The first was FTT until he went on formula (I even used a supplementer for him.) The other never got that far - I noticed his mouth problem at birth (he looked just like my other son) and I tried nursing for a month. He didn't gain adequately, so I put him on formula (and he was fine.)

[ktgrok]

ok, after reading you replies he needs to eat way more often. Frequent feedings will do wonders and help him get the hindmilk. I would feed at least every two hors during the day, every 3 at night with maybe one longer stretch so you can sleep.

[ktgrok]

does he use a pacifier?

[The Girls' Mom]

Just an FYI, Nutramigen has milk proteins in it. (Or at least it did 10 years ago). If you look at the ingredient list, casein is in there. My twins had a horrible time with my milk, and formula, including Nutramigen. Blood in their stools and all. As much as I hated to, I ended up putting them on Soy Formula and they thrived. In hindsight, I wish I had someone council me more on cutting out dairy from my diet, and perhaps it would have helped :confused:

[Harriet Vane]

The others have offered some good thoughts. I will just add my experience.

 

My son spent the first couple weeks of his life screaming in pain and hardly ever sleeping. It was unbelievably intense for all of us. Most of the people (and doctors) with whom I spoke said it was "just colic" and that we'd live through it somehow. One person, however, recommended I try eliminating dairy from my diet.

 

Within one week, I had a completely different baby. He was so calm and so happy and he was sleeping much better. A month later the difference was even more pronounced.

 

Each and every time I snuck a little milk product (cheese, milk, whatever) back into my diet, my little guy suffered again. I had to be completely draconian about staying away from dairy.

 

I would advise you to drop both wheat and dairy from your diet for a solid month (it can take that long for the affected person's gut to heal). Both are major allergen/intolerance foods.

 

As for the formula, I would first try feeding more frequently AND making sure you (the mama) are drinking ridiculous amounts of water. This would boost your supply and the baby will end up taking in more.

 

Try the allergens and the extra feedings before supplementing with formula. If this doesn't work then you explore the option of supplementation.

[Mimm]

Maybe someone else has suggested this so I'm sorry if I'm being repetitive, but what if you offered forumula when you were done breastfeeding him each time? That way if he's truly not getting enough milk from you, he can top off on the formula. But if he is getting enough, fine, he won't drink much formula and you wouldn't be compromising your milk supply.

 

I hope you guys can get to the bottom of this soon. :(

[Dobela]

SLP= speech language pathologist, a speech teacher essentially. Some work with infants to make sure their muscles and such work properly for feeding issues and to help them develop language normally.

[Mama Geek]

I ended up on antibiotics when my dd was a week old. After about 5 days of a 7 day antibiotic, she was miserable and having diarrhea. I took her off bfing and gave her formula for about 2 days and then went back to bfing. In those two days I later figured out she became a lazy eater. She had lost weight after having the diarrhea and we were told to come back in 3 or 4 days to have her weighed again. She had lost even more weight. The ped told me to immediately quit bfing and put her on formula.

 

Needless to say I am a hard headed engineer married to an engineer. We decided against the formula, went out and bought a scale and tracked her for the 3 or 4 days. We weighed her after every feeding. We kept track of the times and kept track of dirty and wet diapers in a spreadsheet. I increased her feedings to every 2 hours during the day and 2 1/2 hours at night. (No it wasn't easy, yes she and I both wanted to sleep and my husband was great about helping us both to stay awake. She started gaining weight and we decided a return trip to the ped wouldn't accomplish anything. It is now more than a month later and she has gained a little under an ounce a day and is doing well. I do suspect she has problems with gluten and have cut that out of my diet as well now.

 

I have since backed off to feeding her every 4 hours at night and at least every 2 1/2 hours a day unless she wants to eat before then.

 

Like I said, it can be done but it isn't easy. I really wanted to breast feed exclusively. I have yet to give her a bottle again even though I have some milk in the freezer that I pumped. I am still paranoid that she could go back to being a lazy eater.:tongue_smilie:

 

I wish you and your baby the best and hang in there. If you need to find a different ped that is more willing to work with bfing mothers.

[mommaduck]

I just changed his diaper and it was green. According to the breast feeding thread that means he is not getting the hindmilk right? It is usually yellow but has been green a few times the last few days.

 

Thanks.

If you want him to get more hindmilk, then you need to pump some of the foremilk first (that is the watery part). I used to have so much milk that I had to pump before feeding my first baby just so he could latch. He was pretty darn plump due to all the hindmilk he got.

 

Not saying this will solve your problem all the way around, but it will solve that one specific concern of hindmilk.

[Terabith]

If you want him to get more hindmilk, then you need to pump some of the foremilk first (that is the watery part). I used to have so much milk that I had to pump before feeding my first baby just so he could latch. He was pretty darn plump due to all the hindmilk he got.

 

Not saying this will solve your problem all the way around, but it will solve that one specific concern of hindmilk.

 

:iagree:

[justasque]

How often does he feed? It is about every 3-4 hours but the last few days about every 4-5. I am going to start making him eat about every 3. ...have you seen an IBLC What is an IBLC a lactation consultant?

 

Like a previous poster, I suggest putting him to breast *at least* every two hours. Meaning two hours from the start of one feeding to the start of the next. There may be one longer interval at some point in 24 hours. Even a *good* eater/gainer really should be feeding no more than 3 hours apart, and this child may need more opportunities to consume food. *Offer* the breast frequently even if he's not asking, though of course you can't/shouldn't force it.

 

Other suggestions include lots of skin-to-skin contact, baby-wearing, rest and fluids for mama.

 

In addition, talk to your midwife or an IBCLC (International Board Certified Lactation Consultant, or something like that) about factors in YOU that might be part of the problem. Do you have an undiagnosed/untreated thyroid condition? Are you on birth control pills? Have you been taking antihistamines? Any of these, and I'm sure there are more, are things that could interfere with your ability to make enough milk, and a competent health care provider treating FTT should take the time to explore this side of things with you.

[Carrie12345]

Like a previous poster, I suggest putting him to breast *at least* every two hours. Meaning two hours from the start of one feeding to the start of the next. There may be one longer interval at some point in 24 hours. Even a *good* eater/gainer really should be feeding no more than 3 hours apart, and this child may need more opportunities to consume food. *Offer* the breast frequently even if he's not asking, though of course you can't/shouldn't force it.

 

 

 

That's what got ds through his "FTT" dx.

If it doesn't work, you can always move on to something else, but a nursing marathon is the best place to start (imo, of course). I'd also start looking for underlying conditions, just in case.

 

I tried to schedule my girls' feedings (not saying you're intentionally doing that, just that the times almost match), and they both wound up on formula. I never even considered feeding them more often.

 

Being pregnant, I'm disgustingly addicted to the baby shows on TLC, and pretty much all of the moms who go home saying "We need to nurse every 3 hours" wind up using formula for "FTT". Tummies don't have synchronized clocks!

[JennyB]

Thank you so much everyone!:grouphug: This is the kick in the pants that I needed. We haven't started school yet so I told my kids that I was going to be in the bedroom with the baby and to pretend that I am not here. :D I am just going to put him in the sling and always have the br**st there for him. I have tons of computer stuff to do in prep for school starting and then I can be on here more! My older children are amazing so they said not to worry they will take care of everything. He was eating great but the last week not as much but I was grateful for the extra time to get more done. It didn't concretley sink in how much less he was eating until posting it here. So thanks again. The spreadsheet idea is so something I would do, so I'm going to. :001_smile:

 

After reading different sites on the internet I thought that gluten couldn't go through the breastmilk? Have ya'll had different experiences than this? That is why I didn't go off of it immediatley. On my husbands side he has 2-3 aunts and at least 5 cousins that I know of that are allergic to gluten. I figure it can't hurt to cut it out and see. Does anyone know how long it takes gluten to get out of your system? I have another doctors appt. next wednesday and was wondering if I'd see a weight gain by then if gluten was the culprit.

 

Again thanks so much for the advice and telling ya'lls experiences.