Monday, March 26, 2012

When pediatricians get in the way

We were living overseas when Donovan was born. We managed to find an English-speaking pediatrician pretty easily, thanks to two separate recommendations for the same guy. We loved this pediatrician, he was cheerful and friendly and seemed to know his stuff. He was also extremely pro-breastfeeding, practically cheering at each check-up when I told him we were still exclusively nursing.

When D was about 4 months old he started dropping down his growth curve. Our pediatrician didn't worry about it right away, but when at 6 months D had gone from 50% for weight down to 25% he sat us down and expressed his concern. Perhaps my milk wasn't enough for him anymore, he said, and it was time to try using formula.

"We want to make sure he's getting enough calories and nutrition for his brain to grow properly," he said. Talk about striking fear into a new mother's heart (mind you, there were no other red flags- D was happy, active, and meeting milestones).

I'm not sure if he ever even asked about diaper output. He didn't mention seeking help from a lactation consultant to help increase my supply, if that was even the issue (and I was too naive to think about seeking one myself, or to know how to go about finding one).  We did try giving D formula, but he completely refused. We kept an eye on his weight and encouraged eating lots of foods with healthy fats and to nurse lots. It took till D's first birthday till we finally realized that our happy, very active, very healthy kid was just...skinny. His growth curve was simply a variation of normal.

A few months later, now living back in California, this strange thing happened where at about 10 months my milk supply plunged for a week or two (I noticed that D wasn't putting out many wet diapers all of a sudden).  We had a different pediatrician, but the experience was mostly the same-- up to then she'd been very supportive of breastfeeding, yet when my supply became questionable the only suggestion was, "Why don't you try formula?" Which D once again refused, and after a week or 2 my supply came back to normal and we nursed for several months after that.

Moving ahead a few years, Quinn had no breastfeeding issues until he started a 12 day nursing strike at 9 months old. I went in to see our current pediatrician (different from the previous two). She was out, and the doctor we saw instead was completely and utterly clueless. I don't think he even knew what I meant when I said "nursing strike." Thankfully by then I knew better-- I walked out of that useless appointment and found an IBCLC (International Board Certified Lactation Consultant) in the area. Her encouragement, advice, and support played a major role in getting us back to breastfeeding again. Quinn is still nursing now at 15months and we don't have any clear deadline for when we may stop.

These are my own anecdotes, but hearing others' stories I get the sense that my experiences are not unusual (at least none of our pediatricians have "celebrated" breastfeeding by gifting bags of free formula for meeting a breastfeeding milestone, yes I know a few different moms to whom that actually happened). Many doctors today "know" that breastfeeding is "best" and certainly encourage and support it... as long as everything's going well. Yet most pediatricians have little or no training on how to handle the challenges that can arise. They won't even refer a mother to an IBCLC so she can get quality information and help. This is perhaps one of the biggest "booby traps" breastfeeding mothers face- we turn to our pediatricians for help (they're the experts, right??) and get well-intentioned bad advice that can derail a breastfeeding relationship.

If you're having trouble with breastfeeding and you want to continue (because when you decide to wean is up to you and your baby, no one else), please seek an IBCLC.  Find someone who is helpful and supportive.  Many breastfeeding problems can be solved with the proper support.

Do these stories sound familiar to you? Was your pediatrician truly supportive of breastfeeding?


  1. Here is a twisted story for you, the two people who were most helpful/supportive were the pediatrician we saw in the hospital (he made the comment that supplementing with formula is a lot of treating the anxiety of parents and caregivers) and the family doctor we go to (here kids only see pediatricians if they are very sick) who supported us keeping the boys on breastmilk only for a few weeks longer and rechecking when Noah had dropped below the 3% level.

    Unhelpful or even counter helpful were the lactation consultant public health nurses who wanted us to keep brining the boys in to be weighed every day/every other day (which at the time, recovering from my c section, was a big outing and meant time the boys were in their carseats and couldn't nurse if they wanted to), and they were also pushing me to keep supplementing the boys with formula after their feeds even when it was clear that my milk had come in and that they boys were getting better at drinking.

    Luckily we had the comment of the pediatrician to fall back on, as well as I had confidence from having read lots of blogs/talked with friends, and the support from both of my parents and husband to stop the supplements and sure enough they boys grew just fine, made it up to 25% on the charts, and at almost 8 months love nursing.

  2. Our pediatrician's office was totally useless with breastfeeding -- until just recently. They hired a staff IBCLC, which I didn't know about until I told them I was going to see an IBCLC, and they said "Oh! We have one of those now! You can see ours!" Which was actually great because it was covered just like a regular doctor visit, which means our insurance paid for it! That helped out a ton. But I knew what to ask for. For another mom, I doubt they would have offered that as a first line of defense when feeding issues came up. A few years ago, I took a picture of a HUGE stack of formula sitting behind the counter at my peds office - there must have been over 200 cans, at least. They just handed that stuff out like candy to every new parent. I was saddened to see that. I told myself I'd get a new ped, but trying to change peds is a job I just don't have time for. I go there, take what I need, and ignore any outdated advice (like how they think all babies should be sleeping through the night at 4 mos old -- HA!)

  3. I have heard tons of crazy stories of moms whose pediatricians pushed formula when their kids weren't growing 'fast enough' but I was lucky with mine I guess.

    Avery started high on the growth chart being born at 8lbs 7oz and gaining two pounds the first month. But after three or four months he went from the 90th percentile to the 70th, to the 50th, then 30th....and now 20th. Fortunately our pediatrician looks at more than weight and even though he's a skinny one, he's tall, his head is average sized and he is developmentally above the curve (walking young, babbling, motor skills, etc).

    I'm really grateful for this because I seriously couldn't take that crap. I would NEVER try formula. If my milk wasn't enough I'd go for coconut milk, or something else but formula is soooo gross.

  4. Our ped was very supportive of our issues. He has never been on us to get her weight up, even though she's always been between the 15th-35%iles for weight and 50th+ for height (skinny kiddo with a big potbelly). I did struggle with low supply - still do, but yay for domperidone! - and he was always very encouraging about offering the breast more often, eating foods that may help increase supply, and suggesting pumping after feeds just for the extra stimulation. Not bad for a young MALE ped! The topic of formula didn't come up after our first out-of-hospital visit, as we did have to supplement for about a week before my milk eventually came in (and to keep Kiarda's billirubin levels at bay).

    The last appointment she had was her 18 month, and I got a "way to go!" when he found out she was still nursing. :) We're still doing well at almost 21 months. I have been doing the "don't offer, don't refuse" for many months, and she's finally intermittently deciding she doesn't want the bedtime boob. (But has also asked at other odd times, too, don't know what that's about.) I intend to continue on as such until she's 2, then gradually wean myself off the domperidone. I want it to be her decision to stop, but at the same time I'm near the end of my rope with nursing. At least if I can gently nudge her in an indirect way, she'll continue on her way.

  5. I think you've heard the story, but I thank God for Dr. Federico Puga, our pediatrician in Santiago, Chile. When your older brother was born, just at the borderline of being a premie by weight, I was totally supported in breast feeding - nothing else was considered. And when I was scared I didn't have enough milk, he kept smiling and refusing to give me any instructions on how to find/give formula. He just insisted I keep just nursing, frequently, and gave me all the right suggestions and support to maximize my supply. I trusted him, and it made all the difference having that confidence.

    When at 5 weeks you developed jaundice suddenly that was linked to something in my milk, he knew to have me stop breastfeeding for a week, pumping all the while to keep up my supply, and after that break from it, the jaundice cleared, and your little system was able to go right back to breastmilk without any problem from then on. Yay for Chile, and wise pediatricians!

  6. I didn't know that story, way cool!



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