Failure to Thrive, Breastfeeding, and Weaning

by Andrea (NYC)

Hi,

I have had low milk supply since my daughter was born almost a year ago. In the fall I went back to work and have been faithfully pumping as much as I can to keep my milk supply up and provide her with milk at daycare. I have been inclined to let her determine when she is done breastfeeding. Recently at daycare she’s been drinking less milk, so I thought she might be naturally beginning the weaning process, which I thought would be a long process. However, my daughter was just recently classified as failure to thrive by my pediatrician. My daughter is a little over 16lbs and is making all of her benchmarks in terms of development. However, she’s sort of dropped off the trajectory on the charts they use to track weight. My pediatrician is not an alarmist and very supportive of breastfeeding (she breastfed her daughter) but she wants to be sure there isn’t anything else going on. We saw a specialist and he said to try to feed her whole cow’s milk. He was not worried either. She’s not taking too much of the whole cow’s milk, but she is eating lots of solids, like avocado, yogurt (plain whole milk), and meat. She drinks about 6 to 8 ounces of breast milk at daycare each day and nurses at night. My feeling is that she’s pretty picky and prefers breast milk straight from the breast to anything else and that is probably why she’s not gaining weight as much as people think she should. But, I would like to know more information:

How much breast milk she should be drinking at this age?
Is it okay if she’s less interested in breast milk from a bottle at daycare?
What kinds of things can we feed her to help with the failure to thrive thing?

Thanks very much!
Andrea

Answer:

Hi Andrea,

It’s good that your doctor and the specialist are not being alarmist over your daughter’s size. It’s especially encouraging that she’s reaching all of her milestones as she should! In answer to your questions:

It’s hard to say how much breastmilk and older baby should be drinking – hard and fast “guidelines” are tough to find because usually babies are self-regulating pretty well with breastmilk at this point. Reading from mother’s experiences, many babies are drinking around 20-30oz at this point, in addition to having solids. Babies will generally nurse (or have a bottle of expressed milk) 6-8 times over the course of the day and night. This is an average, though. As babies grow they eat more food and (may) nurse less. Some days babies nurse less, other days they seem to really only want breastmilk and decline solid feedings. Wet and dirty diapers are still a good sign to go on – is she having plenty of wet diapers and a dirty diaper every day or so?

It’s very natural for babies to prefer nursing from the breast to the bottle. Many mothers (and doctors) have noted that babies will take much less from the bottle at daycare, then prefer to nurse much of the evening and night to “make up for it.” I would encourage your daughter to nurse at night as much as she wants right now, not limiting nighttime feedings in any way. Some doctors advise nightweaning to encourage a baby or toddler to eat more during the day. This advice never seemed right to me with own slow-grower, Galen, however, and I chose to keep nursing him at night while encouraging good eating during the day. You can decide what feels right to you.

I would suggest that first you work on your own milk – I know you said you’ve had supply issues, but you can still do much to boost the nutrient content of the milk that you have. There are things you can pay attention to in your own diet that will boost the richness of your milk and help your little one. I have a couple of articles that you may want to browse:

Improving Milk Supply with Nutrition – these basics will increase the richness of your milk.

Pregnancy Diet – following this diet advice during nursing also helps increase the nutrient levels of your milk :)

Adding in plenty of fats (saturated fats from natural sources – such as butter and coconut oil, and essential fatty acids/omega’s) will help boost the richness of your milk. Oatmeal with butter and heavy cream is a great way to boost milk richness. Organ meats are also a very nutrient-dense food that translates directly to milk for your child. Organic liver or liver caplets are good options, and liver is often inexpensive.

When Galen was not gaining well I consciously worked on my own nutrition and noticed a difference in my own milk – it seemed richer and creamier and my let-downs seemed stronger.

As you are working on your milk, feed very nutrient-dense solids to your daughter (and pack them for daycare). When Galen went to the feeding clinic we were urged to add as much fat to his food as possible. I pureed whatever we were having for our meals (he couldn’t eat solid textures) and added butter and heavy cream (from grassfed cows) to his purees. Butter, heavy cream, and coconut oil are three excellent sources of fat for your little one because they are all very traditional foods that have provided health for centuries.

Carbohydrates also help babies (and big people!) gain weight and thrive. We didn’t feel comfortable giving Galen lots of breads and crackers which are mostly nutrient-devoid and hard to digest (though some grains like traditional sourdoughs and soaked oatmeal are much easier to digest). I did, however, give him more fruit than I normally give the kids. I always served his fruit with butter and cream, though once he started eating solids he loved a banana freshly peeled!

It’s good that she’s eating yogurt and avocados – I would make sure you’re getting whole milk yogurt so she’s getting the good fats.

Encourage her to keep eating meats. You can serve meats with a butter or cream sauce, or a reduction sauce made with butter or drippings (essentially a thick gravy) – these boost the calories for her and also provide delicious taste. Bacon and other naturally fatty meats are good for children. Eggs and fish eggs (many children love the saltiness of fish eggs like salmon roe) are also great choices.

Truly focusing on nutrient-dense foods and forgetting to be shy about fats will really help her. I found that Galen began to gain weight as soon as I started serving him these foods (first served as purees, then simply diced/in chunks) and not worrying about any conventional wisdom on fats.

I did give Galen whole milk, and at first I gave it to him warm with some coconut oil melted into it. Then as he began thriving I switched to just whole milk. I continued to nurse on demand throughout all of this because I felt it was still very important to him.

I hope these suggestions and my experience help, best of luck with helping your little girl grow healthy and happy!