Tuesday, June 26, 2012

Mama Guilt

My biggest frustration today has been questioning whether I should've researched and chosen a pediatrician instead of a primary care physician.

B went in for his 4-month checkup this morning and I left in tears. And not because of the shots-- though I did shed a tear during that as well.

You know when that happens that something needs to be re-evaluated. I then went home and chugged a bunch of water, ate a big bowl of pasta with spinach, a Magnum ice cream bar, drank more water, and have been feeding B on both sides every 1.5 hours since.

Why? Because I got those eyes from our family practice doctor and the run-down on how he is hanging on by a thread in the percentile category (for babies 3 weeks ahead gestationally and on the formula-feeding charts) for weight gain. I was encouraged to give him a formula bottle before bedtime and to start feeding from both sides-- which is the only thing I agree to doing (and the only reason I hadn't been doing so regularly is because B seemed to be content with one side feedings every 2-3 hours). She even encouraged starting him on rice cereal of which I already declared would not ever be a part of his diet because of its void nutritional value. I'd prefer to start him on a food like avocado that is high in good fats and protein.

Let's dispel some myths here. Exclusively Breastfed Babies (EBF) have their own chart, people. It's not fair to assume or compare that formula-fed babies and EBF babies should be compared on the same scale. I consulted the CDC website and it states that the CDC recommends that health care providers:
  • Use the WHO growth standards to monitor growth for infants and children ages 0 to 2 years of age in the U.S.
  • Use the CDC growth charts to monitor growth for children age 2 years and older in the U.S.
According to the World Health Organization's chart for EBF babies, B is not only good, but he's in the upper percentiles... even as a 4-monther and not a 3+ monther that he really should be qualified as considering his barely 37-week birth appearance. Apparently the WHO chart was updated and released recently and it's based on 6 countries-- U.S. being one of the six.

According to the regular charts (at 11lb 14.5oz), B is measuring around the 5th percentile. Small. But according to the WHO website, he's topping the charts! That leads me to believe that even if both are inaccurate (how can you place a basis for babies that are all different with different DNA to begin with?), he's got to average somewhere in the center of fine.

He's eating every few hours, meeting all of his milestones for 3.5 months (because I don't have a 4-month chart) and is even meeting most 5.5 month milestones! Also, his head circumference and height are all well within normal limits (on the CDC charts even!) and he's having at least 3-4 dirty diapers a day. And let's not forget that I'm a pretty small person and my husband's not exactly Hulk Hogan. He's even sleeping in 6-7 hour stretches at night, wakes for a feed, and goes back down for another 2-3 hours! And best of all, B looks and acts, and smiles, and responds and is... happy.

Look at me. I'm freaking happy.
Here's the chart I'm referring to.

I'm just feeling discouraged above all things. I'm not against formula if it must come to that, but I just wanted to be able to feel like I could personally sustain my child and do something as a parent that isn't a failure-- all on my own. I couldn't keep Andrew alive or have any idea of how or why he really died and I failed him. Going into pregnancy with B, I was ultra cautious and the induction happened because we were all afraid of failing him as well, because the NSTs were not looking too fantastic. He was born and had to have NICU intervention and formula then because of his early release... hence feeling like a failure again. Each and every wellness check since his birth has been met with a challenge: low weight, possible hip dyplasia & herniated tissues, and now low weight again. When will I ever take B to the doctor and get high-fived for growing this boy up well?

It's just plain hard having mama guilt over Andrew and dealing with that residual guilt on top of raising B. It's hard enough being a parent of a baby without a previous loss and here we are dealing with B's issues with a nice helping of Andrew sadness and guilt as a base layer to make it all the more frustrating.

Bottom line. My kid is healthy. I truly, truly believe he is. I'm drinking more water, feeding more often and more in general, considering solids a bit earlier than anticipated, and possibly considering a pediatrician switcheroo in the near future. Any recommendations, local Chicago suburbians?

Oy to the vey.


Melissa said... [Reply to comment]

I am speechless. That sort of pressure does nothing to help him grow, nor does it help Mama. I find that treatment to be very unsettling and would have nearly drown in Mama guilt if I was treated in that way.

There is an awful lot to say for your own intuition. You know your boy is growing well, he is hitting milestones. Perhaps looking into another doctor is a good idea. I know I would regret compromising what I know is best for my baby because a doctor said I should. Second opinions never hurt.

And he is a super cute and happy looking baby!

katie illingworth said... [Reply to comment]

You're doing great, mama. My little sister was EBF, was always in the 5th percentile, and my mom was told she had failure to thrive. That sister is now a beautiful, brilliant, wonderful 19 year old.

Be kind to yourself. Easier said than done, I know. Little Davey had serious weight loss the 2 days after he was born (17 oz), jaundice so bad we had to put him in a light box for 6 days when we got home (one night he cried all night long, and I couldn't take him out of the box, talk about total emotional meltdown) and have had major bfing issues.

I feel you, trust me. But you're doing great. He is happy and precious. Docs have their limitations.

Amy said... [Reply to comment]

He looks FINE. As long as he continues to grow and is not sick who cares if he is big or small? Babies grow at different paces. I would keep feeding him on both sides and not worry about it- obviously the large size of formula babies is not natural and those of us who EBF shouldn't worry about whether or not our kids are "keeping up" with them. Considering the high rate of obesity among kids in the US I will be thankful if my kids aren't topping the comparative growth charts!
We see Dr. Murphy- she works from Good Sam and Edward. I don't love every dr in her group, but I like her relaxed attitude. Also, she has been really receptive to everything Nic's hematologist has asked her to approve (since we have an HMO we need referrals for everything) and has thus far always deferred to his expertise.

Amelia said... [Reply to comment]

I am so sorry your pediatrician is being unsupportive. We actually went through the same thing, but for different reasons. (G had silent GERD and a dairy intolerance.) I wish I had known about avacado and rice cereal then. UGH.
I'm so glad you are following your instints, it's so hard for me to do that when faced with a doctor's opinion.
Sending strength.

Angela said... [Reply to comment]

I saw your comment on my blog, so came over here to give you some encouragement. My B is now in the 5th percentile for weight, 1st for height at 9 months old. I didn't start him on solids until he was 8 months and he is just starting to get chubby. He's fine, and your little is fine too! B has always been content nursing on one side. If your B is too, stick with it. Don't give formula or brown rice cereal, he is fine, and you are doing great! B will let you know if he needs more.

My New Normal said... [Reply to comment]

If you're not happy I say you should change doctors. It'sall hard enough without someone making us feel like we're doing things wrong.

Paula said... [Reply to comment]

Doctors have limitations. They go by what they know because it is all they have. Our doctor told us last week to switch to formula due to a high jaundice level. Not on your life! There is not enough evidence that supports stopping nursing due to jaundice. Our little one was born at 37 weeks came home small and had already gained over a lb in the first week. Plus our blood types are the same so no RH issues there. I believe that we have to do our own research and sometimes go against doctor's orders.

LookItsJessica said... [Reply to comment]

I'm no doctor, but B looks fine and dandy to me! As far as pediatricians, we see a local pediatrician group (it's all groups these days) and I find it to be so impersonal that I'm considering changing to a family practitioner. Another thing with pediatricians is that since they see babies all the time, they seem a lot more laid back with their care. As in, they generally feel that the baby is just fine unless there is a glaringly obvious problem. For example: Avery weighed 11 pounds, 2 oz at her 2 month well check (50th percentile) but her head was in the 5th percentile. My doc wasn't concerned at all, just so long as her head growing at each visit which it is. I think as long as B is gaining weight at his own pace, things are OK.

Anonymous said... [Reply to comment]

The only thing you should be considering, in my opinion, is a switch to a pediatrician - and the RIGHT pediatrician. Babies this young do not need solids, and their bodies aren't really ready for them. Good for you for refusing rice cereal (we did the same and at 1 year old, the only grains that M has had is amaranth, quinoa, and his birthday cake - and his pediatrician FULLY supports us). Our first pediatrician had him on formula because he hadn't regained his birth weight at 2 weeks - but most EBF babies don't. He was off by 2 ounces and they forced formula on us. We gave him a total of 12 ounces in his entire life before saying we were done. They just don't know YOUR kid.

Find a pediatrician who values your input and expertise in your own child. We just did 12 month shots and walked out saying, "thank God we switched to her. She is the best!" That is how you want to feel every single time.

I'm sorry she made you feel so bad. Unfortunately, this is common. I am so sick and tired of hearing about the CDC when we have the WHO and other equally valid research on baby/child growth. In our opinion, if the CDC says it - we're skeptical. HA!

Rachel said... [Reply to comment]

Hi Brandy. I have read your blog for a while, and never commented before, but I just wanted to encourage you and let you know you are doing a wonderful job caring for and "growing" your baby. I have a 13 month old daughter, and many of my friends have children around the same age. Some of us use pediatricians and some of us use family practice doctors. And I am always amazed by the conflicting information we all get from our doctors. This is on everything from what and how much a child should be eating to what medications and dosages are acceptable at certain ages. Yes, different DOSING info! It is a little shocking and borderline disturbing. When it comes to Benjamin's diet and eating habits, I firmly believe you should go with your gut. My daughter was EBF and never had a lick of rice cereal or anything of the sort. I know that the latter fact made me weird, but I just decided to start her with something else and it worked fine. My daughter was large at birth and has always been in the high percentiles (I am 5'9" so no surprise there) and that is probably the only reason our pediatrician never questioned me on it.

When you do start B on solids, be open to experimenting a little bit. I tried to start with avocado and my daughter wouldn't have any of it, still won't. I was so disappointed, but I moved on to bananas and went from there.

I am no parenting expert. I still feel like a complete novice, but if there is one thing I have learned, it is to cut myself some slack (easier said than done) and go with my gut. Yes, I do consult our pediatrician, but I also consult other sources and have gotten good information both ways.

Your little man looks wonderful and like he is in love with his parents. :)

Caroline said... [Reply to comment]

You are right - your baby is healthy and developing and that is all that matters. You are doing a great job and breast fed babies are totally different.

I'm surprised to hear they were giving you ANY grief what-so-ever as EBF is BEST for babies until 6 month.

Finn ONLY had breast milk until 6 months at which point I introduced solids (and he loved avocados and it was one of the first foods we did, but it gave him runny poop but I digress).

Finn has always been bottom of the chart. The biggest he was was at 2 months and even then he was only in the 25th percentile but usually around 5th or below. He is below the 5th percentile now as a healthy, happy, developing 1 year old.

My ped never was worried about failure to thrive or even him falling off the chart completely as long as he is growing in a healthy direction FOR HIM. I don't say that to be all "well MY ped never had a problem with is" so much as to say if you want to look for other options, I think you shouldn't feel bad as I think there are lots of people (peds, other Primary Care Physicians) who will tell you that your boy is just fine and to pat yourself on the back for doing a good job AND for still breastfeeding.

He may just be a small kiddo - you guys aren't exactly giants. We screwed Finn in the height department, so we were never expecting him to be huge anyway. Not being on the chart of being at the bottom of it doesn't bother me as long as he his hitting the milestones he should be. And he is.

Hang in there Mama - always something to stress about isn't there!?!

Natasha said... [Reply to comment]

Geez as if we don't have enough to worry and feel guilty about as it is. Thanks a lot doc.

One of the things Mason's pediatrician asks me at every visit is, "Is he happy, laughing, and in good spirits?" And my answer is always yes to which he replies, "then you're doing great mom!"

Our pediatrician also always tells me that those growth charts are just ranges. There are kids on the lower end and there are kids on the upped end. Mason happens to fall on the lower end for everything except his length. And he's fine. He's hitting all his milestones- a lot of them early in fact.

You are an amazing mom which is obvious in everything you do for B. And he's healthy and happy and doing just fine. To me that's all that matters. I think it's absolutely understandable that you want to find a doctor that meets your needs- who works in a way that works for you. And one that doesn't make you feel like you're not doing everything in your power to take great care of your little guy. Which you clearly are ♥

Emily said... [Reply to comment]

Happy? Meeting milestones? Sleeping well? Appears content after feeds? I'm not seeing a problem here.

No offence to your family doctor, but perhaps he or she hasn't actually SEEN a failure to thrive child in awhile. Working at a Children's Hospital I know what a 'sick' kid looks like and B isn't it. Pardon my french, but who gives a shit WHERE he is on the growth chart as long as he's healthy? Honestly. Doctors should remember that growth charts are to be used as guidelines and SOMEBODY has to make up the smaller part of the 'bell'. As long as B. is following his own curve, gaining weight and eating well then he's good to go.

I think you're doing a wonderful job.

Hope's Mama said... [Reply to comment]

You are doing a fabulous job. I don't know what it is about the States, but your docs over there all seem so quick to push the formula. Even if he's 5th percentile, that's still on the charts, not off them. And like you say, it is not a fair chart to have him on in the first place. He doesn't need formula, he doesn't need cereal and you're doing the right thing by listening to your strong mama instinct. I have nothing against formula, but it is a great disservice to those trying their guts out to exclusively breastfeed when it is constantly being pushed in our faces. Angus never had formula and he BF til 15 months, Juliet has never had any either. Like you, this was something I HAD to do. My baby died inside of me and I felt like (and still do) a horrible failure, so BF was just something I had to get right. I'm glad I had the support of health care providers around me, especially in the early days with Angus, when he took a month to get back to his birth weight.
Hang in there, and rest assured you're doing all the right things and your precious B will be just fine. He already is.

Mama Bear said... [Reply to comment]

He looks healthy, happy and perfect! I just had a long talk today with my counselor and then husband about how I feel like I can't trust myself with this pregnancy and I am struggling with my gut instinct versus paranoia. So I certainly need to work on taking my own advice too...BUT if you know your baby is happy, healthy and perfect...trust your instincts! A doctor who sees him every so often and is basing advice on a few numbers does not necessarily know best. You are well educated, informed and paying attention to B's every moment every day. Congratulations mama--it is obvious that he will continue to thrive!

Renel said... [Reply to comment]

doctors can be really stupid smart people. Don't listen to her. SHE IS NOT A PEDIATRICIAN. Get a new doctor. You will always doubt the care she is giving if you feel unsupported or if you can find better charts to weigh your child against.

EBF...That was my son too and he was in the 95% for weight and height- seriously like a round ball. But....whatever, he was healthy and happy etc. The healthy and happy is important. If he isn't acting sickly than go with it.

Guilt is something we are good at as parents. its a sign you actually give a shit about your offspring...I have tons, I had so much before Camille and so much after. I wish we could all give ourselves a break, but it is hard. So instead of getting rid of the guilt which is way too hard to do, get pissed and get a new doctor. Go interview pediatricians now. Find someone new ...

Giant hugs to you and your boob juice and your perfectly growing child.

Brigitte said... [Reply to comment]

Your baby looks pretty healthy and happy to me! I nursed exclusively and on only one side at every feeding because that seemed to work fine for us, and now he is 7 1/2 months and we have been giving some solids since about 5 months (with lots of breast milk). I am fortunate to have a female pediatrician who nursed her own babies until 17 months. There is a lot more understanding and appreciation and education on how to monitor breastfed babies. You just keep feeding and try out the nursing on both sides if he will take the extra milk.

Diana T. said... [Reply to comment]

I too have followed your blog for a while but have never commented. I have two children who were exclusively breast fed until they were a year old. My daughter (who is my first) I did not start on solids until she was 6 months old. My son was a larger baby so I started him a bit earlier on solids right around that 4 month mark. Both were perfectly healthy and FINE! If you feel as though he gets to the point of not being content anymore then you can up his feedings to you know it's time for solids. Whether you believe it or not we do have Mama instincts in us and you'd know when your son needed something more from you!

Your son is beautiful and you should never feel as though you have failed him. He looks happy, content and most of all loved!

I LOVE LOVE LOVE my pediatrician and I am in the NW suburbs. She has two locations one in Arlington Heights and one in Skokie (not sure if either of those locations work for you) but here is her information:

Her name is Dr. Michelle Rose

Medical Care Group of Skokie
9700 N. Kenton, Suite K402
Skokie, Illinois 60076
847-675-4373 (office)

Medical Care Group of Arlington Heights
1515 W. Dundee Road
Arlington Heights, Illinois 60004
847-590-1515 (office)

Hang in there. Best of luck and keep doing what you’re doing!!

The Houser's said... [Reply to comment]

I'm on the find a new doctor band wagon.. Our oldest daughter was a little chunky butt with all sorts of rolls:)But she ended up with a yeast infection all over her body (a reaction to penicillian maybe?!?) and I had been in the dr's office with her 3 times in one week, the office would rotate b/w 3 of them and you hardly ever saw the same physician.. This new dr walks in, tells us to take her diaper off, we did, he puts gloves on, then proceeds to tell us to move her this way and that way, he barely talks to us, never touches her, tells us to put her diaper back on and get her dressed, takes the freaking gloves off, walks out of the room and never returns. I was absolutely furious and let them know as I was checking out that we would not return to their office with the treatment we had recieved not only that day but for the whole week. I made a phone call and later that day we had an appt with a new physicians group and that Dr. is the one we have been with for the last 13 1/2 years.. he's great, he listens to me, tells me to calm down, he's honest, he loves my kids and remembers all of their names and he's become a good friend and someone I trust for advice..
Every child is different, you're little guy looks happy and healthy!! Good Work Mama!!

CK said... [Reply to comment]

Lurker coming out to comment. You are his mama...and mama knows best. Don't doubt yourself. Get a new pediatrician...it doesn't sound like the person you are currently with is supportive at all. Your boy looks like he is thriving. Keep up the good work!!! PS - I had a good friend who went through the very same thing...and her now 8 month old is a little chubster :) Breast is best (this is coming from a mom who did have to switch to formula after 6 weeks for other reasons).

Alice said... [Reply to comment]
This comment has been removed by the author.
Darcey said... [Reply to comment]

Go with your gut and definitely find a new pediatrician. I have big babies...2 were EBF and 2 were 50/50 (breast, formula) and they all are around the same weight (my EBF was actually 2lbs heavier at the same age). So who is to say that he would be heavier if you gave him formula.

My pediatrician has always said it isn't about the published Growth curve, but that they stay on their own curve and continue to thrive. It always has made sense to me and maybe if you look at it that way it will make you feel a little bit better.

J. said... [Reply to comment]

Ugh, that really is awful, isn't it? You should be applauded for your decision to exclusively breastfeed for 6 months and extend BF through the starting solids process, given that this nation is dealing with an increasing obesity epidemic. You're also very right that growth and thriving do not equal weight/heigh/head circumference data... how wonderful that B is making such good emotional and intellectual progress!

The CDC has a whole 'change how we view a child's growth' campaign, Act Early http://www.cdc.gov/ncbddd/actearly/index.htm

If I may suggest, ask your provider about his/her family's story. A's family physician had a grandson who only gained 1 lb between 12-24mo, so she was sympathetic to A's downward weight curve that lingered in the 2%... she also gave suggestions but respected our decision to never give formula, nor give vitamin supplements. She listened well to our proactive WHO chart and feeding strategy findings.



Have you been to a local LaLeche League meeting? What you are encountering from your doctor is very common and LLL can give expert advice on your milk supply, hindmilk, and B's needs.

Brooke said... [Reply to comment]

No advice here, except to echo the idea that it seems like what's most important are the things you have noticed--that B is growing on his on curve, that he is happy, that he is healthy, that he is a good sleeper, that he is filling diapers. He is bright-eyed and does not look like a child who needs additional formula. I would definitely look into a different doctor.

LauraJane said... [Reply to comment]

Benjamin is absolute perfection. He may be a little guy, but that's just how he's built. Don't let the doctor guilt you into formula if you're not ready/interested. The numbers are so easily swayed based on birth weight, height, body-type, etc..

I was kinda upset when the doctor told me the opposite- that Grace is huge on the scale.. But looking at those links she seems like she's kind right on target at 50-75%, so that seems okay to me?

I guess the point is who knows? And don't feel badly about his size. You are a fantastic mother to that little boy. :)

LauraJane said... [Reply to comment]

Benjamin is absolute perfection. He may be a little guy, but that's just how he's built. Don't let the doctor guilt you into formula if you're not ready/interested. The numbers are so easily swayed based on birth weight, height, body-type, etc..

I was kinda upset when the doctor told me the opposite- that Grace is huge on the scale.. But looking at those links she seems like she's kind right on target at 50-75%, so that seems okay to me?

I guess the point is who knows? And don't feel badly about his size. You are a fantastic mother to that little boy. :)

Bree said... [Reply to comment]

You are totally doing the right thing with the breastfeeding. It is hard work but so totally worth it. He is doing just fine and he is not too little at all. That stupid growth chart is whack. Keep doing what you are doing!

Solange, Nik and Caitlin said... [Reply to comment]

From Nik: Hey that is a good weight, what does the doctor think he is going to be...a Rohde? We miss you guys Whale wars is not the same and tell E that my Lacrosse Stick is getting dusty. Love you guys!

Kristi said... [Reply to comment]

I'm just getting caught up on some blogs. I didn't read the comments yet, so I apologize for repeating. First of all, you know B better than anybody! You are also a smart, well researched, and educated Momma that strives to do the best you can for your children all of the time (and in my opinion are pretty awesomely successful)!!

Specifically, on BFing, growth charts, starting solids, rice cereal, and local peds... let's talk, I have opinions on the topics. :-)

Anonymous said... [Reply to comment]

DO NOT put any weight in those stupid fucking charts. I have EBF three kids- NONE of them ever got above the 10% percentile and every single one of them is JUST FINE today- ages 7, 5 and almost 4. This is very commonly 'the way' with EBF babies.
All that matters is that he is continuing on HIS growth line- ie if he is 5th% he stays on it and does not drop below it.
Stay strong mamma- and if you need to talk about it just email me!