5 Month Has Been Brestfed but Dr. Suggesting Formula

Hi. My son's pediatrician told me that as a breastfed baby, it's very common for him to be above average growth for his first 4 or 5 months. He also told me that he will likely dip below average around 5 months and not to be alarmed because this is normal. My son is exclusively breastfed. He is 4 1/2 months and weighs 15.5 lbs. HTH

Stay with breast milk and increase cereal. But that is only my opinion. Many pedies are too quick to suggest formula for anything and everything.

My children are almost grown now, but I formula fed both of them. They were perfectly healthy and fine. Don't feel guilty one bit about switching to formula.

My (breastfed) youngest is much smaller and a much lower percentile than her older sister was. At 17 months she's right around 20 lbs. I joke that she'll be rear-facing in her car seat until she goes to college :)

Contact LaLeche league or a lactation consultant, both for their thoughts and for any pediatrician recommendations. That's a pretty big drop, and it's one I wouldn't just dismiss out of hand, but one I would want a second opinion on as to what it really means, you know? Switching to formula because your baby isn't sleeping through the night at 5 months isn't a solid reasoning at all - 5 months is often too young for one reason or another, and especially if your baby is doing a lot of nursing at night.

Check out the kellymom site: http://kellymom.com/babyconcerns/growth/index.html

I've started charting my teeny one on the WHO growth charts and not the charts the peds use, as the WHO charts are better geared for breastfed babies. On their charts, she really doesn't drop percentiles like she does on her ped's chart.

I'd want to understand why the percentile drops were occurring, so I totally agree with the previous posters who said talk to the daycare. What are his nighttime nursing habits?

I'd not want to switch to formula unless I truly felt I had no choice. Yes, it's fine, yes babies do well on it, but we've got breasts for a reason, and breast *is* best 99.9% of the time ...

Wow! I am really surprised by your doctor's recommendation! Most pediatricans are pro-breastfeeding unless it is absolutly necessary, and from the information you have shared with us, it doesn't seem that way.
My daughter was born in the 90% and gradually dropped and now she is in the 25% (she is 12 months). The pediatrican never seemed concerned (even when I was) and attributed most of my daughters drop on the charts to her high level of activity.
I am one of those people who always goes with what the doctor says, but in this case I would get a second opinion. I am not against formula, but I can guess that when you start adding it to your baby's diet your breastmilk supply starts to drop. If you do want to add formula then you may need to take extra measures to ensure your supply does not drop (extra breastfeeding sessions, longer sessions, more pumping??) I would suggest contacting your local LaLeche League or speak to a licensed Lactation Consultant.
This may also be helpful- The World Health Organization has a growth chart that is for breastfed babies. Think about the typical growth chart your pediatrician has...it is based on the average baby. I am sure that a majority of the baby's it is based on are not breastfed.

http://www.kellymom.com/babyconcerns/growth/growthcharts....

Check and see where your son lies on the chart! Good luck to you!

I just want to add that I think this is totally your call right now.

Maybe you could try breastfeeding him first and if he will take some, offer a little formula. I am all for breastfeeding. I am with the other moms, follow your mommy gut. Or seek another opinion.

Go with your gut. If you feel that your baby is satisfied after nursing and is having normal bowl movments as well as wet diapers throughout the day, then you have nothing to worry about. Most kids drop % wise from one month to another. It's when they drop for 3 consecutive months you need to be worried.(advice from a ped nutritionist) My daughter just turned 1 and only weighs 17 lbs...at 9 months she was 15.3 and since she was hitting all her milestones there was no cause for concern...and I was breastfeeding.

I'm not a doctor, but as a mom that has nursed AND a doula, trained in breastfeeding...this does not sound right. Most doctors look at a loss of weight as a deficiency that needs fixing. They do not look at the fact that you are feeding your child the best possible food and that it metabolizes very fast. All your doctor cares about is putting weight on your child. Besides...if you do switch to formula as prescribed, your milk supply will go squirrelly. Stick with what you do best and just keep an eye on your little kiddo. As long as he is messing his diapers as recommended, he is fine.

Is he happy and healthy? Some children start to become the body shape and style they are meant to be at this stage.

Honestly, my guess is that he's dropping weight because you are adding rice cereal - which does not have much nutrition at all and has no where near the fat and calories of breastmilk. He's eating rice cereal instead of taking in breastmilk at that time. YOu've taken away a big chunk of his calories and fat. Even if he eats after the cereal, you've filled his tummy with something less nutritious and he doesn't have as much room for the good breastmilk.

Pediatricians do not know that much about breastmilk, it seems. They recommend starting cereal at 4 or 5 months when the American Academy of Pediatrics suggests waiting until 6 months.

Another HUGE thing to consider is that the growth charts were developed based on FORMULA FED babies. It's totally different for breastfed babies. Ever notice those growth charts and "recommended feeding schedules" on the walls at the pedi's office are always sponsored by Enfamil or Similac? Not a coincidence. This is a GREAT resource for information (solid, research based information from a certified lactation consultant, IBCLC) on feeding your breastfed baby solids: http://www.kellymom.com/nutrition/solids/index.html
If you still want to give him cereal twice a day, make sure you nurse him to his fill FIRST and then give cereal afterward. It's really only for practice, since ounce for ounce the fat and calories of cereal can not equal that of breastmilk.

Oh, and breastfed babies at 4 and 5 months old don't usually sleep through the night. Keep in mind, too, that "sleeping through the night" at this age is considered 5 hours at a time.

My suggestion would be to check out if he seems at risk to YOU. Rolls don't mean extra health. I think some questions to ask your self: Is he happy and content after eating? Is he hitting other developmental milestones?

My friend and I have had our last babies within a couple of months of each other. Her girl was born a couple of ounces heavier and the same length as our little boy. Her little girl fell off the growth chart pretty soon. At 6 months she is 14 lbs and 25 inches, while at 4 months my boy is 17 lbs and 25 inches. We use the same pediatrician. He is not worried about EITHER of our babies. Babies start to grow in the pattern they are meant to be.

It sounds to me like your biggest problem is a pediatrician who doesn't support breastfeeding much.

Good luck. I really don't think the issue is your baby's growth, but more with a pedi who doesn't understand breastmilk. Please don't jump to supplement with formula till you've really looked at everything UNLESS that's something you WANT to do. It does NOT sound like something you NEED to do. Big hugs - breastfeeding is still vastly misunderstood by the pediatricians in this country. Formula is NOT the same nor is it "just as good". Formula companies even tell you "breast is best". If that's your choice, it's fine, but I think a 5 month old 15 lb boy who is thriving in every way does not need extra formula.

This is a really tough call and I think you might want to try contacting a Le Leche League in your area if you can to see what they have to say. I would not be concerned so much that your son is in a lower percentile, but the fact that he is dropping so dramatically is a little concerning I would think. My daughter and my son are both just tiny kids and have always been no higher than the 25th percentile for weight or height, but since they have always tracked that way, the doctors were never concerned about it....I just have tiny kids.

Does your son seem content after nursing? Are you making sure he is getting plenty of the hindmilk (i.e. are you nursing him long enough on each side so that he isn't just getting foremilk....the hindmilk is much higher in fat and will help with putting on weight). Is he hitting milestones like rolling over and stuff or does he seem like he's not developing because of his weight? My honest opinion is that there are a lot of pediatricians out there that jump at the chance to give your kid formula and aren't very "pro nursing", which is pretty sad considering it really is the best thing for your baby. They just don't know enough about it to help women through things like this without just giving up. Contact a lactation consultant or La Leche League and just see if you are comfortable with what they tell you. You're probably going to have to go with your gut on this one and if you are really feeling uneasy about your son's weight, then the formula certainly won't hurt him. You can still nurse him when he's home and continue to pump so that most of what he's getting is breastmilk.

I hope you get some answers and that you can come to a solution that you're comfortable with. It's really tough to know what to do, but sometimes you have to go with your instincts. Good luck!

IOM, Le Leche is far more knowledgable than any pediatrician regarding true, optimal nutrition for your baby. Each individual baby needn't be compliant to their artificial "charts", and your breastmillk is specifically designed for YOUR baby's needs. Formula should only be used when breastmilk is unavailable, and even then it's benefits are fractional compared to Nature's bounty. Doctors are not gods, after all. And often, they're just covering their 'back sides' with questionable advice. I agree: listen to you mommy gut.

My oldest daughter was almost exclusively formula-fed. She was born with a weak suck and could not latch on; when she finally figured it out at about 2 weeks, she would latch on and start screaming within 2 seconds when the milk didn't let down fast enough for her. (I subsequently breastfed my next 2 children without any problems.) I pumped what I could until she was about 6 weeks old, then gave it up. She started out tipping the charts in the 75th percentile for weight, but by the time she was a year had dropped to the 50th (she only weighed 18 lbs.--I think she would've been lower nowadays--they changed the charts a few years ago). She stayed there for quite a while, but now she is 12 and over the course of the last couple of years has dropped from the 50th to the 15th percentile for weight. Her height has also dropped from the 50th to the 30th. She is healthy and growing. I guess what I'm trying to say is that children do sometimes move around the charts but it can be normal for THEM. As long as they are growing, gaining weight, healthy and still ON the charts, they are usually fine. I would definitely try NOT to give up on breastfeeding. I know he isn't sleeping through the night, but have you considered taking him to bed with you for a time so you can feed him as much as he likes at night and perhaps get your supply up? I know you are working so that may not be feasible.... The only thing I'd be worried about is that he will be so satisfied by the formula he's getting at daycare that he will want to breastfeed even less at home, all of which is going to decrease your supply. Once you start giving formula, it is a vicious cycle of decreasing supply due to the decrease in demand. Have you talked to a lactation consultant? They normally have them available for free through the hospital where you gave birth. They are wonderful when it comes to giving you tips for keeping breastfeeding going for as long as possible. But, in the end, if it doesn't work out, try not to beat yourself up over it...you've already given him more than most women give their children, and you should be proud of that! Best of luck to you.

I went through the very same thing with my children. My extremely wise and dear friend and Lamaze teacher advised me with my second to "plan" on offering a supplemental bottle at least one time a day when I was probably the most exhausted. Just knowing I was going to do this took so much pressure off that breastfeeding went MUCH better. With my third baby 11 years and 8 years younger than the first two and I had when running my private school I planned from the beginning to breastfeed and if there was any sign of agitation,etc. I would offer a supplemental bottle. He was OFTEN still hungry and I felt fine knowing he was getting both breastmilk and supplement and not hungry.

Breastfeeding is extremely important but often we just can't do that exclusively , Just relax and enjoy that precious baby .

I to agree with contacting La Leche I am sure you have recieved much advise here did not read them all but from what I did read is that I saw no one ask you if you were taking vitamins you should still supplement while breast feeding also are you giving your baby supplements. I also Breast feed my three children for 1 1/2 years for two of them and 11months for one of them got prgo with the third so I had to cut him short and way breast feed kids are Sometimes Vitamin D deficient so it would be good if you both supplemented and it might increase is food intake. Here is a link for a womderful all natural baby vitamin in powder form so you can mix in the cearl.
http://www.shaklee.net/healthydesire/product/20057

there is a mom and baby speical right now if you like to know about it let me know

be blessed

Hello J.-
I didn't read all the responses below and hope to keep this short because it could have already been stated.

Breastfeed or formula before cereal feedings always. The cereal is not as beneficial as the formula you are not wanting to give. The breastmilk has everything the baby needs in the first year, therefore, cereal is just practice of food manipulation.

BTW- He may turn up his nose at the taste of formula after 5 months of perfect milk.

I agree with contacting La Leche- they've seen it all :)

Hope this helps- Glad you are keeping a watchful eye.

Don't stop breastfeeding; that's the best thing for your baby. My 2 1/2 year old went through the same thing. He kept dropping in range. I was so stressed out about it. My doctor wasn't concerned. He said as long as he's gaining weight, he's fine. When he turned a year, he didn't even weigh 18 lbs. I would be more concerned about your doctor suggesting formula over the fact that you have a small baby.

This is not a straight-forward question since there may be other reason's for the weight loss.

If breast feeding is important to you, I suggest calling the La Leche League and asking to get a lactation consultant who can help you make a more informed decision.

But I think your instincts to not just accept the Dr's advice at face value is right on.

Hope this helps.

La Leche was sooo helpful for me. Also are you and your husband big people? My husband and I are rather small ourselves so all of our children were tiny. Also if your child was hungry they would show other signs of being unhappy. I would talk to La Leche and consider everything before I switched to formula. With formula you get so many other problems and then the cost.

Ulitimately it is your decision. Do what you think is best. However, your child could not be getting enough of the fat that is necessary for brain growth and development. If your child is right on target developmentally I wouldn't worry about it. My daughter was underweight and about 4 months I started her on formula. Several reasons, I could make sure she was getting enough, she didn't tolerate breast milk (always crying and spitting up even when I altered my diet), and it did help her sleep through the night. Once I started her on the formula she jumped up in weight rapidly. For a moment the dr was then concerned about her weight gain. So, you do what you feel is best. As long as your child is steadily gaining weight and not losing it you should be fine.

My son has been in the 5th-10th % all his life. I pumped breastmilk for the first year and that's all he had.

I suggest keeping doing what you are doing. Also take into account your body type and his dads.

Do what you think is best and don't let a doctor tell you otherwise. Check out your supply and perhaps La Leche to see if they can help make sure he is getting enough hind milk.

Go from there. If your son is happy let things stay the way they are.

I think those charts are bogus. Did you know they just take the weights of all babies and average them out? So if the average kid is now overweight, your normal weight, healthy baby will be below the "average" line! Unless he drops down to below 10% I see no reason to give any supplements! I do think he's old enough to try some other cereals (oatmeal or barley) and maybe a couple fruits. Just be sure he tries one at a time and you should wait a minimum of 3 days, or the ideal 2 wks between new foods so you can watch for an allergic reaction. But I think you should definitely keep breastfeeding and pumping! And kudos to you for making the effort to pump for him! I know how difficult it can be!

I'm not going to contradict your pediatrician, but I would suggest getting a lactation consultant to evaluate your baby and do before and after feeding weights on the baby. The growth charts are known to be off for breastfeeding babies, because they used many formula-fed babies to establish the percentiles.

As others have said, does your baby look and act healthy? Is he doing the things babies his age should be? Is he having wet and poopy diapers? These are important issues, in addition to what he weighs.

Keep us posted on how he's doing.

J.,

DON'T DO IT, unless you intend to wean sometime soon. As long as you are breastfeeding successfully (he's not way fussy/crying because he's hungry), and he appears to be healthy and happy otherwise, I wouldn't worry about the weight gain. Rates of gain tend to ebb and flow, and he may just be in between growth spurts. Neither of my girls got over the 3% mark until they were about 2 or 3. My pedi knew that nursing was the best thing for an infant, and she supported me through it all. As you supplement formula (and rice cereal - I'm surprised he's eating it at such a young age), your milk supply will go down, so if you intend to wean sometime soon, then formula would be the way to go.

Best wishes,
M.

I know quite a few moms who have supplemented with formula. I would give it a try.

My son was a big baby and did something similar. He was born 9 lbs 4 oz and quickly dropped in percentile. He ate ALL the time, and by the time he was 4 months, I started him on solids. I had hoped to wait until he was at least 6 months to feed him solids, but since he was hungry all the time and interested in what we were doing, I went ahead and fed him solids. He did really well with them, and I know he is healthy. He just went in for his one year check and he is now a little below the 25% for weight, but he eats ALL the time, both solids and nursing. I know he is getting enough nutrition, and even though the doctor said I "can feed him more," I am not worried. I worried when my daughter did the same thing, but this time around, I have just realized that doctors don't know everything! (my daughter who just turned 3 did the same thing) I just think that's how my kids are. I would never go to formula. Enjoy your boy and don't stress about the weight drop, unless your gut is telling you something is wrong. I believe that is more accurate than following some standardized chart!

Talk to the daycare to see just what he is eating while you are there. It may be time to introduce table foods. Is he moving around? My oldest was VERY active at 4 months and crawled at 4.5 mos. He also plummeted in the percentiles at that age. He has not recovered. He is just small statured.

Don't put too much stock in to those percentiles, they are just guidlines and compare to AVERAGE children. Your son is below average.

If he is otherwise healthy, producing feces and urine on a regular basis, and actually growing (not necessarily gaining wt) then he is getting enough and he is fine.

You are obviously curious so have your milk tested to see if it is providing all he needs.

Good luck!

I have to agree with your doctor on this one. How low on the percentile chart are you willing to let your son drop before you realize he's slowly starving and needs more nutrition for his body to grow at a healthy rate.
I'm sorry but you ignoring your doctor's requests doesn't make sense to me. Why go to the doctor and go through all the routine, necessary check-ups for your baby if you're not going to make the necessary adjustments that result from the check-up?????
What is most likely happening is your body is (for some reason)not producing a sufficient amount of breastmilk and thus you need to supplement it with formula. Period.

I am sure the only reason the doctor has suggested formula is because the baby isn't consistantly gaining weight. It has nothing to do with your breast milk and whether or not it is good for the baby, but formula is a good way to get calories into a baby and measure how much he is drinking compared to the weight gain. I know you made a good choice to breast feed, but the baby has definitely received all the nutrients that he needs by this age. Good luck to you!

Basically the doctor is saying that the breast milk isnt nutritious enough for your son. I would definatly start him on formula. He has gotten five months of the breast milk and all the goodness for him. He will be much happier with a good meal in him.

i honestly would ask your dr how he feels about breastfeeding in general. he may tolerate it but not support it. there are 2 main things when you are breastfeeding that i would stress - qty & quality. are you pumping enough for him to get the recommended oz per day he needs? are you eating healthy protein rich foods so that your milk is nutritious? if the answer is yes to both, then i see no reason why you should quit nursing. my daughter went from 25% (birth) to 50% (3 mo) back to 25% (6 mo) to 15% (9 mo) to around 8-10% (12 mo) to 4% (15 mo) to about 5-6% (18 mo). she was breastfed until she was almost 16 mo old and my dr never once mentioned giving her formula unless i wanted to or if it got to the point wehre she seems like she wasn't thriving or my milk production stopped. at 19 mo she still only weighs approx 20 1/2 lbs but she is 33 in tall (75-90%). she has always been skinny with very little rolls/fat and EXTREMELY active. no matter how much she eats (which let me tell you i think some days she'll eat me out of house and home!) she has kept the same size/shape since birth. if he is starting to eat food and still getting the amount of milk needed each day, appears healthy and you've not noticed any problems i would not start supplementing. talk to a lactaction consultant, and maybe get a second opinion from another dr in the practice. follow your gut. if you don't feel there is a need to supplement at this point, then i wouldn't do it. my daughter also didn't sleep through the night until about 13 months. good luck!

My son is 5 moths and 16lbs. He was born 7 12oz and his dad is 225 and 6ft 4. He has been in the 90th percentile and is now like your son varying some. My pediatirician is not worried and strongly encourages my BF to continue. Babies instinctively know how much they need to eat. My son does cluster feed from time to time and it is hard not to worry when he does this, but it never fails that after he is finished cluster feeding I have an over supply of milk for about 24 hours and then Irealize, his eating patterns, like my own are NOT the same everyday... they vary. Stay flexible and don't worry.... just think, someday soon you and I may be worrying about obesity instead, or worse yet, girlfriends!!!

Are you feeding him the cereal after you breastfeed? Ceral doesn't have nearly the amount of calories as breast milk, so it should be more of a dessert after he has had the milk, and not the main course.

No, do not give your child formula. My dd went through the same thing, I breastfed her the whole time. I did start giving her whole fat yogurt and cottage cheese around 9 months. I can not imagine a ped telling you nursing is not the way to go. Maybe you should contact the le leche leage and ask what if anything they suggest. Formula is not as good as breastmilk, period. Good Luck.

Do you trust your pediatrician? Do you share common beliefs about things such as breastfeeding, immunizations, and medical versus natural intervention? If not, he may not be the right doctor for your family. He may be a good doctor, but not the one for you. Please clarify what he meant by starting formula. Hopefully his suggestion was to supplement with formula. My oldest daughter weighed 7lbs 14 oz at birth. She did not gain much weight. She stayed in the 5 - 10% range throughout her baby years. She was on breastmilk only until eight months. I could tell I wasn't producing enough breastmilk for her when I pumped at work because she was still hungary at daycare, so my doctor and I agreed it was time for me to start "supplementing" with formula. She hit all her developmental milestones ontime, she was just very tiny. I continued to breastfeed whenever we were together. I sent formula to daycare with her. We started introducing cereal and other baby food at 6 months. Since she wouldn't drink cow's milk at one year, I continued to nurse her until she was twenty months. She is now eight years old, in the 50% percentile for height and weight, and an honor roll student (ok I'm bragging now). I did what was right for my family with my doctor's consultation based on all the facts. Please consider your childs weight, height, and development.
By the way, my daughter was five before she really slept through the night. Prior to then she would sleep about five hours straighy before waking up. Some parents consider that sleeping through the night, but I don't. Once they start potty training you will be happy when they wake up at night to go to the potty. By the time she was five her bladder was big enough for her to sleep ten hours without using the bathroom.

First I would suggest if you can talk to a breastfeeding consultant in your area. I am a strong breastfeeding believer and I don't think any baby needs to have formula. But I always think that everyone should do what they really feel the right thing to do. Good luck :)

Great job nursing! The first thing you have to consider is if your son is at 50% that means 49% of children still weigh less than him. The same goes for 25. Also, the chart your Dr. is using is most likely from a formula company and based on babies that formula feed. Go to the World Health Organization and look up a breast-fed baby growth chart. See where he falls on that. Rolls do not equal health. If he doesn't look malnourished or sick I wouldn't worry. It's not how fast a baby grows, it is just important that they grow.

Hi J.,

You have gotten a lot of good advice already. I would definietly suggest checking with your local La Leche League chapter or a lactation consultant to see if they can offer support.

I breastfed both of my children but for both, due to decreasing weight issues, supplemented with just one formula bottle a day and breastfed the rest of the time. This seemed to help. I also did not start cereal or any other solid foods until 6 months so they were exclusively breastfed until then (the formula addition came later). But my son did drop into the 10% for weight at around 9 mos.--I'm not sure what happened--either I stopped making as much milk or he stopped eating enough to help make more, so I needed to do something else, like supplement. I never planned to nurse much beyond one year so this worked out for us.

I know your baby is younger than mine were...I would just ask your doctor for clarification. Does he mean you should give up BF entirely or just supplement with formula? Is it a "failure to thrive" issue? Find out what he means. I have a friend whose daughter was in the failure to thrive category and she is still a small child at 4 1/2 now. But her parents are not big people either so I do believe that is a factor (turns out she has food allergies too that was causing some problems but that is a different thing!)

My kids were happy with both breastmilk and formula and my daughter is now consistenly in the 75% (or higher for height b/c I'm tall) range for everything. She was always in the 50% for both height and weight until she was three years old--my son too. I remember for both of them that they were not 20 lbs. at one year b/c we could not turn their carseats around until they were!

Just keep the communication open between you and your doctor--if you think you are being a pest with all your questions, find a new doctor! I know mine learned who I was probably just by my voice those first few years b/c I called so much! :-) But they were always patient with me and that is why we still love them and continue to go there!

Good luck!

When my baby was 5 months old, I started spoon feeding her baby cereal mixed with breast milk once a day. When she turned 6 months I upped it to twice a day. I know that some say not to start cereal before 6 months but I did with both of my kids and my pediatrician said it was fine. Maybe that's an option.

Is he drinking what you take to the day care? Maybe that is the problem. But I would say yes to the formula since his weight is getting low. He can just have formula during the day and you can nurse him when you are with him so he can have it all:) It will probably be easier on you not having to pump at work as well. You might have to a little bit to release any engorgement, but our bodies are so amazing and adjust to fit the need in a very short time frame usually. Plus, if he becomes more satisfied he is very likely to start sleeping through the night, which would probably be great for everyone. I say most of all go with your gut. I think that breastfeeding is wonderful, I breastfed mine and it was great. But your child's health is the most important and he will do great with a combo or even all formula if need be. Tons of children, including me were formula babies and I was never a sickly kid and have not had any damage from drinking formula:) I wish you all the best!

My son didn't sleep through the night until closer to 1 year so don't worry about that. As for the weight gain issue -- you can mix breast milk with formula. I had to do that when I went back to work because I wasn't producing enough. I breast fed when I was home and pumped as much as I could at work. My son would get half and half during the day while at daycare.