Most mothers of young children will run across this problem at one time or another. It seems that the standard pediatrician office, even the excellent one, still may be behind the times in dealing with child-rearing. Their advice is unlikely to hurt your child, but you still may end up reading the newer publications and gaining quite a different opinion from theirs. What do you do then?
I ran across this problem just a few days ago. My daughter had her nine-month appointment, and they checked her weight and height. Her height was fine by their standards, lying right along the same point in the growth curve as her last appointments. Her weight, however, had barely moved. She had not lost any weight, but she did not gain enough to maintain her point on the curve, or even the point below it.
"We're not concerned yet," the pediatrician told me. "But I would like for you to push solids four or five times daily. Sit her down in her chair and feed her all she'll take. I'm an advocate of breastfeeding, and I breastfed my own children, the last one for two and a half years. But sometimes they just need that extra help. Besides, they say that you need to introduce solids during this time period or the child may become resistant to them."
Fair enough, I suppose. So I took her home and gave it a try.
My first problem was that my baby is not interested in solids. Oh, she loves to eat from a spoon, but she'll only consume an ounce or two before losing interest. To put this into perspective, the baby food jars labeled for her age are six ounce containers. Then, despite having eaten only one ounce of food, she will skip half a nursing session. That means that she loses probably about four ounces of breastmilk for one or two ounces of solids. The calorie count of solids runs from seven calories per ounce for vegetables like carrots or green beans to eighteen calories per ounce for a banana and cereal mixture. The average calorie count for breastmilk is twenty calories per ounce. So this effort is not likely to help her gain any extra weight.
I suppose that many doctors assume that low weight gain after six months on mostly breastmilk is a case of low milk output from the mother, and we will be able to add solids without reducing the amount of nursing sessions. This is not the case for my baby. I'm an overproducer, and she just isn't hungry.
My mother assured me that I underwent the exact same weight change at the exact same age. I told her the doctor's recommendations, and she told me that her doctor had made the exact same recommendation... thirty years ago! She had obediently pushed solids. "Did it work?" I asked. "Did I gain the way they wanted to see?" No, I hadn't, but introducing more solids into my diet hadn't seemed to hurt, either.
This is not the case for my baby, which brings me to the second problem with following the pediatrician's advice. From her earliest days, my baby has been strongly prone to intestinal trouble. Every feeding results in gassiness, and she used to have frequent episodes of reflux. These episodes died down over the past month or two, and I was hoping that the trouble was behind her. Every time I feed her, I sit with her for a while afterwards and help her work the worst of the bubbles out of her body.
Now I'd like to take this moment to clarify that I have not actually refused to start her on solids. In the morning, either I or my mother (if I am working) tries her on a basic, First-Foods item. She'll eat an ounce of it, or, some days, two ounces. It causes her a little bit of intestinal discomfort at times, but not too much. Then, in the late afternoon, she often gets fussy and wants frequent feedings while I'm trying to get supper on the table. I sit her in her chair and give her a handful of Cheerios. She eats most of them, and I get a break to cook and eat!
I took her home from the doctor's office and started her immediately on the solids regimen. On the first day, she ate pretty well, and I thought that this was surely the right thing to do! But on the second day, her appetite had fallen off significantly, and by the third she was in agony for most of the day with stomach trouble and constipation. On the fourth day, she ate very little and then threw up in the evening...
What do you do when the doctor is wrong?
I had a long talk with my mother and with the lactation consultant, and they both told me the same thing I had already guessed in my own heart. This baby is not like the typical bottle-fed baby not moving to the next step quickly enough. This baby is a different case. It's in her genetics to slow her weight gain at this juncture. Her ribs do not show, she has little fat folds on her legs, and she sleeps through the night. She is a very happy, active, healthy baby when she is not having severe intestinal pain. I have been reading about some babies whose intestinal tract mature more slowly than others. Some of them need to be nearly exclusively breastfed for two or three years as they are very slowly transitioned to other foods. Nearly all of them have shed the majority of their difficulties by age six.
Therefore, I am going on record to say that I will not be following my pediatrician's advice. I am going to return to her previous schedule, with a mashed food introduced in the morning and Cheerios (or bread) given in the evening, and I am going to keep breastfeeding her as much as she'll take. Now for the concern... am I going to get into trouble?
In this country, there seems to be a movement towards further government interference in the health of the population, which often translates to further government interference in the raising of young children. Already, doctors can label a child with the dreaded FTT (Failure To Thrive), and that diagnosis can cause a good parent all sorts of trouble if that good parent would rather follow the guidelines of the World Health Organization instead of the conventional wisdom of thirty years ago. Some pediatricians are more proactive than others and will put you in contact with the dreaded Social Services... simply over their disagreement with your method of parenting.
Some pediatrician groups are convinced that they know what's best for your child and you do not. These are the ones who groan when they find out that one or more of your children are homeschooled, because that immediately puts you into a different group entirely, an independent-thinking, intelligent woman who is not likely to follow their advice to the letter if she disagrees with it. Admittedly, sometimes they have cause for concern. At times like this, however, it may simply mean that they become frustrated with the mother's refusal to fit like a cog into the Great Machine.
Now I may be maligning my own pediatric group, so let me state that they have typically taken the individual approach much more kindly than most. I do not foresee being sent to Social Services over the amount of green beans that my baby may not be consuming instead of breastmilk. Still, I find myself making my decision and then preparing for my next appointment as if for battle, to fight for my right to care for this baby in the way I feel best.
