Now that our little one has been diagnosed with failure to thrive and we know she will not take bottles or solids, we need to make the best of our nursing relationship to get her to grow.
Here are the specific changes I'm making to help increase her weight:
Babies Eating Schedule and Supplementation:
Prior to the diagnosis of last week, I had been feeding her every three hours and only at night if she woke up. Since returning from our Texas trip she had been sleeping through the night for at least a week before the diagnosis. She was getting 5-6 breast fed meals per day.
After the diagnosis we tried offering bottles and she surprised us by taking 5 two ounce bottles after every meal. The next day she was constipated and took maybe 2 bottles and by the 3rd days she was so cranky she wouldn't touch a bottle. She finally had a big poo and didn't take another bottle for the remainder of the week. By Tuesday I was worried that I wasn't making enough impact so I spoke with a lactation consultant from the hospital who suggested that Evie was not staying on the breast for long enough and to work really hard with her to keep her on longer. I realized that she was so distracted during the day that maybe she'd take longer feedings at night so I started waking her up every three hours to eat - even though she was sleeping through the night! This got her to 7 breast fed meals per day. By Wednesday she had gained 3 ounces which is normal weight gain for her age.
We're not out of the woods yet. She's supposed to be taking in 150% of a normal calorie intake so the doctor still wants us to do whatever we can to increase her calorie intake. I've started feeding her more frequently than 3 hours. If she sees me and howls at 2 hours I'll feed her. If it's 2.5 hours I'll feed her. I do work full time from home but have the flexibility most of the time to feed her regardless of what I'm doing and I've even fed her during conference calls because she really can't wait and her refusal to take a bottle just means she will cry and potentially lose weight from the stress of crying hard.
We're supposed to give her solids and anything that she'll take but she really has no interest so far in solid foods. We have given her a high chair and a place at the table to sit so she can get accustomed to our eating habits and we know that over time it will become more interesting for her.
My theory is this - between 7-9 months babies get really super active. They are on the floor learning to crawl and getting super jazzed about life. All that movement burns calories and makes them really hungry so I think she will pick up an appetite just from having a more active life. This is exactly what has happened with my other two ultra slim girls.
My other girls took bottles early on because I went back to work at an office. With this baby I've had the joy of working from home but it's also made it to where baby has never really had to take a bottle - with the exception of business trips and that's a story for a different post!
This is really my first attempt at breast feeding a baby full time. It requires an extensive amount of care for my own self which leads me to the next part.
Mama Eating Schedule:
I've researched what a breast feeding mom needs to eat and the general consensus seems to be eat about 300 to 500 calories more than normal, eat fish twice weekly and eat a well balanced diet. I was concerned that I should be eating with every meal that baby takes throughout the night but I've found no evidence that this is necessary. Therefore to keep up with the babies needs I'm eating a large breakfast when I wake up that is around 500 calories, lunch at noon with 500 calories, snack around 3pm that has around 300 calories and dinner usually has around 500 calories. I drink a 20oz glass of water per day, one 15oz cup of coffee in the morning and an iced latte in the afternoon. I considered reducing my coffee but this amount falls into LaLeche's standards of 4-5 cups per day so I think I'm okay. I'm also drinking several cups of Mother's Milk tea per day with honey and decaf iced tea with lunch and dinner.
I found this article today "Healthy and Petite" that seems reflect many of the issues I've had with our little one. I certainly don't want to rule out that there might be something wrong that's causing our baby to not gain weight but then again there does not appear to be any indicators that there is something wrong except for the fact that she doesn't fit into the doctor's growth chart. I think it might be time to start looking for a more supportive doctor who knows more about FTT and it's relation to breastfeeding. According to this page breast fed babies do grow slower then formula fed babies so its important to keep this in mind.
Finally I'd like to share this website, KellyMom, who has many articles on this issue and significant support for breastfeeding moms and there is always the awesome LaLeche website for advice on everything related to breastfeeding.