Sunday, October 25, 2009

What to Do?

Kairi had her 6 month check up and shots last week. We are about a month behind on her appointments due to some clerical errors, but I won't get into that. Her appointment went fairly well. She was weighed and measured. They checked her temperature and her ears. Everything that you would expect to be done at a typical pediatric doctor's appointment was taken care of. Then the doctor came in. He looked over her charts and immediately noticed how high her weight was on her growth chart.

"Hm," he began, feigning concern, "I see here that Kairi's weight is pretty high here. She's above the 95th percentile. We need to start restricting her diet."

"What do you mean, restrict her diet?" I asked him, caught off guard by his claim.

"Well, she needs to only be taking 24-26 oz of liquid each day. How much are you feeding her?"

I was confused. "I couldn't tell you. I breastfeed exclusively and have no way to measure how much I am feeding her."

Dr. A looked a little surprised. "Oh. Okay then, you need to only be feeding her 3-4 times daily."

Again, I was caught off guard. "Is that including nighttime feedings?" I didn't mention the fact that from the time we go to bed to the time we get up in the morning I feed her 3-4 times still.

"Yes," Dr. A said, his impatience becoming slightly apparent. "You should only be nursing 3-4 times in a 24 hour period of time. You can give her water and 2 servings of baby food or cereal per day as well, but I really want to stress how important it is that you reduce her nursing times to 3-4 times a day."

"Um, okay...." I was bewildered into agreement. Well, I wouldn't necessarily say agreement, but I couldn't begin to wrap my head around his request long enough to question it until I had left his office. The further away I got, the more angered I was by what he was telling me.

Now, I don't claim to be a doctor, but I am not some uneducated schmo from off the street who will take his word without a second guess if it doesn't feel right. I have done enough research into breastfeeding to know that until my daughter is a year old her primary source of nutrition should be breast milk and the rest of it, the baby food, the juice, etc, is all supplementary. Sure, she needs those things, because after 6 months of age she needs more iron than I can produce for her and she needs other vitamins that aren't found in adequate amounts in breast milk. But most of her basic needs are met in my milk and every single article I have ever read states that until she is a year old I should be nursing on demand.

That is not to say that I am a 100% by the book kind of girl. I know that nothing works exactly the way the books say it will and often times I have to find a compromise between what I've read and what I feel to make things work. More often than not I lean towards what I feel over what I've read. But in this instance, everything I have read is completely aligned with everything I feel. And down to my very core I feel that reducing my daughter's nursing times to 3-4 times daily - like I said before, that's just what she eats once we go to bed! - is absolutely not what she needs.

Today when I logged into Twitter I saw a link to the growth chart used for breastfed babies. I followed it and entered Kairi's information into it. According to the chart at her doctor's office, Kairi was above the 95th percentile in weight. That's supposed to be a cause for concern. According to the chart that is provided by the World Health Organization, my daughter is in the 75th percentile. Right on the line.

I realize that I have a chunky baby. In fact, I expected Kairi to be a chunky baby. I was a chunky baby. So was Jason. Gracie was ENORMOUS. By 3 months she was in the 95th percentile in weight on her chart and her doctor was cramming dietary information down my throat even then. But take a look at Gracie. Go on, I posted recent pictures of her in my previous post. Take a look at her, come back, and tell me that you are worried for her weight - that you fear she might just tip into the range of obesity should she eat one more Twinkie. Granted - Gracie's weight hindered her physical development to a degree that we had to have specialists come in and determine she would be able to catch up with the other kids. Gracie didn't roll over until she was 6 months. She didn't sit up until she was 8-9 months, didn't crawl until she was a year old and didn't walk until she was 18 months old. But once she started moving that weight fell right off.

I have no fear that my children will be obese. I realize that obesity is quickly becoming the number 1 preventable cause of death and that while children are less at risk of weight related health problems, being overweight as a child often leads to being overweight as a teenager and as an adult, which we all know can lead to all kinds of health problems. With that knowledge in mind I try to feed my children healthy food - at the very least home cooked food, which we all know is often times healthier than eating out - as well as I allow them to get plenty of age-appropriate physical exercise. Kairi may be at the top of the charts (the WRONG charts) at her doctor's office, but I know that like her father and I, as well like her sister, once she becomes more physically active she will thin out.

All weekend I have been fighting with myself over whether or not to switch doctors. Ultimately I have decided that I am going to try to find a more pro-breastfeeding pediatrician. Sure, Dr. A has spouted "breast is best" but beyond that I have seen no support from him. In fact, he suspended breastfeeding when Kairi had jaundice. After getting out of the hospital from that ordeal I found out from several sources that there was no need to suspend breastfeeding or to supplement formula as the doctor had ordered.

But I am concerned for the mothers who aren't as sure of their decisions as I am. Even with my level of certainty I faltered briefly when ordered to reduce what I know is working. If I was less certain of my choice to breastfeed, his order to reduce nursing would ultimately lead to a reduction in milk supply and eventually to having to supplement formula or even wean altogether before I am ready. I wonder how many mothers have gone through that with their children because of faulty claims that they are nursing too often. This also leads me to wonder what other misguided information Dr. A is giving.

I would like to do more than just switch doctors. I would like to raise awareness of what is going on, but beyond this I just don't know how. This man is a very popular and trusted doctor in my community. He's been around for a very long time - he was even my pediatrician when I was a child. This issue pulls at me, pulls at my morals and I don't feel that I can simply walk away and only do what is best for myself and my child. What would you do in this kind of dilemma?

1 comment:

Sarah V. said...

I don't think there's a lot you can do about the other people who go to him. I *do* think you can write him a short, simple letter pointing out the fact that he is using the wrong growth charts and raising your concerns about the fact that you were told your baby was obese and advised to restrict breastfeeding when, in fact, your baby's weight was quite normal. If that mistake had been made with a younger baby, it could have potentially meant breastfeeding coming to a premature end due to the cut-back in milk supply.

As to what I'd do - well, I guess the honest answer to that question is that I'd fume over how I should be writing to him, and end up just not having the time or energy to do anything. :-(

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