by Melissa Clark Vickers       MEd, IBCLC Lactation Consultant

Question:

I have been advised by my pediatrician to consider weaning or at least supplementing with formula because my 8 1/2-month-old boy is not gaining weight as he should. Currently he nurses about every three to four hours during the day, and not at all during the night. He goes to bed between 7 and 8 p.m. and wakes around 6 a.m. My little guy is VERY active and fairly attached to breastfeeding. He is eating solids, but tends to hold out for nursing, so I have to work at getting him to eat solids. He has, just this week, started taking formula from a bottle for the first time (after many attempts to give him pumped milk and/or formula in the past).

My milk has been less abundant at night, so I decided to supplement or replace his last feeding of the day. The first couple nights I allowed him to nurse, and then gave him what he would take in formula after he seemed frustrated that I was out of breast milk. He took 3 ounces those first two nights. The third night, he nursed briefly but actually started to look for the bottle when I didn't let down immediately, so I gave him what he would take of formula (6 1/2 ounces). Tonight I decided to just give him the bottle without offering the breast first, and he took 7 ounces.

I would prefer not to replace his other feedings until he reaches 12 months. However, just in the past few days it seems as though my milk has decreased, and I was wondering if this is my body's response to the replaced feeding. I thought my body would adjust and just not produce milk for that time slot but still produce what is needed for the other feedings. Is this correct? Is there anything I should do to assure my supply for the rest of the day?

Answer:

You have a number of things going on in your note, and I'll try to touch on some of the major ones. First of all, you said your son is "not gaining weight as he should." This statement really doesn't tell us a lot about what is happening. Weight gain is not always a steady upward march up the weight charts. It has to be taken in context of a number of things:

• What has been your son's pattern all along?
• Has his weight gain pattern slowed from what it was before? Is he losing weight?
• Are you and his father "big" or "small"? (Genetics plays a role.)
• How familiar with breastfed babies is your pediatrician?

The standard growth charts used to be based primarily on figures from formula-fed infants who grow at different rates than breastfed infants. Breastfed infants gain weight more quickly the first few months, and then slow down. Formula-fed infants gain more from about 4 months on, so the old charts tended to have "average" as being artificially heavy. There are newer charts being developed that are based more on the breastfeeding infants. This acknowledges that breastfeeding is the norm against which formula-feeding must be compared, rather than the other way around.

Is it possible that your pediatrician is basing his assumptions on formula-feeding statistics?

Also, you mentioned your son is "VERY active" – this age is so much fun, isn't it? Just as an adult who is trying to lose weight does so by increasing exercise, when an older infant reaches the point of being independently mobile and actively crawling, cruising, walking, etc., sometimes they burn off more calories than they are used to consuming. They also tend to be distracted more at mealtimes – the world is far too interesting and attainable than sitting down to nurse or eat!

The fact that your son is so active provides an additional consideration – is he where he should be developmentally? Nutrition drives development, and if his nutrition was seriously compromised, then chances are you would see some slowing of development, as well.

The first question you really have to deal with is whether there really is a problem with your son's weight – and there may be. It is just important to understand his weight in the context of breastfeeding.

As for your supply concerns, your breasts make milk based on how much is removed. It is a wonderful process, and nature designed it to work in concert with a breastfeeding baby. Baby takes what he needs; breast replaces it and is ready for the next feeding. Baby needs more, takes more; breast makes more. Baby needs less, takes less; breast makes less.

Introducing anything in the system will generally decrease the amount of milk the breast makes. This includes the introduction of solids, as well as supplementing with formula, juice, etc. The bottles you are giving are most likely affecting your supply. Some women are able to adjust to a schedule of producing milk for the times Baby breastfeeds and slacking off for scheduled formula-feeds. Others find this a hard way to go.

If you want to increase your supply, you need to increase the amount of milk that is removed from your breasts – either by having your son nurse more or by pumping milk. It may not take much to create a new equilibrium that allows for a bottle a day.

What kinds of solids does your son eat? Perhaps you could experiment with various foods to see what he might like. Give him as much opportunity to self-feed as possible. If he wants to "do it himself" he might be more interested in eating more.

One last suggestion – talk with your pediatrician so that you fully understand what his concerns are, and talk with him so that he knows what YOUR concerns are. Think of you and your doctor as partners whose "business" is to raise a healthy child. Each of you provides information the other doesn't have, and your son benefits when both "partners" share their expertise.