Look at the Child, not the Scale

I love our pediatrician, but I really wish doctors in the US were more well-versed in breastfeeding, and that they followed Dr Jay Gordon’ advice to “look at the child, not the scale.” To be honest, I often had that complaint in the UK, too. Leo had his well check today, and I knew they’d ask about his feeding habits. I breastfeed him on demand, and he also eats three meals and snacks. Actually, he’s the only one of my children to eat so much solid food at 12 months, in part because he doesn’t like to comfort nurse.

Before the doctor ever came in, she’d looked at his growth chart. His weight is still between the 5-10th centiles, and now his length is down to the 10-25th centiles. His weight has held pretty steady along that curve since he was 6 months old, so to me that’s not a concern. His length has tapered off since he was 6 months, but again I don’t have a concern with that (perhaps in part because my other children didn’t have their length measured at all until 12 months, so there was no way to know the growth pattern).

So anyway, after I’d said there were no concerns on my end, the doctor asked if Leo had “graduated” to whole milk. I explained that he has a dairy intolerance and so doesn’t have cow’s milk. That prompted a question of what he does drink, to which I answered that he has breast milk and water and is still breastfed on demand. Perhaps I should’ve omitted that bit, as I was then told to get him down to breastfeeding only twice a day! Twice a day?! It’s normal to mostly breastfeed at 12 months!

Well, I was feeling defensive then and asked her why she said to nurse only twice a day. The answer didn’t help: she told me that if he were drinking cow’s milk he’d only be getting x number of ounces (can’t remember the number now, I think she said 8-12) and so he should only get that amount of breast milk. See the problem? Cow’s milk was used as the standard, not breast milk. She also said his growth showed he needs more calories, which should come from solid food, not liquids. I, of course, countered that breast milk is calorie-rich, and that the slower growth is easily explained by how active he is. While she somewhat agreed with breast milk being calorie rich, she still wasn’t convinced, but the conversation ended there.

The most upsetting part for me isn’t that the conversation took place, but that that conversation will happen with other mums who aren’t as confident in their breastfeeding and/or aren’t as knowledgeable about it, and thus will cause them to wean before they or their children are ready. I really wish pediatricians, or any medical practitioners dealing with infants and toddlers, had to IBCLC certified.

I wonder what the chances are of having a very similar conversation in a couple of weeks when we see his GI specialist. She’s never been concerned with his growth before, but did recommend cereal at 4 months, so I’m going to guess that it’s rather likely. Hopefully I can get through he conversation without being defensive, though.


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