Expert: Sally Wendkos Olds - 3/8/2011

Question
I m a pediatrician and mother of 4 mth old boy.I m exclusively breastfeeding my baby n have never even given a pacifier to my baby. My baby's birth wt was2.8 kg,it was a normal delivery no complications,started breastfeeding within an hour of birth.I took iron n calcium supplements in pregnancy n took iron till    2months post delivery n am continuing calcium till date.since his birth my baby's wt has been in the 3rd to 15th centile.recently he had  diarrhoea for 2wks n his wt further dropped to below 3rd centile.even his length is between 3rd-15thcurve .myself n his father have been healthy n chubby as babies but our son has negligible fat even on his cheeks. My baby 's characteristics are as follows-1.lean appearance,light wt,very active in all milestones ,roll over n creeps before 4month completion,coos babbles laughs etc. 2.very light sleeper since birth,hypersensitive to sound-wakes up repeatedly even to the sound of newspaper ruffling,needs to b rocked to sleep n constant caresses,sleeps better  on my lap! 3.weird or no feeding routine ,has never emptied my one breast in 1 feed,feeds only for 7-8 min then either sleeps with nipple in mouth or starts playing.so needs another feed after an hour or two.if asleep,he makes sucking action for half n hour.he has started smacking n biting his lips since last 1 mth.at night he sleeps for 8-10 hrs but feeds at 2hrs-4hr intervals for  few min 4 he pees n passes stools adequately sometimes passes stool during feed 5 my breasts are mostly engorged n I've oversupply n overacting mk let down.   My question is how to increase his wt? Have tried blockfeeding n expressing foremilk to let him have some hindmk which I doubt he ever takes. Should I get any tests done or is he normal? Should I start solids?

Answer
Dear Hema,

First, congratulations for giving your son the best start in life by breastfeeding him!

Dr. Laura Marks (the pediatrician who coauthored my book -- see below) and I both appreciate your concern about what seems like an issue of your baby's failure to thrive. It sounds as if you have been following good health practices, and so it does not seem that you have caused his problems. It's hard to tell from a distance, however, even with your detailed description of your baby's development, what might be wrong in his development.

Dr. Marks recommends that you take your baby to another pediatrician (besides yourself) for an evaluation.  Once the evaluation is done your pediatrician should be able to determine the best way to get your baby to gain weight.

Regarding your oversupply of milk and engorged breasts, you may want to pump your milk after feedings if you feel that your baby has not taken in enough milk. Then you can store this milk and if necessary feed it to your baby in a bottle. Meanwhile, removing the extra milk from your breasts should make you feel more comfortable.

Good luck!

Sally
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Sally Wendkos Olds
Author, THE COMPLETE BOOK OF BREASTFEEDING: Olds & Marks, 4th edition, September 2010, published by Workman Publishing, and available in most public libraries, bookstores & La Leche League chapters.