Expert: Sally Wendkos Olds - 6/12/2011

Question
QUESTION: Hi,
I have been exclusively breastfeeding my 8 month old since the beginning.  He has never had formula.  He also stopped taking any bottles of EBM around 2 months so I have only been bresatfeeding.  Over the last 2 months, he has become a fussy eater.  It started that he would have some very short feedings which I chalked up to (with my pediatrician's advice) to becoming more distractable.  He was still getting 4 solid nursings during the day (usually at sleepy times), with 2-3 short feedings mixed in and 1 night feeding.  When 1 month went by he continued to become fussy  and actually the short sessions were now nonexistent.  My husband took him in for a weight consult and he was gaining OK, not like he used to but at an acceptable rate.  THe pediatrician (different one) seemed to think that he just wasn't hungry as often.  I was to keep a log for a week and bring him back.  I forgot to mention that he eats practically no solids.  He is unwilling. We offer a few times a day and he may take 2 baby spoonfuls here and there, but not usually very happily.  When he was brought back he hadn't gained anything.  The NP that examined him asked about milk supply, which I don't really know since I don't pump, but Ithought if supply was low then he'd want to nurse more to make up fo it.  He is really irritable and I am stressed thinking that too much time has gone for him not to be hungry.  I feel like all I am doing is going upstairs, offering to nurse with little success.  It has also resulted in me getting up with him 2-3 times per night since I feel he still needs to eat.  His schedule is something like:

3:00AM nurse
6:00AM_ wake up- offer to nurse,usually rejects.  I will try again in an hour if he is fussy, sometimes a short session, sometimes nothing
8:00AM nurse to sleep for a nap
11:00-12:00 offer somewhere in there usually a short one or nothing.
1:00- nurse to sleep for nap
4:00- offer- usually nothing
5:30-600- nurse to sleep
10:30- 11:30- nurse

I am really concerned.  I do offer solids periodically during the day.  DInner time is usually the most successful with maybe 2tsps being eaten.  He does have some very wet diapers a few times per day and BM usually every day.  I just question whether going 5 hours without eating is OK.

Thanks in advance for your help!

ANSWER: Dear Jen,

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

I can appreciate your concern since your baby didn't gain any weight at the last visit. Usually five breastfeedings a day is enough for an eight-month-old, and usually going for 5 hours without eating is not a problem. The fact that you are offering more frequent feedings than that, with little or no weight gain, may suggest a breastmilk supply issue. However, it could also be the result of some other problem that your pediatrician should be able to diagnose through examining the baby and going through a thorough history with you.  A baby's refusal to eat can have many different causes and is best determined by you and your doctor working together.

I'm wondering which solids you're offering your son. Although most doctors recommend starting with cereal, babies usually like fruits the best. If you can tickle his palate and get him to eat fruits, he might be more likely to eat other foods as well. Again, this is something you can discuss with your pediatrician.

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.



---------- FOLLOW-UP ----------

QUESTION: I have been working with my pediatrician group.  He otherwise seems like a healthy baby and gained like gangbusters early on.  They have suggested reflux and we will be trying medicine to see if that makes a difference.  In terms of supply issue, when I offer, I offer because it's either been a long time (at least to me) or he seems fussy or suckingon something.  He usually refuses.  I would think that if it were a supply issue, he'd want to nurse more. Am I mistaken there?  I've been trying to keep my supply up, but it's been difficult with the fussiness and refusal to nurse often.  He just went over 6 hours in the middle of the day and nursed, but not very willingly.  
In terms of solids I have offered: bananas, apples, pears, sweet potatoes and cereal with apples.

Answer
Dear Jen,

I'm glad to hear that you are working with your pediatricians, and that they are looking into other possible causes of your baby's not eating. Reflux sounds like a distinct possibility. There's nothing like actual hands-on physical examinations and exploration of possible causes for a problem -- something you really can't get from a service like this, in which my pediatrician consultant and I don't know your baby's history and can't do trial-and-error to see what could be wrong.

Speaking to your question that if it were a breastmilk supply issue, wouldn't your baby want to nurse more? This sounds logical, but babies (like adults) are not always logical, and sometimes when they don't get enough milk at a feeding they just seem to lose interest and don't try.

You seem to be offering a good varied early diet of solid foods.

Good luck!

Sally