Wednesday, May 9, 2012

WHO cares about growth charts anyway?

For the past month I've been a little stressed out about something to the point that I haven't had the desire (or the time) to write about it until now. At Natalie's two-month check up, which actually happened when she was closer to turning three months old, our doctor expressed concern over Natalie's weight. Weighing in at 9 lbs., 13 oz., she was only 1 lb., 12 oz. up from her birth weight. But, she had grown 4 inches since birth. Four inches!!! Can you imagine growing so quickly in a matter of weeks? This meant she was now in the 85th percentile for length and 10th percentile for weight. At first I took issue with the growth chart itself, thinking that maybe our doctor was using the older growth charts that are no longer considered particularly accurate because they deal with a small population sample, but then I realized after going home and looking it up myself that our doctor is in fact using the World Health Organization's (WHO) growth charts that look at breastfed babies worldwide. (Fun resource: You can also enter your baby's stats into the BabyCenter Growth Chart Calculator.) In one breath the doctor said that Natalie's weight being in the 10th percentile is probably no big deal because Natalie is likely genetically predisposed to be thin, but in the next breath she said she wanted Natalie back in four weeks for a weight check. If she hadn't made sufficient weight gain the doctor said we would have to discuss alternatives, or something to that effect.
As a breastfeeding mom, I took this fairly personally. On my extended leave of absence from work I treat raising my baby, and particularly feeding my baby, as my full-time job. I devote many hours of my day to nourishing Natalie. The doctor's words, though they obviously come with good intentions/medical concern and no true judgement, still felt like she was saying I wasn't doing a good job at my new full-time job. 

So then I went through a range of thoughts and feelings:

1) Breastfeeding is going great for Natalie and me. Unlike what feels like the majority of moms I know I am not experiencing any problems with the process: I do not have a supply issue, I do not experience pain, Natalie has a good latch, and dare I say it we both enjoy breastfeeding (most of the time....even though it is hard work). Why should I have to supplement with formula, as the doctor seemed to imply might need to happen, when we are not having any issues? If the American Academy of Pediatrics now recommends exclusive breastfeeding for the first six months and the free book on breastfeeding that the hospital gives all new moms says that 99 percent of women produce the right amount of milk for their babies, why mess with a good thing?

2) Natalie is probably going to be small. Matt is of average size for the American male. I am slightly below average in height and weight and have been all my life, but I've always been healthy. I come from a family of remarkably short people, and despite the odds I am only marginally petite.

3) Natalie produces plenty of diapers every day, sleeps well, and has a rather perfect disposition. If she was undernourished, wouldn't she display clear outward signs of distress, and wouldn't I, as her mother, pick up on those signs easily?

4) I just feel, in my gut, that Natalie is fine.

5) Still, I tackle challenges head on, and this is a new challenge, so bring it. I'll come up with a way to tip the scales, literally.

Then I got to thinking, perhaps Natalie enjoys breastfeeding too much. It almost always puts her to sleep, which is great, but maybe she's not always feeding long enough to get to the good stuff, the hind milk, which is what the baby drinks after the first third of the milk, or foremilk, is depleted. The hind milk is fatty and calorie-packed, so maybe I needed to help Natalie get that more often.

Determined to get Natalie to put some meat on her bones, I started pumping 3-4 times daily. I wasn't stockpiling the milk in the freezer; instead, I was doing half of Natalie's 7-8 daily feedings with a bottle. I was frequently giving her 4.5 to 6 oz. bottles, and I knew that she needed approximately 25 oz. of milk a day, so I figured those bottles plus whatever she was getting while nursing would meet her daily nutritional needs.

I started to also perform some weight checks of my own using the Medela infant scale available at the New Moms group I attend through a local hospital. From one week to the next Natalie gained about 8 ounces! But then the following week Natalie gained nothing. I went from moments of elation to moments of disappointment. When I would get disappointed, the nurses at the New Moms group reminded me that babies don't always gain weight every single week. As my gynecologist likes to say to expectant moms, babies don't read textbooks so they don't follow the rules whether in utero or out.
I tried performing my own breastfeeding weight experiment where I weighed Natalie before and after feeding her. I didn't know what I was doing, though, so I did it wrong. The scale showed that Natalie gained a couple ounces after the feeding, but: 1) I was supposed to weigh her in grams, not ounces, for the best results and 2) I was supposed to keep her clothed for this weigh-in so that if she went to the bathroom during the feeding it would be accounted for through her diaper. One of the nurses who volunteers to run our New Moms meetings very nicely emailed me a ton of resources after the fact so that in the future I can go back and do the weigh-in correctly.

Finally, on Monday morning, the day of reckoning had arrived. Natalie didn't have the best night Sunday night, but I was so tense that I could hardly sleep to begin with so her erratic sleep patterns Sunday night weren't a problem. Monday morning before we went to the doctor's office Natalie had a couple last bottles, but then of course she had a dirty diaper and I thought to myself, "Great, there go a few ounces." This is what you think when you're trying to do everything in your power to get your baby to gain weight.

As I placed my naked baby on the doctor's office scale, I was sufficiently freaked out to see where the numbers would land, but I was thrilled to see the scale read 12 lbs., 3 oz. In four weeks Natalie had gained 2 lbs., 6 oz. The nurse was shocked. She had me weigh Natalie again, this time only to see the scale read 12 lbs., 2 oz. She told me to dress that baby and take her home because she is completely healthy and there is nothing wrong with her.

I walked out of the office elated and with these thoughts in my head:
1) Growth charts are silly. Yes, they exist for a reason, particularly for majorly outlying babies, but basically no babies are 50th percentile in everything and most babies are fine. Some babies will be small. Some babies will be in the 10th percentile. Even after gaining so much weight in a matter of weeks, Natalie is still only somewhere between the 10th and 25th percentile, but she is a healthy weight for her size.

2) Babies grow at different rates. When we had gone in for Natalie's two-month appointment her length had just gone through a major growth spurt and her weight was waiting to catch up. She was clearly growing, but she was growing up rather than out, and that's part of the reason why the doctor was concerned.

3) I need to trust my instincts. I knew there was nothing wrong with Natalie. I see her for every waking minute of her day. I knew, moments after her birth, that there was something wrong with Natalie even though the doctors thought I was crazy and under the influence of whatever drugs they'd given me. I knew she was going to the NICU before any doctor or nurse acknowledged the possibility. Similarly, I knew Natalie's weight was fine but I let the doctor's slight concern weigh (ha!) on me too much when I needed to just be enjoying my time with Natalie.

Ironically, we haven't once called our pediatrician with any health concerns, and it wasn't until after going to the doctor that I had my first parental freak-out moment. I will continue to give Natalie a couple bottles a day just in case she is, in fact, a lazy eater who isn't always getting to the hind milk, but I won't stay so attached to the breast pump as I've felt this past month. It has been exhausting.


  1. So proud of you mama. Glad Natalie is packing on the pounds! I wish I had the same problem myself le sigh

  2. My healthy 9 and 11 year old children have always been between 10-25 percentile. They were chubby little babies, but still in the low percentiles. They too were breastfed, and later, I made fresh (organic when possible) fruit and veg babyfoods for them. We're just on the smallish size, but that doesn't mean "unhealthy". Keep trusting your instincts!