March 31, 2010 Failure to Thrive

The examining rooms at our pediatrician’s office are painted with murals of aquatic scenes. One room has a big sandy beach in the foreground and a sliver of where the ocean meets the sky in the background.  Another has a surfer riding a huge wave. The third has a big tank filled with brightly colored fish, seahorses, corral and crabs. We were most familiar with that one because that’s the room with the scale they kept using to weigh our baby, and they weigh him quite a bit – about three times a week. The nurses like to use the same scale for every weight check to make sure they’re comparing apples with apples.

The Fish Tank Room

Our pediatrician thought the baby wasn’t gaining weight fast enough so she had us supplementing the breastfeeding by giving him a bottle of formula after every time I nursed. She then had us coming in to her office two to three times a week to have the baby weighed. He was now gaining more than an ounce a day — more than the American Academy of Pediatrics recommends.

Pleased with our progress, I decided to try to slowly wean the baby off the bottle. Instead of giving him formula after every breastfeeding, I gave it to him after every other feeding. But two days later, when we were back at the pediatrician’s office, the baby’s weight appeared to have stabilized — a phenomenon that, given the tiny increments we were measuring, could have been the result of a dirty diaper the last time he was weighed. Still, our pediatrician said if the baby didn’t gain weight faster, she might have to consider him a case of “Failure to Thrive,” and he would have to be hospitalized. I was sure she had the Department of Youth and Family Services on speed dial.

I don’t know who came up with the term “Failure to Thrive,” but it should be reserved for situations like a baby bird withering away, its little heart beating perceptibly through paper thin skin before it expires. It should not be thrown at two college-educated yuppies, who have access to a grocery store, a credit card, and a scale.

Glug, glug, glug

Or so I told myself. The reality was, I feared I might accidentally starve our child. I’d struggled with the breastfeeding from the beginning. But lately, things seemed to be going better, so I was chomping at the bit to get rid of the formula. I knew the longer we gave the baby bottles, the more likely it was that we’d never be able to get rid of them. I figured the baby would get tired of having to work for his food by sucking it through my leathery old nipple rather than getting it through a bottle, where I can actually hear the glug, glug, glug as the milk pours down his throat. Who could compete with that?

I also feared that the more we supplemented, the more likely it was that my milk supply would fall. That’s because breast milk is produced according to demand: the less demand, the less produced.

I theorized that if I skipped the bottle after every other feeding, the baby would be hungrier at the breast for the next feeding and thus get more milk out of it. He was never going to have a voracious appetite for breastfeeding if we kept giving him bottles of formula. I knew the baby’s weight might stabilize, temporarily, as it took time for him to realize the only game in town was my breast. It was a leap of faith, like when someone leaves a job to start a business and has a temporary dip in income as their business ramps up, or how a heavily pruned tree might look barren for a season before it comes back with even more blooms. But our pediatrician was monitoring his weight so closely, it made my plan impossible to execute.

“I don’t think you have enough breast milk,” she said. I tried not to cry, but I could feel my lip quivering. “I didn’t want to say that, but I think that’s what the problem is,” she said.

“But I sometimes pump as much as 1.5 ounces,” I told her. I felt like a child bragging about how many sit-ups I can do.

She asked me if I could feel it when my milk let down? I said I couldn’t. She asked if my breasts sometimes felt taught if I went for a long time without a feeding? I said they didn’t.

I was frustrated. I have large breasts. Always have. And yet I couldn’t seem to produce enough milk. I felt like a well endowed man who can’t rise to the occasion. Interestingly, when I would talk about the issue to women with smaller breasts, instead of comforting me, they seemed compelled to tell me how their milk would shoot out by just looking at their child.

“I’d get into the shower and as soon as the warm water would hit me, the milk would run down my stomach,” one said.

“I’d blow through three shirts a day because I had so much, it would just leak out,” said another.

The day before, I’d called one of the lactation nurses from the hospital at which our baby was born to see if she had any advice.

“Some lucky women have so much milk, they just produce bottle after bottle when they pump. And then some try and try and can’t make it work,” she said. “Just try to enjoy your baby,” she said. I took that last sentence to mean she didn’t think my future in breastfeeding was bright.

We left the pediatrician’s office, and by the time we got to the car, I told Bruce I didn’t want to go back to supplementing after every feeding.

“Why do we have to listen to her? Because his weight dipped one day? Scales aren’t exact. I’ve overeaten for days and not gained any weight, and then a week later, the scale will say I gained three pounds in one day!” I said. “Why is she in our business, anyway? Why are we weighing the baby so much? It’s like he’s a fucking wrestler trying to make weight.”

The baby is too fat, the baby is too thin

I was angry, but the truth was, the pediatrician had me so worried about the baby’s weight, I bought a $100 scale for our home. I feared that in my zeal to breastfeed, I might inadvertently starve our child. Every time we would reduce the amount of formula we gave him, I thought I could see the ribs above his belly, his face would look bone thin, even anemic. But then every time she would force us to increase the amount of formula we gave him, his cheeks would suddenly look swollen like a chipmunk’s, his belly would blow up like a blow fish. Even his hands would look fat.

I felt so guilty every time he cried, I assumed it was because he was hungry. I forgot babies sometimes cry for other reasons.

And yet despite my fears, I didn’t want to go back to giving the baby a bottle after every feeding. We were making progress in reducing his reliance on formula and bottles. I didn’t want to go backwards just because of one bad weight day. I had no intention of watching our baby wither away as I tried to get the breastfeeding right, but I wanted a little wiggle room.

Our pediatrician was going on a ski trip to Vail for 10 days. I suggested to Bruce that we continue to only give the baby a bottle every other feeding, at least until the weekend. If the baby didn’t gain weight by then, we’d still have time to fatten him up with formula before she got back from vacation. Bruce reluctantly went along with it.

The baby did gain weight – though perhaps not at the hefty rate the pediatrician sought – and so we continued to supplement every other feeding. I felt good about our progress, until the pediatrician returned from her trip, and we were scheduled to go back to her office to have the baby weighed. I knew if she saw the baby hadn’t gained at least an ounce a day, she was going to wonder why, and we were going to have to explain why we didn’t follow her instructions.

“Let’s lie, and tell her we’re giving the baby a bottle after every feeding,” I said, and paused. “But only if she asks. If she doesn’t ask, then we don’t say anything.”

“I don’t want to lie to her,” Bruce said. “We shouldn’t be lying to our medical doctor. If we’re going to do that, we should find another doctor.”

If I wanted to lie, I had to do all the talking, he said.

As we pulled into her office parking lot, I said, “Fine. I won’t lie.”

We decided to tell her what we wanted to do: supplement after every other feeding instead of after every feeding.

“How about if we try it your way for the weekend,” the doctor conceded.

“I don’t think that will be enough time,” I said.

“Okay, let’s go until next Wednesday,” she said. “And then you come back, and we’ll weigh him.”

I agreed. It sounded like a fair compromise – though by the time I got to the car, I felt like a dog that marches into his owner’s house to demand his leash be removed only to come out with one that was a little bit longer.

Did the baby's indented chin affect his latch?

It was a Pyrrhic victory. The baby was indeed hungrier being given fewer bottles, but it didn’t help him get any more milk out of my breasts. I was starting to wonder whether the problem wasn’t inadequate milk supply but rather that he wasn’t sucking properly. I couldn’t understand why my breasts felt heavy with milk, and every time I squeezed my nipples, milk would come out, yet he would suck and suck, and at the end of every feeding, he still seemed hungry. I would stare at his throat to see if he was swallowing anything. I would put my ear to his mouth to see if I could hear gulps, like the ones he made when he sucked on the bottle. I tried massaging my breasts, even compressing them – advice I’d found after scouring the internet for advice – and yet he always seemed to come off my breast hungry.

He was also getting stronger and becoming a hindrance to the process. Given the choice between my hand, his own hand, and my nipple, he’d start sucking first on my hand, then his own, before finding my nipple. And when I’d try to latch him on exactly as I was taught at the hospital, he’d get his hands in the way, or instead of making him latch onto the nipple and some areola – as I was taught to do in the hospital – he would latch on and then push himself backwards away from me, so he’d end up with just the nipple in his mouth, rendering the latch ineffective. Sometimes he’d be really hungry and wanting to breastfeed, yet as I moved my breast closer to his mouth, he’d push it away. There’s a life lesson in there: I want this thing so badly, and that is why I will do everything in my power to stop myself from getting it.

Unknown woman breastfeeding child

Occasionally, it would work. He’d get near my breast and pounce, and for a few precious moments, I could feel him getting milk. His little hands would hold my breast like a big balloon (when they’re filled with milk, they’re bigger than his head. My father once took a photo of me standing at the base of a blimp. The size differential between his head and my breast is similar).

But mostly, we struggled. I started to feel like a fraud every time I put on the special nursing bra. I felt like I was donning the accoutrement of the breastfeeding population, and yet I had no right. My baby wasn’t really breastfeeding.

As I tried desperately to make the breastfeeding work, a part of me was slowly trying to get used to the idea that my baby would have to be raised on formula, almost the way a terminally ill patient will try to reconcile the fact that they’re going to die. Obviously, the stakes are higher with terminal illness, but there’s a similar process, of denial, then anger and tears, and then the quiet submission.

I started looking at children and wondering whether or not they were breastfed. Not just real children. I was watching a television commercial the other day for a pharmaceutical product called Reclast, and I wondered if the young boy in the ad was raised on breast milk or formula. I wondered if formula babies were as happy. The funny thing about formula is that people who are smart enough to understand the benefits of breastfeeding and yet raise their kids on formula will always start the conversation with how smart their kids are, despite having been formula-fed. I’ve begun to look forward to a time when he’s on solid food, and this whole breastfeeding saga is behind me.

When we got home from the pediatrician, our neighbor, Judy, and a friend of hers dropped by with a nurse from the neo-natal nursery at a nearby hospital. I was in the bathroom when they arrived, but I heard Judy open the door and yell, “Caren?”

“I’m in the bathroom,” I yelled back.

“Caren?” she said again, obviously not hearing me.

“I’m in the bathroom!” I yelled, hastily pulling up my pants. I quickly flushed the toilet and ran out into the living room to find the nurse had taken the baby, who was sleeping, out of his bassinet and was rocking him in her arms.

“What are you doing?” I said. “We have a no-touching policy.”  It was all I could think to say. I was stunned that a complete stranger had walked into my house and lifted my sleeping baby out of his bassinet.

“A no-touching policy?” she said, looking at me as she continued to hold my child.

“We don’t let anyone touch the baby, except for immediate family,” I said. Our pediatrician had suggested the policy for the first eight weeks, to prevent him from getting sick.

“Why?” she said, continuing to rock my baby as I plead my case.

“Germs,” I said.

“I work in a nursery. I touch other peoples’ babies all day long,” she said, finally handing me back my child.

I don’t know why I didn’t throw them out of my house. Instead, I asked them if they wanted tea, and we all sat down in my living room. Sometimes I do that. When what I want to do is light someone on fire, I instead will ask them if they want tea.

Judy had brought the women over to see if I had any questions about caring for a newborn. I had so many questions about breastfeeding, I decided to make use of having a nurse at my disposal. I fired away: How often should I feed the baby? How long should each feeding be? If I’m supposed to feed him according to demand, how do I know when to stop? He doesn’t give me any indication he’s done, I said.

“I just fed him for an hour, and the only reason I stopped is because, well, I was done. I felt like he could go on until we both died,” I said.

The Three Fates of Formula

“Well, maybe he’s not getting enough from you,” the nurse said.

She asked me to give her a bottle of formula, with 1.5 oz. She said if he’s full, he’ll push it away.

“He’ll do that?  You’re sticking a bottle in his mouth, and pouring this stuff down his throat. How can he stop it?”

“He can stop it. He’ll push it away with his hand. I’ll show you.” she said.

She gave him the bottle, and I watched with bated breath, hoping he would push it away. He didn’t. Instead, he began to suck, and suck, and suck. As I watched the level of formula go down in the bottle, I hoped his hand would come up to say he didn’t want any more, but it never did.

“He’s still hungry,” she said.

She asked for another bottle. I reluctantly gave it to her. The baby once again failed to push the bottle away and instead began to drink, and drink, and drink. I watched the level of formula go down and down in the bottle, again wanting him to stop, but he didn’t. It broke my heart

“He grabbed that one like a barracuda,” Judy said. I wanted to punch her.

“He’s a hungry little fellow,” the nurse said.

“But I don’t get it. He’s gaining weight. And the doctor said if he’s only getting 12 ounces a day from the formula, and he’s gaining weight, then he must be getting the rest from me, “ I said. I was trying to convince this woman that I indeed had breast milk.

“You may have milk, but he may not be sucking strong enough,” she said.

“But when I massage my breast while I’m feeding him, I can hear the milk squirt,” I said.

“Yeah, you’re squirting it into his stomach like a water gun,” she said.

She asked for a third bottle with some formula, and I gave it to her. She stuck it in the baby’s mouth, and I watched his eyes start to glaze over.

“He’s tired,” I said. “You should stop.”

“He’s still drinking it,” Judy said.

I wished these three women had never come into my house. They looked like the three fates from Macbeth, sitting there on my couch.

“No, really. He’s getting tired. Look at his eyes,”

At the end of the third bottle, the nurse finally said, “He is looking a bit tired now. He’s still awake, but he’s drinking slowly now. Can you see that?”

Fuck, yeah. I could see his drinking had slowed when he was on the second bottle. I wanted them to leave.

When they finally did, I cried. And then I pumped a whopping 2.5 ounces.

Let Them Eat Cake

I later found out that giving a baby bottle after bottle of formula is not how to determine how much one should feed him. Babies, like beagles, can eat well beyond what they need.

I also found out that women with large breasts are not likely to feel full or engorged, and they may never feel their milk let down.

A few weeks ago, a friend, quoting some mommy book she’d read, said to me, “Just do the best you can. Remember that at the end of the first year, no matter what, your baby will be eating birthday cake!”