Thursday, October 20, 2011

Failure To Thrive: Mommy Doesn't Always Know Best

What would you think if I told you I have a one month old boy who nurses throughout the day, sleeps soundly in the night waking only once to be changed and fed, rarely cries, and smiles often? It sounds like a perfectly healthy little baby, doesn't it?

We thought Rafael couldn't be happier and healthier. Sure, he drank all day long with only very short naps of about 15 minutes in between, but I had informed myself about cluster feedings and growth spurts, and assumed that's what was going on. Besides, everyone says 'breast is best,' and I was following the feeding-on-demand routine that I had heard such good things about. Sure, it was all-consuming and was all I did, day in and day out. But that's what the first few weeks are like, right?

My friend Daniela had her baby just a few days after me, and when she said her daughter slept between two and four hours between feedings, I was surprised. I barely had time to go to the bathroom or pour a fresh glass of water before my little one was awake again, fussing for milk. I just thought he needs to be nursed a lot right now, was having a growth spurt, and didn't think anymore of it. After all, you hear from mothers all the time about never getting to do anything because they are consumed with nursing.

That's why I was upset when I brought my son in for his 5 week check-up and heard the doctor say with dismay, "Why are you so skinny, little man?" She weighed him and I was utterly shocked to learn that he weighed less now than he did when he was born.

"Your baby has acute failure to thrive and must be supplemented immediately. If he doesn't gain weight quickly, it could have very bad consequences for his health."

Meanwhile Rafael was screaming, naked, on the doctor's changing table, and for the first time, I could see that he was, indeed, thin. I had assumed that, since I was feeding him all day, he was having a growth spurt, and was stretching out longer, accounting for the fact that he wasn't round. But now I understood that I was so terribly wrong. I held back my own tears, looking at him, so small, and feeling like I had truly failed him.

The doctor told me to begin a new daily rhythm: Nurse him from both breasts, note the time he stopped nursing, then give him a bottle of formula and let him drink until he is full. Two hours after he stopped nursing the last time, repeat this. At first this sounded impossible to me, because Raffi had never had a two hour pause, whether sleeping or awake, between feeding during the day. This, I came to understand, was the root of the problem. He would drink, doze off after a little while, rarely getting to the fatty hindmilk and never drinking until he was really full, and then would wake up unsatisfied a short while later. Not only was he not getting sufficient nutrition, my breasts also didn't have time to recover and build nutrient-rich, fatty milk. So it was a very new experience for me (and certainly for him) when he drank from my breasts and then had formula, and was truly FULL. He slept peacefully for two hours, and would have slept longer if I hadn't woke him up to be fed again. So THIS was how it was supposed to be! He was now getting real meals, instead of snacking all day.

Not only was Rafael getting his fill of nutrients, but now the days actually had a schedule, a routine. I was able to take walks, go grocery shopping, clean the apartment, or eat a meal.

As nice as this new rhythm is, and as absolutely relieved and overjoyed I am that Raffi is now thriving (he gain over 100 grams in two days), I am constantly haunted by how my 'motherly instinct' failed me, and by how I in turn failed my baby. I still can't fully understand how it could get so far without me realizing something was wrong. Of course, one of the main reasons I believed I had a totally healthy child was because he acted like one, including giving me me big sunny grins every time he woke up or when I stroked his cheek or belly.

This whole ordeal has really put a dent in my confidence as a parent. I always thought I would instictively know what to do, and would automatically feel what is best for my child, but I was so wrong. It's hard to know how to continue now that I have experienced just how off-track my sense of how things are can be.

It's very little comfort that no one else ever commented on Rafael being to thin or looking like he was in poor health.

In any case, we are on the road to recovery...Raffi is recovering physically, and I am trying to recover emotionally, trying to build back my confidence as a mother.


  1. Cheers to you Dawn, for your honesty and learning. It makes you a great mum. Thank goodness for doctors and good information and cheers for the new routine working so well!

  2. Hi Dawn, even though I only know you through your blog, I feel like we are friends -- and I wish I could give you a big friendly hug right now and tell you face-to-face that it's going to be o.k.

    Mother's instincts are tested often, and as time goes by you will understand more and more about your darling baby. But you are learning! Be kind to yourself and trust that with time you will have clearer and surer leanings as to caring for your precious boy.

    Your experience points to how great it is to have access to health-care providers.

    I have 3 adult children, all living in the States; I think back on when they were small and remember when my hunches were wrong, but how in time they became stronger and truer. I can remember plenty of mistakes made, but I remind myself that I made the best decision I could at the time, with what I knew then.

    Being a mom is an adventure -- God bless you and your family.

  3. Oh Dawn, you can't beat up yourself for something that you truly did not know. That is one of the downsides to breast feeding, is that you really don't know how much your child is actually feeding, unlike formula, which you fill to the specific ounces in a bottle. Your child was content on what he was getting, and sure the doctor might say otherwise. I've heard of many babies who do fall asleep during nursing. Your are now on the road to healthier child, that is all that really matters. It will always be trial and error with the first child, that is how you learn, and your second will be so much easier. Here is hoping for a fuller, even happier baby soon.

    Warm wishes,

  4. Chin up! I'm a student midwife and we have to promote the breast is best, which of course in many ways it is, but people forget that sometimes nature doesn't always do what we would like!
    You have given him a great start to life with breastfeeding it's such a shame you've had this knock - but I wouldn't worry. You know about it now and you can give him the best of both worlds with your breast milk and plumbing him up on formula :)

    I hope this doesn't hurt your confidence too much. Just try and remember it's a very steep learning curve. I bet you're doing amazing!

    Amanda |

  5. Dawn, don't be so hard on yourself. You are a wonderful mother, and your instincts will be spot on many times during your son's life. I don't have any children myself, and I've often wondered how a new mother would know if the baby is getting enough to eat when breastfeeding. I can only imagine how much there is to learn! And that's why you have regular check ups with your pediatrician, to make sure everything is going well. The important thing is that your sweet boy is gaining weight, and will be just fine. Don't let this shake you. There's nothing wrong with your maternal instincts. I'm sure many new moms have been through the same thing. Enjoy your new schedule with Rafael and keep the photos of him coming!

  6. Dear Dawn, Rest assured, you are not the only new mother to make mistakes in those first trying weeks and months! I made so many mistakes with my first child, I'm amazed he came through it all with wonderful smiles! He has grown up to be a tall, happy and affectionate young man.

  7. All the above comments speak from my heart also as well as my own experience as your mother, and all the grave mistakes I made, even listening to current health trends at the time, which turned out completely false and did damage.
    So it's a sobering and humbling experience and you are doing the right thing to ask people who can help and keep learning more every day.
    Rafael will always love you and I am confident that he will grow into a strong healthy boy with all the attention and care you get for him.
    See you Sunday evening.

  8. Bless your heart!! We all learn and grow with our first born, but rest assure you are not alone and things will get better in time. You are a great mama and those baby smiles prove it!! Looking forward to new photos of that sweet little boy! Take care of yourself too, a frazzled mama isn't good!

  9. Be gentle with yourself...

    Motherhood instincts are tested often and we grow from the experiences. You are not alone, and your son is incredibly blessed to have such a dedicated mother.

    Grace in the journey.

  10. Dearest Dawn...please don't feel ashamed or that you've let Raffi down...being a new Mom is so overwhelming, it's like nothing else and you don't really have any preparation for it. This same thing has happened to two of my close friends...and they both felt just like you but their babies are now walking & talking and none the worse. That's what check-ups are for, and you are so honest and open I know this post will help other first time mothers. You're doing a great job and I know that Rafael will thrive now - and that will be down to YOU and the love & care you give him. Sending a big hug xoxo Rachel

  11. A big hug to you! I know just how you feel and just how it can hurt a mama's heart when she's doing her best and her baby isn't thriving as they should. A few days after my little one was born, we went to a check up and were told she was dehydrated and had to be re-admitted to the hospital right then and there. She needed more than I was able to physically make at that moment and so I was submitted to a rather humiliating pattern of 'weigh the baby, have the mother nurse, weigh the baby, feed the baby a bottle.' Before the hospital would consent to us even taking her home again. It was a blow to my confidence as well. We always assume that we naturally will be able to give our child whatever they need. She more or less continued on the nursing/formula routine until she weaned. And she is a healthy, happy, beautiful and lovely girl who just started school:)
    Just wanted to give you a little "I've been there" and know its rough but its just a small blip on the path of parenthood. You're an awesome and caring mama!~

  12. Dawn, please don't be so hard on yourself. I know how it is ~ I just had the EXACT same experience with Clara. She wasn't getting enough to eat and lost enough weight as to be below her birth weight. Due to those issues, I now exclusively pump and feed her with bottles. Now she's grown tremendously over the past few weeks. I also felt that I'd failed her (and she's my 2nd baby, felt like I should've known). Everyone kept telling me she just had a fussy nature. I never believed that deep in my heart and I was right. She's wonderful. This is parenthood. You learn a lot as you go. Don't let this affect your confidence. The fact that you have these feelings just proves what an amazing mother you are and how lucky Raffi is to have you!! I admire your honesty and think it's good to have other women read this and know they might not be alone. Hang in there! XOXO

  13. As concerned and upset as you are feeling about this, please do not lose confidence. There is no manual that comes out of us along with the baby to know everything. The important thing to remember here is that you are a quick student and are doing what the doctor prescribed and already seeing those benefits.

    Your little guy has a wonderful mommy! One who loves and nurtures him very much!

  14. Dear Dawn,

    We all learn every day in so many ways. If we didn't learn we wouldn't grow. You are learning every day. You had nothing with which to compare Rafi, but you take him to the physician regularly and that is good mothering. You are not a mind or body reader.

    Be kinder to yourself and hug your boy for me.


  15. Ah, sweetie, this could happen to anyone. Being a good mom doesn't mean you can always make everything go right. It just means you try your best. Part of it is taking your baby to the pediatrician to make sure everything is on track, which you did. And now everything is on track, because of you, because you're a good mom who loves her son dearly and is doing everything she can to help him grow up happy and healthy. Being a new mom is one of the hardest things a person can do and you're doing a wonderful job. Give yourself hug for that! xoxo

  16. Oh honey...I wouldn't beat yourself up too much! Your new to this and this is why we have doctors and check-ups. You caught the problem in time and THAT is what matters. So glad to hear everything is back on track! :) xxx

  17. Sending hugs too!! My Mom had a baby scales for us that she used while nursing. Not as popular now, but thought I'd mention it.


  18. It's also hard to see what's happening slowly in front of your eyes. It takes fresh eyes to notice that kind of weight loss. He'll do fine -- and this is why we have doctors and checkups! :-P

  19. Oh heavens, don't beat yourself up! One day you will look back on all this and laugh. Sixteen years ago, I so admired my three-day-old's lovely golden skin tone, proudly envisioning what he would look like as a handsome young man on the beach. Then my mother came, said he was "orange as a pumpkin," and off we went to the hospital. He was severely jaundiced and spent the next three days being fed intravenously under a billi-light unit! Live, learn and laugh!


  20. Please don't be too hard on yourself sweetie,it happens a lot to first time mom's. It happened with my sister-in-law too and you should see her baby now, he 6'2" and a dad himself. Once the baby gets the formula and you get to rest between feedings all will be well. I don't know how you held up to feeding Raffi every 15 minutes, my "girls" couldn't take that, if you get my drift.
    You are a good mom, we all learn as we go no matter how many books we read, it's not the same as doing it. Good having another mom you can compare notes with, it helps a lot.
    Hope you are now seeing what it should be like, you do get little breaks and before long dear little Raffi will be sleeping all night long. My boys were 8.8 oz. and 9.5 oz., they both had to be supplemented with formula.

  21. This comment has been removed by the author.

  22. ooops had to delete my comment... too many spelling we go again

    Oh my dearest friend...
    You are doing such such such an amazing job. Your instinct was to provide for your baby and that's exactly what you were doing. It wasn't your fault or anyone's fault that Raphael wasn't getting everything he needed, it's unfortunate and of course (because you love him so much) you feel bad... but it wasn't your fault. It's a blessing that your doctor was able to see that there was a problem and that she was able to get you the help that you needed.
    I'm so happy to hear that you get to continue nursing and that Raffi is getting that extra little bit that he needs. It sounds like a good solution!
    There are so many bumps in the road with little ones. Each child is different and has their own needs. It's all a learning process, trial and error.The most important thing is that you were all able to solve the problem and now are on the path to more of a routine.
    You are one amazing mama and deserve a big pat on the back for doing so well.
    xoxo hugs to you and a squeeze to baby Raffi!

  23. ciao Dawn, I'm sure if you ask all new mammas everyone has a different story while adjusting what nurses tell them about breast feeding and reality. Do not feel you did something so wrong, you have made experience, all the best to you and Raffael

  24. Don't be hard on yourself dear, these things happens frequently expecially with the first baby. So,you have learned now and stick to the routine because babies do need a schedule!Lots of love
    mamma carla

  25. Don't beat yourself up. I have known other mothers have the same experience. My son was adopted, but the first 4 days in the hospital, he would not eat for the nurses and they said he was having failure to thrive. And these were professionals feeding him! He finally would eat for me.
    La Leche league deals with breast feeding and their volunteers are more than eager to assist new mothers in proper techniques, problems, etc. I am not sure it was ever suggested to you.
    You are doing well, and sometimes things happen when a new mother without experience. I am sure many of us would have made the same mistake! You are and will continue to be a great mother. Hang in there.

  26. Dear Dawn, I know that you were disappointed to hear "failure to thrive" sounds so severe and negative...when, simply your feeding routine needed adjustment. Your sweet Raffi will continue to gain and get back on track. I raised two breast-fed and one bottle-baby...makes no difference in their health and happiness in my experience. The most important thing is to do what is best for your baby. I called the nurse at the Pediatrician's office quite often in the not hesitate to ask questions...Also, you will feel like a new woman once YOU get rest and fresh air and some time to yourself...You are already an amazing mother. Go easy on yourself right now, sweetie..xoxo

  27. You're an amazing mama- don't beat yourself up. I'm happy to hear that the little guy is gaining his weight and napping for longer bouts of time:). He's such a cutie. And he is so loved, I'm sure he feels it all around him:).

    I hope you're having a nice weekend with your boys. xox, Blair

  28. Oh please don't feel bad about yourself! I've worked in early childhood for more than ten years and I can promise you nobody ever has all of the answers and parents and care givers alike often are at a loss for what to do with their baby or small child. They don't come with a handbook and we all just do the best we can, truly. Sadly being a parent is full of worries and guilt! I'm sure you are doing a wonderful job with Raffi, and remember you are new at this so don't beat yourself up for not being a newborn expert :) So glad you were able to find a solution that makes you both happy. Take care x

  29. First off I want to give you a massive cyber-hug, because it is clear how much this has upset you! I'm not going to write anything about "not beating yourself up" because I know how pointless that is as becoming a mother is a strange time when suddenly even the tiniest slip up makes you question yourself for days. What I do want to say though is that you didn't fail! You spent hours each day nursing and caring for your little man and had no way of knowing he wasn't getting exactly what he needed. And the very fact that you threw yourself straight into the new routine without a second thought because you would do anything for your little guy shows, to me at least, that you are the best mother Raffi could ever ask for and failure should never come into your vocabulary x

  30. Love what everyone else said Dawn! You are a GREAT mom!! That little boy is just plain Lucky he picked the right mom. xoxo

  31. You are a great mom! You love your son and you care about him! And you are on a steep learning curve of getting to know your little guy and help him get to know the world. And he is smiling to you - ain't that great :-)
    Not all things that are natural are learned instinctively, they have to be learned by others who know (midwives, doctors, ...), and sometimes things can get so wrong (and not everyone is as honest as you are). Even if you are ninth time mother there is so much to learn form each little baby and its very special needs. I think it is really great that you stick to breast feeding, as it can be tiring and difficult at times. There might be a "breast feeding support" (e.g. la leche liga) group or a "mother-baby group" close to where you live, I used to got to our local Eltern-Kind-Beratung every once in a while...
    A big virtual hug!

  32. My grandma had to teach my mom to wake up her babies if they hadn't finished feeding before they went to sleep. The first time she did this my grandma just plugged the baby's nose so that it would wake up. My mom laughed so hard she wet herself.

  33. Dawn,
    Please don't be hard on yourself. What in the world was that doctor thinking? Why didn't he just say, you need to supplement your baby with a bottle rather than make you feel so bad? Breastfeeding is supposed to be so wonderful and I totally understand the benefits, but there is NO WAY that you will know exactly how much the baby is getting,unlike a measured bottle. My baby was also a skinny baby. I made the decision myself to give him a bottle along with breastfeeding. I was told by EVERYONE that my baby would refuse the breast if given a bottle...that was a bunch of nonsense. My husband really enjoyed being the one to give him a bottle at night... perhaps that could be something special that your family could do too?

  34. Dear Dawn,
    Your honestly is so refreshing----I've recommended your blog to two of my own daughters as 'life learning.' Both absolutely LOVED your description of the birth of are an incredible mom.....and he is a blessed little baby!

  35. Dear Dawn
    Don't be so hard on yourself. You are an amazing mum. Not all aspects of mothering come naturally. If something was seriously wrong with him you would have known. He was not thriving but he remained healthy and I think it is wonderful that you have been quite relaxed about his growth. I was really stressed when I had my first and was obsessed with her weight gain - for my 2nd I was way more relaxed. Being stressed is not good for baby. These are early days for you and your little boy - things will become more natural for you, make sure you continue to trust yourself. xxx

  36. Dearest Dawn, I hope things are going smoothly for you and little Raffi now. He is a lucky little boy to have such a sweet mom. We can't know everything and that is why there are doctors to help us all through life. Sending you and Raffi big hugs! Love, Sherry xxxx

  37. I am a little worried about you since no recent posts. I know new mommies can be emotional after giving birth (even without giving birth! I was that way and I adopted!)
    Do not beat yourself up. It is all new to you and the doctors should have given you a heads up as to "things to watch for" and all that.
    I do hope you connected with LaLeche League for nursing advice and help! They are so supportive and understanding.
    And I had to post as anonymous because the google thing did not work....grrr!
    Rose Lefebvre

  38. Yes, find a La Leche League group! I am a leader here and we just had a mom go through the same thing. It happens, don't beat yourself up.

  39. I think that being a mom is not as natural as we think. There are just so many things we don't know. That's so wonderful that Raffi is doing so well!

    My daughter had more long-term feeding issues that I didn't know how to help. I found this great website that really helped me understand that a lot of parents have trouble feeding their children adequately and helped me find the help I needed.

    All the best to you both! Jenny



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