You know how they say it takes a village to raise a child?
I think in many cases, it takes a village to breastfeed a child!
I was fortunate to not have many issues with Jack when I was nursing him. He nursed well, and while he was smaller, he grew along his curve, so our doctors left us alone.
However, when Oliver was having trouble at times, I quickly found out that not all pediatricians are breastfeeding friendly. Upon doing more research, I found that unless a pediatrician took it upon themselves to take courses in breastfeeding (or breastfed their own children), the amount of education they received on the topic in med school was very minimal.
I believe one of the biggest reasons women don’t meet their breastfeeding goals is due to the lack of support or bad (usually well-intentioned) advice. Sadly, this occasionally comes from pediatricians, and it’s something we experienced with Oliver’s first pediatrician. She was a lovely woman, but her feelings and advice on breastfeeding just didn’t feel right.
This is in no way written to insult or degrade pediatricians. I think they are worth their weight in gold, and almost every pediatrician I have met has seemed to love their job and children. They can’t be experts in everything, and there are some that are more knowledgeable about breastfeeding. You want to feel like a team with your pediatrician and that you are on the same page!
And if you are pediatrician reading this – know that if you take the time to be a breastfeeding friendly practice, your name will be known far and wide in the breastfeeding community in your area 🙂
If you want to breastfeed, I highly recommend interviewing pediatricians before your child is born and ask them these questions. I actually recommend everyone interview pediatricians before their child is born – they play such a huge part in your child’s upbringing (and I have a post at the end of this article that goes into that more – a must-read for all parents, whether they breastfeed or not!)
Be sure to join our Breastfeeding Mama’s Support Tribe on Facebook!
1) What Growth Chart does your office use?
This is a big red flag. When your doctor pulls out the growth chart, make sure you ask them if they are using the CDC growth charts or the WHO growth charts.
Kelly Mom has a lot of great information on this discrepancy. Basically, before 2006, the charts being used were based off babies who were not primarily breastfed for the for the first six months of life. Breastfed babies growth patterns are different than formula fed babies, so the CDC charts, which represent babies who were not exclusively breastfed, don’t accurately represent their growth patterns.
Starting in 2012, the American Academy of Pediatrics said:
Infant growth should be monitored with the World Health Organization (WHO) Growth Curve Standards to avoid mislabeling infants as underweight or failing to thrive.
So make sure your doctor is using the WHO growth charts!
2) How long does a baby have to get back to their birth weight?
Babies have about two weeks to regain their birth weight. Unless they are really lethargic, showing signs of dehydration, lost more than 10% of their birth weight, it’s important to give them these two weeks.
Long story short – our pediatrician not knowing this caused our family a lot of unneeded stress, grief, and even a brief hospital stay. When we relayed what happened to our current pediatrician, she was shocked (he was 1/2 an ounce a way from his birth weight at 10 days, which is good, but our old pediatrician felt otherwise).
3) How do you recommend supplementation?
As I was leaving the office, quite distraught, the pediatrician said, “Oh don’t worry! Giving him a couple bottles of formula a day won’t hurt your supply!” She did not tell me that if I were to give him a bottle I should pump to keep up my supply. She just said that most parents have to supplement at some point, and this didn’t mean I would never get to nurse again!
If YOU want to supplement with formula, then that is completely up to you and fine! However, the fact of the matter is, the less stimulation of the breast, the less the baby will eat, and the less milk you will produce. Supplementing can be a slippery slope, and if you are doing it, it should be done under the care of an IBCLC.
4) When is supplementation necessary?
I think some doctors feel like formula is some kind of magical potion. If a baby is having trouble, the first thing they should do is to help you figure out the problem. Insisting that you supplement right away can sometimes make problems worse.
For instance, some babies might not be eating enough because they aren’t latching correctly. Others may have a tongue tie. There are many reasons why a baby may not be breastfeeding correctly, and the help of a qualified IBCLC can often solve those.
So ask your doctor when they would start to suggest supplementation. The doctor we see now told me that they do everything they can to help a mom breastfeed if that’s what she wants, and they only step in when needed. It’s good to be aware of what factors your doctor looks at.
5) What is the average weight gain for a breastfed baby?
The average weight gain for a breastfed baby changes as they get older. They tend to gain 5-7 ounces a week for months 0-4, 4-5 during months 4-6, and 2-3 from 6 to 12 months. These are averages, and some babies may gain a little less and some a little more. If they were born large or were premature, these may change as well. But it’s a good rule of thumb.
Not all babies gain weight at the same rate. We noticed a pattern with our boys – they started out with a little bit slower weight gain and then really chunked up around 5-6 months. I think this partially had to do with both of them having reflux (and Jack’s weight gain slowed significantly around 10 months, which is when his reflux and other digestive issues started getting worse again).
Weight gain is certainly an indicator of well-being. They do need to gain weight! However, there are other factors that can and should be taken into account. Dr. Jay Gordon is a breastfeeding expert, and I think his article, “Watch the Baby, not the Scale” hits it right on the nose.
6) How do you recommend introducing solids in addition to breastmilk?
Food before one is just for fun. Until they turn one, an infant’s primary source of nutrition should be breastmilk or formula. Around six months, you can start introducing solids. Some pediatricians may recommend four months, but that is more or less outdated, and six months is the most appropriate time according to many health professionals.
Your pediatrician should encourage you to add them in slowly, but not to replace breastmilk with solids. They should roughly get the same amount of breast milk until they turn one. Here is a guide I wrote about how to introduce solids!
7) When do you encourage weaning?
The average weaning age in the world is around the age of two from what I’ve read. It is far earlier in the United States, and most women aren’t even breastfeeding by the age of one. Because of this, there is a stigma about breastfeeding past the age of one. But there is nothing wrong with it.
Breastfeeding should be encouraged for the entire year, and then for as long as mom and baby want to after that. I’m a big believer in gentle weaning (but that’s a topic for another day!)
8) How much should baby eat at different ages?
From about one month to six month, a breastfed baby needs 24-30 ounces per day. This does not increase with size or age, and recommendations for more come from formula recommendations. There is no reason for a breastfed baby to be eating 40 ounces a day! If you are breastfeeding (not bottle feeding breast milk), just feed your baby and try not to worry about the ounces – just pay attention to diapers!
Until about one month, the amount baby eat increases until it gets to that 24-30 ounce mark at one month. The first few days they don’t need very much – colustrum is very nutrient rich and their tummies are super tiny!
9) Should I limit how long baby nurses for?
With few exceptions, you shouldn’t restrict how long a baby should nurse for. Oliver’s first pediatrician said I should not let him nurse more than 10 minutes. When I visited with an IBCLC the next day (one of the best in state), she was appalled at that.
In the beginning, breastfed babies take a long time to eat. If they are actively suckling and swallowing, it’s generally okay to let them continue.
10) When is formula better over breastmilk for supplementing?
If supplementing is necessary, the mother’s own breast milk or breast milk from a donor is the preferred supplement. This isn’t always possible, but it should be given as an option to the mom. When supplementing was brought up, our pediatrician was very hesitant to suggest that I could use my own milk.
Supplementing can lead to supply issues, bottle preference, etc. Make sure that if you are supplementing, you are doing so under the care of an IBCLC.
11) What factors do you look at for an appropriately growing breastfed baby?
There are several factors to consider – weight gain, meeting milestones, healthy looking, generally content, and, one that I think is very important – if they are growing along their curve. Some babies will just be small, and that’s okay. Not every baby can be in the 100th percentile. If they are growing along their curve – even if it’s a lower one – then this is a good sign.
12) Do you have lactation support on staff?
I think all pediatrician offices should be required to have a lactation consultant on staff. This isn’t always the case though. But I think it’s worth asking about!
13) What percentage of your patients are breastfed and are exclusively breastfed?
Having a higher percentage indicates that the staff is encouraging and supportive of breastfeeding. If they don’t know, or it is rather low, this shouldn’t be your deciding factor. But you should inquire about how they are able to support you in reaching your goals.
I’ve found that pediatricians who have breastfed their children (or they have a spouse that have) are generally going to be breastfeeding friendly. So don’t be afraid to ask if they have experience with breastfeeding! I also think it’s appropriate to ask if they have taken any lactation courses – who knows, it might encourage them to do so!
Where to find a breastfeeding friendly pediatrician
This can be tricky! I recommend joining a local Facebook group and asking there. You can also reach out to your local La Leche League leaders. While they can’t specifically endorse someone, they can give your resources to find one.
All in all, I want to emphasize again that I think pediatricians are wonderful! It’s so important to find one that works well with your family. These are just some questions to keep in mind as you search for that perfect one for you! You may find a pediatrician you love who may not be as knowledgeable in lactation, and that’s okay. Just be willing to express your opinion, be knowledgeable, and have a great IBCLC on call!
Here are some additional things to consider when choosing a pediatrician: