The Home School Court Report
Vol. XXV
No. 3
Cover
May/June
2009

In This Issue

SPECIALFEATURES
REGULARCOLUMNS
ANDTHEREST

Doc’s Digest Previous Page Next Page
by Dr. Rodger Sayre
- disclaimer -
When Momma Ain’t Happy

Our twins (numbers four and five in our crew) are now 19 years old. That realization startles me! The memory is vivid—like it was yesterday—Mary sitting on the old couch in our living room, babies propped with pillows on either side, breastfeeding. This worked well for the first four months or so, until Mary contracted mononucleosis. The combination of mono and inadequate rest took its toll on Mary’s milk supply, a fact plainly evident at the end of feedings, when the twins made their lack of satisfaction loudly known. We were forced to consider alternatives for meeting their nutritional needs. We began to supplement with formula, eventually making the transition to total bottle feeding around 9 months of age.

Make sure your baby is well-fed
www.istockphoto.com
...
A CONTENTED BABY
HAS A FULL TUMMY;
A FULL TUMMY REQUIRES
A CONTENTED MOTHER.
...

About this time, Mary and I traveled to visit friends with an infant the same age as our twins, their sixth child. I decided it would be fun to take a picture of the babies dressed only in their diapers, heads touching and bodies arranged radially, like spokes on a wheel. With camera ready, I hovered. Parents played peek-a-boo, made animal noises, and exhibited other strange behavior in an effort to elicit simultaneous smiles. I was thinking how silly everyone looked when it occurred to me, “Their kid is really skinny!

The picture taken, I set about a more critical examination of our friends’ child. Other than appearing underweight, the little girl was completely normal. I inquired as to her feeding habits. She was a good nurser, but was fussier than the previous siblings. The mother seemed stressed, stretched by the daunting responsibility of caring for both home and burgeoning family.

The obvious conclusion was that this baby was not receiving adequate nutrition and needed immediate intervention. Like myself, these folks were avid proponents of breastfeeding, so bracing for what I thought might be an offensive suggestion, I recommended to the parents that they consider supplementing with formula. To my surprise, rather than objecting to the suggestion, they embraced the concept, seemingly freed to pursue what they knew in their hearts was a needed course of action. So that night, after nursing, we decided to experiment with a bottle. Four ounces later, a contented baby settled into her crib and slept through the night for the first time in weeks, confirming my diagnosis. Within a month, she no longer needed suspenders to hold up her diapers! Now she is a college student and an accomplished track and cross-country runner.

In the last Doc’s Digest article (“Short Stuff and Long Drinks of Water,” March/April 2009 Court Report), we discussed how important it is for parents to track the growth and development of their children. I directed you to a website where growth charts could be downloaded (www.cdc.gov/growthcharts). I also mentioned that some babies are born “supersized,” eventually drifting downward to their niche on the growth chart (usually within the first 18 months of life). Other newborns are smaller than would be expected, given the size of their parents, gradually rising on the growth chart to a percentile ranking where they will continue to track for the remainder of their childhood.

For an occasional child, the weight (and sometimes height) curve will unexpectedly flatten, as growth fails to keep pace with age-matched peers. Such a child qualifies for the diagnosis of “failure to thrive” (FTT). Given the normal variation in newborns noted above, the diagnosis can be a little tricky. Nonetheless, it is critical to diagnose this condition early in its course to avoid long-lasting mental and physical repercussions.

Without question, the most common cause for true growth delay in infancy is inadequate nutritional intake. There are other less common causes, such as problems with absorption of nutrients, disease states that cause increased metabolic demand, and assorted uncommon genetic disorders. In the opening examples (as well as most of the cases of FTT with which I deal), the “inadequate nutritional intake” was a consequence of insufficient breast milk supply. This condition is especially prevalent amongst homeschooling mothers with multiple other children and the one on which I would like to focus for the remainder of this article.

For there to be a high-quality and abundant milk supply, the following maternal conditions must be met:

  • good health,
  • good nutrition,
  • adequate rest, and
  • a quiet, comfortable nursing environment.

Did I hear some of you just snort? I know, the typical homeschooling mom fails miserably in the last two categories!

So, dads, listen up! Remember the old adage, “When Momma ain’t happy, ain’t nobody happy”? A contented baby has a full tummy; a full tummy requires a contented mother. If your wife is to succeed at the nursing endeavor, it may be up to you to ensure she receives adequate rest and has a quiet, peaceful environment for breastfeeding.

“How in the world am I supposed to do that?”

So glad you asked!

First, with respect to the rest issue, Mary and I came to an understanding that during the nighttime hours, she got up with the baby, and I got up with the rest of the kids. There were exceptions of course, but this was the general rule of thumb by which we functioned. When the kids had a bad dream, had the croup, had to potty, or fell out of bed, it was “yours truly” that responded. When the baby needed to eat, it was Mary’s turn. I know what you are thinking, “Hey, I gotta get up and go to work in the a.m.” So does your wife.

Second, it is of great help to a mother to have her husband occupy the other children when she is nursing. Read them a book, have them crawl under the car with you while you change the oil, or have a tickle fight in another room. When daddy is not at home and there are no older children around to occupy the younger ones, interactive computer games or instructional DVDs may be helpful to the mom yearning for a few quiet moments.

Mothers, you do have control (at least in our country) over your nutritional intake. Many nursing mothers, in an effort to get back their girlish figures, will severely limit their caloric intake. This will often result in a compromised milk supply, as the body attempts to conserve calories. I didn’t say you shouldn’t attempt to lose weight while nursing. But if you are losing more than one-half to one pound per week, your weight loss program is probably too aggressive. Keep yourself well hydrated and adequately supplied with nutritious food.

Parents, if you have done your best to control these potential impediments to nursing and your child is still not demonstrating appropriate growth, give your family physician a call! A medical evaluation under such circumstances is of utmost importance. If the exam is completely normal, the doctor may simply recommend supplementation with formula, a move which can be both therapeutic and diagnostic. But be prepared for a more aggressive approach should history and a physical suggest a more complex etiology.

Finally, from our “Kid’s Quips” files: our 5-year-old recently took tattling to unprecedented levels when he proclaimed, “Daaaddy, Peter just said ‘I love you’ in a mean waaay!"


About the author

Rodger Sayre, MD, FAAFP, has been an HSLDA board member since 1997. He and his wife, Mary, homeschool their 12 children.