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How many of us with breastfed babies have gone to a wellness visit to find out our little ones are really low on their growth charts? From how many moms I’ve heard talk about this, I’m guessing there is a good show of hands! And for first time moms, or first time breastfeeding moms, or- heck- even us experienced mom, it can be startling to have a pediatrician look at your baby and think they are underfed! Rest assure, though, if your breastfed baby is low on the growth chart– there could be a good reason for it. Your doctor may be using the wrong chart!

There are two charts widely used in the US. The CDC’s growth chart is the more widely used chart and reflects mostly formula fed babies. Then there is the WHO growth chart that uses Exclusively breastfed babies. It may not seem like it would be a big deal which chart a pediatrician uses but breastfed and formula fed babies grow and thrive differently. Formula fed babies grow more rapidly and growth doesn’t slow down as drastically for them after 6 months of age, while the breastfed baby has slow steady weight gain that decreases even more as they get more mobile. So, when using the CDC chart on a breastfed baby, it’s quite easy for the baby to look like they are having insufficient growth or irregular growth patterns.

The problem with breastfed babies falling on the growth charts is that the moms will often get pressured to use formula very early on. Milk Supply goes into question and pediatricians, who are often lacking in sufficient breastfeeding knowledge, give misguided advice to the mom, like pumping to see how much milk she has or giving formula after each nursing session. Or the pediatrician may quickly recommend a visit to an endocrinologist, where baby will have to undergo intrusive testing, when it may not even be necessary. Even my own pediatrician was giving out booby-trap information and saying that babies urine output had nothing to do with if they got enough milk (which is incorrect)

Many pediatricians also do not take size of the parents and their family genetics into account. I have known mothers who barely skim 5 feet tall and are married to 5 foot 6 inch tall men that are concerned because their doctor said their breastfed baby is only at the 5% line. Typically, tiny couples do not have enormous babies. Many families have told me that their doctors didn’t even take the size of the parents or their families into account when decided that their baby was suffering.
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While doctors are being urged to switch to the WHO chart, since breast milk has been universally agreed upon to be the healthier option and should be the standard for infant diet, many doctors have not yet gotten on board since the AAP has not made any updated guidelines specifying chart use. Some pediatricians have begun tracking BMI, which seems to be a balanced way of measuring all babies, whether breastfed or formula fed but it has continued to give parents stress about their child being in a healthy range for their age, since a toddler at 50% for weight and 10% at height will now fall under obese.

Try not to stress too much. Ask your pediatrician what chart he/she is using and what other factors he is taking into consideration before getting worried about baby size. And If you breastfed infants health is in question- please, Go to a Lactation Consultant! IBCLC’s are 10x more trained to deal with and help you with breastfeeding issues, including evaluating your milk supply, over the pediatrician. Good Luck mama!

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