Ep 112 Optimizing Growth & Development

Slow gaining, faltering growth, failure to thrive- all of these are babies that are not getting optimal growth and development during the crucial early years.  When you add in babies not stooling regularly and the effect of the microbiome, babies aren’t doing so great.  In this episode Katie discusses how both weight and poop are common issues for babies and how these are areas we need both more research and more attention to.  

Reference Links for studies mentioned: 

Stanford Study referenced 

Industrialized countries and infant gut microbiome study

HMO study

Strains in babies for digesting breastmilk 

Podcast Host: Katie Oshita, RN, BSN, IBCLC has over 25 years of experience working in Maternal-Infant Medicine.  While Katie sees clients locally in western WA, Katie is also a telehealth lactation consultant believing that clients anywhere in the world deserve the best care possible for their needs.  Being an expert on TOTs, Katie helps families everywhere navigate breastfeeding struggles, especially when related to tongue tie or low supply.  Katie is also passionate about finding the root cause of symptoms, using Functional Medicine practices to help client not just survive, but truly thrive. Email katie@cuddlesandmilk.com or www.cuddlesandmilk.com  

Transcript

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Disclaimer, this content is meant for information only and not as a diagnosis or medical treatment for any condition. If you or a loved one needs help, please seek out a qualified medical professional for assistance. Welcome to the podcast. I'm your host, Katie Ostadt, BSN, RN, IBCLC, and infant feeding specialist. Quench your thirst for knowledge and travel with me across the nation to discover, learn, collaborate, and better serve clients from all over the globe. Let's ride and thrive together. Hi, today in the podcast, I want to talk about two things that are really um common that I see issues with uh babies that I'm seeing. So I just want to kind of talk about these two topics and really bring these into the light and get us all discussing them a little bit more often because they're really common for me. And I'm sure some of you other providers out there are seeing issues here too. So, what I'm talking about, first of all, is faltering growth or slow waking and poop. Um, so let's let's dive right into these. I want to start with um the pooping part and with babies that are not pooping adequately. Um, in the last, in the last two weeks, I've heard from clients that they've been told from other providers, um, let's see, uh babies only need to poop once a week. Um I actually had one that said they only needed to poop every two to three weeks um, that babies can't get constipated, um, their gut health is is fine because they're babies, so they don't have any issues, and um that it really doesn't bother them when they're not pooping, right? So parents come to me in my private practice and they're confused. They're like, my baby isn't pooping, they haven't pooped in, you know, four days, five days, whatever it is, and they seem uncomfortable. You know, the parents are saying, well, the babies are, you know, fussier. Um, they're pulling up their legs and scrunching their face and grunting a lot, but they're not pooping. I, you know, I feel like something is wrong, but I'm constantly being told by providers that it's fine. You know, that, you know, they've been doing this for the last month or two, that it's totally normal that they're only pooping every five to seven days. Um, so that first and foremost is something I have to combat right away, that these parents are are feeling that it's not okay. Their intuition is saying there's something wrong. And when they reach out for support and they reach out to a provider, they're instead dismissed and told, it's totally fine. You're just kind of imagining things, it's it's normal, it's no big deal. Right. And that right there is kind of the big part of the issue, is that we are normalizing this dysfunction. We are not addressing these issues and we're just dismissing these parents who also are coming in because they feel like something's wrong, because their baby seems uncomfortable, because they're not pooping regularly, and it just doesn't feel right. Um, one of the first questions I ask the parents is, how often do you poop? And how do you feel if you haven't pooped in a while? You know, if the parent says to me, Well, I have a bowel movement every, you know, twice a day, I say, Great, you know, how do you feel? Fine, good. And what happens if you don't poop for, let's say, three days? They're like, oh gosh, that feels terrible. Like, I don't feel good. My stomach hurts. Um, I might not feel like eating, you know, I might even be nauseous. And I'm like, okay, so we can kind of understand and look at it from that perspective for babies that they're probably not feeling great when they're not pooping, right? And so if we start with that, um, you know, I will start there with clients, you know, really cluing into what is the baby saying and where, you know, what are they, what are they really showing us here? Um, you know, and I even went to the research and pulled up some studies. And this is where it gets interesting, you guys, because first and foremost, we just don't have enough studies, especially US-based. But I think there's also such a bias in our studies now that our gut microbiome is so different in industrialized countries that we are not seeing the normal, is what I would say. Right. If you look at other studies and you look outside the US, you'll see that there is a change since industrialization in our gut microbiome. And I think we're seeing the generational epigenetic change now. We have increased um increased birth intervention, right? Increased C-section rates. Um, I think the average US C-section rate is around 30%, which is pretty significant. We know that having a C-section will affect gut health, right? We know that it is not the way that the baby is supposed to be born, and that's not the way nature intended, and we're not getting all the vaginal seeding of the microbiome that we're supposed to get. So that increased intervention and increase in C-section rate rate there changes our gut health. And then you can look at increased antibiotic use. Um, you know, obviously, first and foremost, in labor itself or postpartum, in labor, it's commonly given for GPS. So there's a lot of antibiotic use in labor and in pregnancy. And then you can even look and, you know, in that group of industrialization and changes in our diet, you also have the increased antibiotic use for generations, right? And so when I meet a client now and their gut health isn't great and their baby isn't pooping, we also sometimes talk back about, well, what is, you know, what was their parents' gut health and diet like? What about their grandparents? And looking at these generational changes and as a society, an overview of we have way more antibiotic use. We have way more interventional birth and C-sections. And we have a huge change in our diet, right? We are not eating the same diet we were humans were 100 years ago, or even more than that, a couple hundred years ago before industrialization, right? Like 200, 300 years ago, our diet is vastly different, and that is leading to changes. Um, so I'm gonna pull up some of these studies and talk to you guys about them. I will reference these studies in my show notes as well. Um so there have been some interesting ones, and um, you know, one of them that I was reading talked about the relationship between the breast milk microbiota and the infant microbiome and their long-term health. And this was really interesting because we need to look at those long-term outcomes, and we're just starting to understand all of this. There is a microbiome, there are different microbiomes, I should say, all over our body, right? Our mouth has its own microbiome, our breast and the breast milk has its own microbiome, our gut has its own microbiome. You know, for someone um with a vagina, they have a microbiome there. Like we have different microbiomes all over our body, and our skin has one, right? So, like this affects so much. And this study looked at how the maternal diet um really did affect that. It was very, very interesting. Um, there's also a few studies that discuss the HMOs, the human um milk ogliosaccharides, and these are necessary for development of gut microbiota and show a decrease in neck, necrotizing enterclitis, um, and they help with brain development and cognitive development, infection, allergies. So these HMOs are really important. They are, they do a lot. This actually is also why premies should only have cumin milk and shouldn't be having formula because they do have an increase in risk of neck with um with formula and they have less of the HMOs, right? Because they're not getting the breast milk. Um, there's also some discussion on whether the artificial HMOs are good or not, and if they will be seen by the body as the same way, because we know that formula manufacturers are out there every day learning about what's in breast milk and trying to copy it, right? Not for understanding breast milk or its benefits, of course, because this is um capitalism. And so they're trying to mimic, trying to copy breast milk to make it just as good. But we also know that things aren't the same, right? That um, you know, taking vitamin D is not exactly the same as getting it from the sun. We know that taking all the supplements is not the same as getting it in your food, and that there's pros and cons to everything. You know, if your gut can't absorb it out of the food, it might absorb it better from a supplement. There can be times when one is better for this person overall than the other, but we don't really understand yet if the artificial HMOs will be good or not. Will those really help the babies in the same way? Will they help develop their gut microbiome? Will they decrease the risk of neck because we know that formula increases it? So, you know, adding those artificial HMOs hasn't really been seen to decrease the risk of neck. And that would be nice if we could get there, but also the brain development, the cognitive development, the infection, the allergies. We really don't know if the artificial HMOs are going to help with any of that. And we really aren't seeing it yet. So I think that we need more studies in there looking at um the HMOs from human milk and the artificial HMOs and kind of comparing those. Um, I pulled up another study where they talked about uh different strains that are necessary to digest breast milk, and that breastfed babies have more of that gut microbiome strains to support the breast milk. And we're seeing a decrease in them. We are seeing babies with less um B. infantis, and we're seeing less of these good bacteria and more of the bacteria that don't help as much. Um, you know, I think the most interesting study I read was this Stanford study of these Hazda infants, which are hunter-gatherers from Tanzania. And they compared these Hazda infants with infants from 17 different areas of the earth, including Europe, Africa, Asia, and North and South America. Okay, so we've got a nice wide range of places. Um, so you're not kind of having a one-country view on it, you're trying to get a nice broad view of the earth and really looking at babies all over the world. Well, these Hazda infants had 23.4% of their microbiome was not found in any of the other infants anywhere else in the world. So, what that's meaning is these infants that are being raised in a hunter-gatherer society in Tanzania have microbiome and these strains of bacteria in their microbiome that nobody else in the world has, that is literally dying out. We are no longer having the strains that we're supposed to have. And this was a really interesting study because to me to be able to look at that and say, I mean, almost a quarter, a quarter of their microbiome is not found anywhere else. So they have strains that help them digest their food and grow and develop that we don't, that we don't have anywhere else in the world. Um I think there's a lot of interesting discussion out there on industrialization and oversanitation, our diets being higher in saturated fat, lower in fiber, higher um artificial sweeteners and emulsifiers that are being added to everything, rising C-section rates. You know, there's a there's a lot of um really interesting discussions that this study brought up about all of these and how they are affecting our microbiome. And I think we're just barely scratching the surface on microbiome research, you guys. It is fascinating to me how our gut is so important to really so much of our body. You know, I was reading a study the other day that talked about how for every every impulse and every um communication our brain sends down to our gut, our gut sends up nine more, like all through our vagus nerve and everything else. But our our gut microbiome is telling us how to feel. It is literally controlling our hormones and our feelings and our thoughts. And it's so massively important. And these make a huge difference. And addressing the gut microbiome makes a huge difference in mental health and physical health. And, you know, if we start looking at these for babies, what could the outcomes be? You know, could we see babies that are feeling better and growing up into kids feeling better? Because we have so many issues right now in our country with children with lots of physical mental health issues. Um, you know, lastly, I do want to add that the Stanford study also talked about how industrialized countries have low B infantis, which is mainly responsible for the digestion of breast milk, and a higher B brevi, which is not as helpful. Um, so the strains are different, right? We are actually seeing different strains. Um, so I think that was, you know, looking at all these poop studies, um, I think the biggest thing was that we have a different microbiome than we used to, right? And then other other remote places of the earth have. So how do we support that microbiome that we have? I think there are there are a lot of different ideas out there. And there may be changes that we can't make, right? We may not get back to our pre-industrialized microbiome that may be just out. But there are a lot of things we can do that can support good growth and not um, you know, not just a wait-and-see approach, but changes that will help both the, you know, pregnant and andor lactating parent and the baby. Um so I think it's really important that we discuss this and that we talk to the parents. And I would always say, number one is listen, when a parent comes to you with a concern and they're telling you this doesn't feel good for their baby, even if it fits into a normal parameter, if their baby doesn't feel good during this parameter, then it's not normal for them, right? Um, for example, even if they came to me and said, Hey, my baby is pooping four times a day, great, that's a normal amount of poop for, you know, six-week-old. I said, Yeah, but every time they poop, they cry. They pull up their legs and they scrunch their face and they cry and they arch and they seem really uncomfortable. That wouldn't be normal, right? So we think it's really important for us to listen and to have those discussions with the parents and to really investigate and try to see how we can support this. Um, I will just kind of quickly mention my usual interventions. Um, first and foremost is the the first thing to check always with, you know, infrequent stooling is weight and transfer. Are we getting adequate in income, like input, you know, like is the baby getting enough volume to make enough poop? Because there can be times that they're not pooping daily because their intake is very low. You know, if the baby's only getting, you know, five, a six-week old and they're only getting 20, 22 ounces a day, they're not going to be stooling multiple times a day. They just don't have it, right? So, first and foremost, um, referring to a lactation consultant to look at that intake and to look at the transfer and um to start getting some data points is a great spot to start because we do want to rule out the obvious, right? Rule out that they're not getting enough volume. And then from there, we look at what else is going on. Are we having reflux, right? Are we, do we have oral ties? Do we have antibiotic use? Do we have maternal gut health or diet issues? You know, and kind of looking at all of those and and listening to the parent and seeing where they want to go with this, right? Um, I've also found that bodies highly effective. You know, having an appointment of craniocral or chiropractic or craniofascial, something like this, having some bodywork usually gets babies pooping. So that's also a great, very low-risk option to start with. Um so that's one of those common ones that I will recommend as well. It obviously depends upon the case, but it can be a very low-risk option to start and can have a nice, a nice, good outcome. Um, I just want to touch briefly also on the faltering growth, failure to thrive, babies slowly gaining. Um, I just want to start there and just just bring this out into the light, basically. And I want us all to start having these conversations. My goal with this podcast is never to really tell anyone what to do. I don't view that as my role. I really want us to start having conversations. I want to hear from other IBCLCs, pediatricians, uh, body workers, pediatric dentists. Like, I want to hear from the other people supporting these families, and I want to hear their perspective that they have from their role and how they've been supporting these families. And I want to um to really ensure that I'm having a more well-rounded view, that I'm not just looking through a lactation lens and that I'm hearing other perspectives and other information out there. Um, so I think the first and foremost on weight is that some of these old terms are really not adequate. The idea of babies need to gain half an ounce to an ounce a day, which is 15 to 30 grams, and that being normal is not adequate. That if you actually sit there and plot out a baby, and I highly encourage you to do this, like test it out, plot out a baby for like, you know, four to six weeks and see what happens if they gain only 15 grams a day and where that takes their percentile or their Z-score, right? Um, so I think it's really um, these are outdated terms, and it's really important that we don't use these and that we are looking at their age and their necessary growth to maintain their percentile curve, which 15 to 30 grams is not going to make it overall. Like you definitely can't say that for the first six months. There's such a wide range, we need to gain a lot more weight in those first, you know, two to four weeks of life than we do from month five to six. Like there is a huge change. So that is one thing. Also, we should be using who growth chart. Um, who growth chart is based on uh over 19,000 babies. It's you have four times bigger than the CDC, and it is based on breastfeeding babies worldwide, much more diverse population, and also what babies should be gaining, whereas the CDC chart is based on historical growth that is assuming that historical growth of babies in the past is normal. So I want to start by saying we should all be using the WHO chart. Um, it's much more inclusive chart. Yes, we still have to do a assigned female and assigned male at birth to use that chart, but it is more um diverse in racial profile than the CDC chart. And as I said, it has a much larger population that it pulls from, and it's looking at the growth that we should be having instead of historical data from previous growth. Um, so that's one thing is I'm always using the Who chart and I'm always showing my clients, I'm looking at that with them. And then talking about where are we with our percentiles, right? Are we crossing percentile lines? And are the percentiles failing? And this is one that I'm seeing a lot. I'm seeing babies that are are really not gaining, and they've gone from the 50th percentile to the 30th percentile to the 10th percentile. And I'm the only one standing there concerned. Um, and frequently the parent isn't concerned because their pediatrician said it's fine, they don't need to be concerned. And when I raise concern, a lot of times it is dismissed. Um and We should be addressing this, right? We know that infant growth and development in those first two years is massively important. We are having a huge brain growth and cognitive development. We are talking about major motor skills and speech and brain development and so many things that are happening in those first few years of life that monitoring growth is very important. And we want, we really want to optimize. We don't want it to be just okay. You know, and if a baby is born at the five percentile and they stay between, you know, one and 10 percentile and they're kind of hovering in that line, that's maintaining their percentile curve. And that can be an appropriate growth and trajectory for them. However, when you have a baby born at the 50th percentile and by six weeks they're down at 10, that is not an appropriate growth. And these things need to be addressed. We need to be looking at these percentile curves and looking for these babies to grow adequately. And when I see one of these where we're not growing, of course, the first and foremost is are we getting adequate intake, right? Are we breastfeeding often enough? Do we have a decent transfer? You know, are we bottle feeding? Do we know our ounces a day? Can we, you know, can we look at where we've been and and look at the number of feedings and supplementation and all that? And then from there, we're also gonna look out at other things in terms of baby's gut health, right? Because we know that if we don't have a healthy gut microbiome, we are not absorbing our nutrients, we are not gaining weight as well. So then we look at things like where is that baby's growth? You know, where is their gut microbiome? You know, are these babies pooping, right? Because a lot of times when we have faltering growth, we don't have adequate poop. So these problems can really be intertwined and overlapped. And it can take a little bit of teasing out of which one is really the issue. Are they, are they kind of both issues and just bouncing off each other? Are we slowing our growth and then that slows our poop and then we go back and forth? Is one really the issue and the other the red herring? Like, where is this coming from? And these are important things to be looked at. Um, these are important things to be addressed. And I think I see this way too often that babies have really faltering growth and they're falling percentiles, they're not maintaining their percentile curve. And I'm not hearing a lot of concern or, you know, encouragement for finding a cause and supplementation, whether that's, you know, at the breast with a bottle, you know, looking at transfers, um, really looking for adequate intake, all of these things. Um, I'm not seeing that. And anytime I do hear, frequently I do hear from parents that then they're told their breast milk must not have enough calories. And then I bring up studies for them and I show them that, you know, we have studies that show that breast milk is anywhere from 20 to 30 calories an ounce. Formula is always 20. So it is not a calorie issue. It might be an intake, a volume issue, right? We might not be getting enough in, but breast milk is adequate, more than adequate in calories compared to formula. And we know it has those other things, like those, you know, HMOs and all the microbiome-building bacteria that we need. And if a parent's goal is to breastfeed, that's something we should support. But I think it's really important for us to be looking at how these two happen, why they're happening, how they're impacting this, you know, this growth and development for this little human, and how we can support that and help them thrive. We don't just want these babies just making it, you guys. Each of these little humans is so special. I feel honestly so, so happy. And I really feel um passionate about my role as supporting these new families. And I look at each of these babies and I'm just blown away. Every baby is special and wonderful and different. And each one of these clients that I see is a loving, caring parent who really wants the best for their child. So I think it's really important that we support them when they come to us and say, I'm concerned this baby isn't pooping, or I'm concerned we're not gaining enough. And I think it's also our role and responsibility to look for those things as well. And when we see faltering growth, when we see that the baby hasn't pooped in a week, that we investigate and address these issues to optimize growth and development for babies. So I think that's the biggest thing that I would say today is that we want to optimize growth and development. We want to, we want to have an idea of what actually is normal and not common. And we really want to support that for these babies and really help them. And kind of that's that's the my big thing today is growth and development and optimizing that for babies. So I encourage all of you to have this conversation with your patients, with other providers, and for us to start discussing not just weight and poop, but how we can optimize growth and development for babies, how we can really help all of these families thrive and not just get by. Each of these humans is so special and they all deserve optimal growth and development. So let's start talking about this and figure, you know, figure out some ways forward and design some studies that are going to help us have even more data so that we can really support and have very evidence-based practice. So thank you so much. I would love to hear your thoughts and what you think about, you know, optimizing growth and development and slow gaining and weight and poop babies. So let me know. When you change the way you look at things, the things you look at change you. I hope that you enjoyed the podcast today and learned something new. If you know someone who would benefit from this podcast, please share.