Here’s the situation (this will be long, so please bear with me):
My 16-month-old was born average: 7 lbs, 4 oz, but gained weight very, very slowly. At 6 mos he was only 14 lbs, and didn’t gain any weight between 6-9 mos, but he was cruising at 7 mos and started walking assisted by 8. Fast forward to his 15 month checkup, and he’s 15lbs 4oz, at -3rd percentile (yes, that’s a MINUS), and his pedia is now checking his weight every couple weeks just to see if he’s gaining any. She ran some blood tests (CBC, thyroid) and they all came out normal.
She didn’t want to diagnose him “failure to thrive” because he is active, meeting all his milestones on time or ahead (he walked at 10 months old so he’s now running, is saying many words and signing, doing animal sounds, stacks blocks, knocks them down, climbs stairs and play structures – in other words, his development doesn’t seem to be affected by his weight gain, or lack of it).
Besides, hubby and I are not very big either – we’re thin Filipinos, I’m barely 5 feet and hubby is 5’ 6, both underweight as babies and kids (even now, I think) and even my older son who is now 4, has always been on the lower end of the growth chart. But at least with my first, he was ON the growth chart. My second is not even on it from 9 months old onward. So now, his pedia is more worried.
He eats EVERYTHING, but very little of everything. I feed him almost every hour – 3 meals and 2 snacks in between each meal, because I noticed that even if I wait to feed him (to make him hungrier) he eats the same amount, so I try to just feed often. Everything I’ve read said to make every bite count – so I feed avocados, ice cream, pizza, full-fat everything, which he takes but as I said, in tiny amounts. As in, 1 tbsp of anything AT MOST, 2 on a very good day.
We tried Pediasure and whole milk, which he will just take SIPS of, too (and it makes me cringe each time we have to throw away an almost-full bottle of Pediasure because it’s been 48 hours since we opened that 8 oz bottle). And I give juice for the calorie content, and also because he drinks more of that and water than anything.
And he also still nurses up to 3x during the day (before his 2 naps and at bedtime) and 3x at night. Now this is where it gets confusing for me.
The pediatrician recommended I wean cold turkey as a drastic measure to make him eat more solids and gain more weight. But aside from the stress baby and I are going to have to face (I’m a SAHM so it’s more difficult to refuse nursing when he can’t be with anyone else but me who HAS the milk) I know that breast milk (hind milk especially) is high in calorie content, and I’ve read in other forums that it’s best to keep nursing or even INCREASE nursing so he can get more milk and my supply increases.
I’ve also read on kellymom.com that it’s normal for toddlers to take in a higher percentage of breast milk vs solids, and have seen it first-hand. At 15 mos, DS1 was on 90% bmilk, 10% solids, but gained weight with no problems. This baby, on the other hand was eating way more than DS1 did, nursing less, but now we have this weight issue.
I’d rather really not go toward the increased-feeding route because we already started the GRADUAL weaning process at 13 mos – and so far it’s gone well because he’s down to 3 daytime feedings from 5 (and can now even go 11 hours without a feeding if he’s distracted enough, like when we’re at the zoo).
But I still don’t know how to factor in breast milk in his diet. We’ve seen a dietician from our network (we’re on HMO), but she isn’t a pediatric specialist (they don’t have any in-network) so she couldn’t count breast milk in his diet plan. So without factoring in breast milk and looking at the amount of solids he’s eating, his diet will really seem lacking.
I guess after all this, the real question is – should I really wean more aggressively? How true is it that nursing hinders a child from gaining weight through eating more solids? My fear is if it backfires – what if he doesn’t increase his solids, then I just took out the added breast milk calories (not to mention added more stress on him and me), and he ends up losing more weight that we can’t afford to lose anymore.
Or should I just continue what we’re doing? I weigh him every week at home (I have a baby weighing scale), and he only gains about 1 to 2 ounces a week – he is extremely active, too, but I don’t know if that even matters.
If you got to read up to this point, I thank you with all my heart. I very much appreciate any advice and suggestions you wonderful, wise moms have for me. Many, many, thanks in advance!
Thanks, everyone for your opinions, food ideas and good luck wishes. I have long ago tried looking for a growth chart based on Filipinos, but to no avail (my older one was also a small baby at 3rd percentile for weight - he's only at 5th percentile now at 4yo). Guess I'll keep looking, I'm sure there is one somewhere.
Also, we did want to get a second opinion from a pediatrician with a holistic approach, specializing in nutrition, but his fees are too expensive for us and our insurance won't cover it because we're on HMO and they won't authorize our consultation. Anyway, I guess I will stay on our slow weaning track. I do believe in the benefits of extended nursing (my first weaned at 24 mos) especially because breast milk helps him get better quickly from many bugs his brother brings home from school. Thanks again for sharing your thoughts!
I would wean immediately. It's stressful but bottom line is that he's not getting enough calories from the breastmilk. If his belly is full of breastmilk then he won't be eating something solid.
I agree with looking for a Filipino growth chart. I think doctors are way too concerned about kids following "averages" when they don't apply to everyone.
I don't understand the "cold turkey" approach especially. If you were to gradually cut down the breastfeeding, you could see how he responded and if it changed his eating habits, without causing the both of you undue stress.
I also would ask the question of malnurished vs. small. If he's getting adequate nutrition, then why make a sudden change to his diet? I wouldn't stop breastfeeding, just cut down on one feeding at a time, or limit feeding time, and monitor the effect.
Your breast milk is far better than Pediasure!! Even doctors can throw out a "hail mary" to see if something just might work. I would consider a second opinion, particularly from a doctor who is pro-breastfeeding, maybe a naturopath? Maybe see if there is a doctor of Filipino or Asian descent in your area, as they may be more aware of the development of typically smaller children. I apologize if that sounds ethnocentric of me, but I know several doctors who have at least a passing knowledge of issues that pertain to their ethnic group within their specialty. I think the suggestion of locating an alternate growth chart is brilliant.
I also noticed that you said he is gaining weight, just not "enough." I would definitely be comforted by consistent weight gain, even if it is only a little. It seems so odd that a recommendation for an underweight child would be to take away that child's primary source of excellent nutrition... Like any nursing mom, definitely be sure you are eating a nutritious diet and drinking lots of water. If there is not a clear medical reason to stop breastfeeding, such as an allergy that causes him to vomit when he nurses, then there is no way that I would stop.
Personally, my son would NOT eat until we weaned him. (He was bottle fed, but it's the same idea.) Typically, I am one to say if he is eating normal, or not declining in weight, even if they are super tiny...go ahead and keep nursing. BUT, your child is in the minus of percentiles, DEFINITELY not eating enough, and in your case...I would listen to your pediatrician. Simply put, your breast milk does not have enough calories to be the main source of nutrition for a 15 month old.
Here is the thing, breastfeeding consultants are wonderful and educated...but they are not medically educated (in most cases) for pediatric issues as doctors. I would trust the Dr. Do you have a pump? If so, could you pump after you drastically wean your child, so that if he simply eats nothing and doesn't increase, you are at least keeping you milk going. If it doesn't work at all, you could then begin nursing again and build your supply back up by nursing.
I would go by your pediatrician's recommendations, she is knowledgeable and experienced, we are not, she has infinite medical information available to her that we do not, she has actually seen your son, we have not, and you and she are responsible for his well-being, we are not. At this point breastmilk is not providing the calories your son requires and he needs more calories. Being off the growth chart can be serious, If he doesn't obtain the calories needed his body can start taking them from his muscles and organs, a very serious problem.
Do as your pediatrician suggested, solids are more important to development after the first year of life and beyond than breastmilk, and since your son has been weaning for 3 months it should be an easy transition.
I sincerely hope all works out well.
The last thing I would do is wean him. Whether he is just small or has another problem, breast milk is the best food for him. I think you are doing great with feeding him frequently. The only thing I would do is stop juice and try whole milk instead.
Sure sounds to me like he is active and healthy so don't worry too much. I would follow through on all of the tests the doctor recommends, but I would not wean him. Both of my children were small and their ped said the best thing I could do was continue to breastfeed, so I just don't understand where your doc is coming from.
I once worked for pediatric specialists including an endocrinologist. I remember a couple came in with their son because he was very small. The doctor looked at them (Mom 5 ft., Dad like 5'5"). He could not under-
stand why they were there. He had to nicely tell them that because they
were both small, he would not be 6 ft. Sometimes the answer is right in
front of you. You are both small so, of course, he will not be big. You also
say you are also tiny. So he will probably take after his parents!!! That being said, he probably should be eating more. I would probably wean him.
You are on top of this, so keep what you are doing and hopefully he will gain
a bit of weight. He sounds like a perfectly normal, active toddler. Good luck.
Definitely do you compare your child to an average american growth chart. My kids are on the low low end of those. There is an obesity problem here and all those kids are on the growth charts which skews them IMO.
I would not wean either. Sounds like everything food wise is going fine. You may want to consider night weaning so that you can add some morning hunger and get yourself more sleep ;)
They also make whole milk yogurt and whole milk mozzarella cheese. Try Trader Joes for them.
Hi M.,
My first concern here is your son eating a tablespoon of food at a time. He needs a larger variety of food in his diet, including proteins.
My thoughts are that you will have to discontinue BFing because his weight is down. I thought possibly only BFing at night, so he still gets the calorie intake. That way if his weight doesn't increase, you will still have milk. I hate to share my thoughts against the PED, but at least you will still have milk.
I think this is a problem for children who are on the bottle at a later age as well. They sip on the bottle all day and graze at meal time.
Here is another concern that crossed my mind. Has he had a dental check up? Do his teeth and gums have enough nutrition with the majority of his meal coming from BM? Do you brush his teeth after his BM feeding and bed time?
Nationality has a lot to do with size and charts. My little one goes to school with quite a few Philippine children. They are tiny and my daughter remains at the 98th percentile. I just tried to google children's growth percentile by nationality, but nothing comes up.
So in my conclusion, something has to change because he is underweight, regardless of his nationality. I suggest if you don't go cold turkey, at least stop the day time feedings so he will be hungry enough to eat throughout the day.
It sounds like you have put a lot of thought into it. I would definitely be concerned since the doctor does seem concerned. If she is considering a FTT diagnose, that is a pretty big deal. Instead of trying to decide whether to wean or not wean, why not keep feeding him solids and nursing him as usual, but throw some formula in there to supplement. 2 small glasses a day, if he'll take it. If he won't drink it, give him oatmeal mixed with applesauce, berries and made with formula instead of water. Or make him smoothies out of formula and berries and ice. Don't wean him, just add the formula to it in whatever form he'll take it. It is much healthier and tastier than pedialyte, which I can never get my kid to drink either. Good luck!
I would take a step back on this one. Is your doctor saying that he is malnourished? Or simply that he is small? If he's malnourished, then obviously that is a problem. But if he's just small... well, somebody has to be! That's how they define "average" - some kids weigh a lot more, some weigh a lot less! As long as he is healthy, who cares what size he is?? It sure sounds like he has plenty of energy and is a real go-getter, so I'm guessing he is NOT malnourished!
If it makes you feel any better, I have one kid who is WAY above the growth chart (like 110% in height), but my younger child is below the 10th percentile in height, and has been since her 6 month checkup. And, here's the kicker, my husband and I are both over 6' tall. So our pedi FREAKED that our baby was so tiny. Poor little girl had to go to children's hospital for a million tests. It turns out she is just little, but otherwise is healthy as a horse. Not every kid is going to grow up and be a giant, and all the avocado, ice cream and pizza in the world won't change it! My daughter also eats very small amounts of everything (as a 6 year old, she eats maybe half a cup of food per meal). The way I measure her growth is in milestones, as you said. She is exceeding all milestones in terms of development, so obviously she is getting the nutrients she needs for brain and muscle development. It's a little hard as a mom to let it go - we all want our kids to top the charts in everything! But it's okay if they're short. They're cuter that way, right? ;)
Best of luck!
Would you be able to get any type of a growth chart from the Philippines? I can understand why your pediatrician is concerned, but he is probably going to be built like you.... very tiny! Your pediatrician is probably more familiar with Caucasian growth scales, and with both you and your hubby being thin and shorter, your baby will be, also.
I am an avid extended breastfeeder...none of my kids had issues with growth, so this purely my inexperienced, uneducated opinion...1st thought: what growth chart is the ped usuing? may not make a difference but could bump baby ONTO the chart instead of below. 2nd thought: it's hard for me (and you it sounds like) to be crazy concerned about what seems like a thirving baby...he IS gaining, not losing...if the only issue is height and weight on a growth chart then it seems there shouldn't be an issue. I would not wean...just my two cents.
My gut feeling is continue on your slow weaning and not rush it. Some people still nurse until age 2 or beyond. I think breastmilk is better than the alternatives like pediasure. Offering high calorie foods before offering to nurse is a good idea. My son was always big for his age but my daughter was/is very slim and that is her pattern so far. She is 3 and a few months and grew a lot between ages 2 and 3 (still under 30 lbs though).
My children were breast fed and ate just fine, they ate more as they got older and nursed less. By 16 mos. they were usually nursing three times a day, morning afternoon and at bed time, if not feeling well more often, some babies nurse more at this age. How often are you nursing? Are you eating a healthy diet and does it contain enough calories are you drinking a lot of water. I'd give him food more often and make it as healthy as you can. Give him lots of oat meal, whole grain, this builds the body. Give him other whole grains. Stopping to nurse will not necessarily make him eat more. Some babies/kids just don't like food or don't eat much - I have a grandchild like that and he too is very small. But part of it is just the way he is. The quality of food is imperative especially if he doesn't eat much, don't fill him up with white breads and sugars. Offer food more often.
Try not to worry.
The Best to you both
I would nurse. I would think that your milk is better than pediasure.
There are a couple of things to consider - family genetics. My DD is not yet 35lbs at 3.5 yrs old. I'm only 5ftish myself, so she's not likely to be big. Pediatrician said that DD is small, but not off her curve and growing steadily and that was the important bit. I would ask if there's a regional growth chart or maybe one based on averages for your heritage. It might give you a better picture given his genetics. My mom had me tested for growth disorders when I was 4 but she's only 5ft2 and my birthfather was 5ft4 so the likelyhood of me being tall was...about zero.
Beyond nursing, what does he eat and does he eat appropriate TODDLER portions? I had a discussion with a friend a month or so back about what people think toddlers need and what they really need.
I would continue on the weaning route, since you've started it, and increase the amounts you try to get him to eat. Offer the solids first since he's weaning anyway. Try to sneak in things (like make oatmeal with cream vs 2%). Maybe he's just not going to be a kid that eats tons at a sitting and it sounds like there's a genetic predisposition toward that.
The other thing to consider is allergies. I wonder if eating certain things (say, dairy) doesn't sit well so he stops eating quickly. Or reflux. Might be worth asking about.
I wouldn't wean - just my gut.
I have 2 daughters, my oldest (now 4) is off the charts for height and 90th percentile or something for weight. My youngest is 10 months, just under 16 pounds. She's like 9th %ile for height and 20something %-ile for height. Kids are different! I am concerned about her small size, but because she's meeting milestones, the doctor isn't too concerned about her petite frame. (I'm 5'7" and my hubby is 6'2", but out of the 4 grandparents, 3 of them are on the average/shorter side).
ANYWAY, to increase my little's caloric intake, I started adding coconut oil to her fruits and veggies. She gained over 1.5 lbs. between 9 and 10 months. Maybe something to consider? It's tasty, and really good for brain development. I've read that it has some of the same benefits as breastmilk, so as your babe does start to wean, that might be helpful.
Have they checked his thyroid? It could be overactive.
But all in all...nope, wouldn't wean any quicker than you were planning. :)
Weaning seems like a shoot in the dark -ie "maybe this will work"- but, what if it doesn't? I'm with you. I think the extra calories of breast milk is what I would want to keep giving him. Instead of juice, what about whole milk? (a touch of chocolate goes a long way to making it toddler friendly, until he gets used to the switch) If you're looking for food ideas, what about homemade pumpkin pie? (whole milk, a veggie and high fat crust) Creamy vegetable soups?
I think I would be looking at your other child's stats for your comparison, more so than the chart's "average".
Has your milk been tested? If he is filling up on breast milk that is not offering him the calories and nutrients he really needs, you need to wean him, or at least not nurse as much.
M
