My 9 month has fallen off growth chart. What would you do?

[ourdayourjourney]

my 9 month old has fallen off the growth chart. at 4 months he fell into the 25%, 6 months into the 5%, 7 1/2 months 3% and at 9 months he is below the chart. His height was 90% at 4 months, 50% at 6 months and 25% at 9 months. From the very beginning, we struggled with nursing difficulties. I was diagnosed with oversupply and I worked with a lactation specialist to adjust my supply by doing block feedings. It seemed to be worked out at 5 1/2 months, he was more content and less fussy. at 6 months, I felt that he was spitting up too much when I consumed anything with cow's milk so I eliminated that from my diet. He also started on solids at 6 months (1 T quinoa and 1 T fruit/veg) once a day. Also at 6 months, at the advise of my lactation specialist, I then started pumping after my nursings to try and increase my supply. After 2-3 weeks of that, I noticed I had less milk pumped out so I felt he was consuming the extra supply. Over the last 2 months, my little one has been sick, with congestion, cough. A blood test and chest xray confirmed he was fighting something viral. Cystic fibrosis test came back negative and blood work came back normal (fighting something viral). Blood work also tested for inflammation, most common food allergies, dog allergy, liver, kidney, protein, calcium, thyroid, celiac, and a few others and ped says all normal.

Right now, I nurse on demand, every 3 hours and sometimes more frequently at night. He also gets 2 feedings (1 T quinoa, 1 T fruit/veg + 1/2 t olive oil). After round of blood work came back normal, my ped recommended giving formula after nursings and we have appointment follow-up in 6 weeks. So far after 4 nursings, he has refused the formula. Obviously, if he does not take to the formula soon, I call the ped and let her know. But, when I look up tests on failure to thrive, like here. I see there are other testing that is recommended and I feel that it is important to rule out other things or to use these other tests to point us in a new direction, while I continue to try and offer formula. What do you think?

[Bokonon]

Instead of giving formula, have you had test weights done before and after nursing? Ideally this should be done on a baby scale specific for this purpose, before and after every feeding for 24 hours. You may not have a supply issue, but if you end up giving formula, you may.

Additionally, if your LO does have a sensitivity to dairy, formula will only exacerbate the problem.

Is he having sufficient wet (5+ per day) diapers, and regular stooling? Given that his length is falling on the curve as well, I would be leaning more toward an absorption issue than a supply one, but I'm not a medical professional.

Instead of the quinoa, can you try giving avocado instead?

[kamane18]

Originally Posted by Bokonon

Additionally, if your LO does have a sensitivity to dairy, formula will only exacerbate the problem.

Is he having sufficient wet (5+ per day) diapers, and regular stooling? Given that his length is falling on the curve as well, I would be leaning more toward an absorption issue than a supply one, but I'm not a medical professional.

ITA with both these statements.

Originally Posted by Bokonon

] Instead of the quinoa, can you try giving avocado instead?

This too and also maybe egg yolks?

[ourdayourjourney]

we are going to try goat's milk and i am going to increase my proteins to 80 grams. and avocados, too. our other dr said that there may be a sensitivity to soy, wheat and/or egg so i'll eliminate them from my diet and maybe bring them back it at a later time. thank you for support

[Parker'smommy]

I would also try offering to nurse more often than every 3 hours.

[lilabet]

That seems like very little food for a 9 moth old, my seven month old has more than that. Also quinoa is probably not great as it will make your baby feel full without giving enough cals. I'd add in more protein and frankly a lot more fat. Children can become easily malnourished by being given too much low fat high fibre food. Go back to basics, you'll need to subsitute if you do think there's an allergy but I'm thinking of high fat things like cheese, butter on white bread with mushed up fruit on top, that kind of thing. Think comfort stodgey food. Pasta and homemade sauce, with minced beef in?

ETA remember that food is replacing one of the highest fat things there is, milk.

[CookAMH]

Originally Posted by lilabet

That seems like very little food for a 9 moth old, my seven month old has more than that. Also quinoa is probably not great as it will make your baby feel full without giving enough cals. I'd add in more protein and frankly a lot more fat. Children can become easily malnourished by being given too much low fat high fibre food. Go back to basics, you'll need to subsitute if you do think there's an allergy but I'm thinking of high fat things like cheese, butter on white bread with mushed up fruit on top, that kind of thing. Think comfort stodgey food. Pasta and homemade sauce, with minced beef in?

ETA remember that food is replacing one of the highest fat things there is, milk.

I would advise against the grains, esp white bread which is empty nutritionally. A 7 or 9 mo old doesn't need food other than breastmilk, imo.

That said, what about coconut oil? High fat, my 8mo loves eating chunks off my finger or a spoon, melts in his mouth. Maybe 1 1/2 tsp a day?

[Liquesce]

If you would like more testing or are concerned that there might not be enough things ruled out definitely you should feel free to discuss it with your pediatrician.

Given that allergies have been ruled out, if he's refusing formula but accepting solids you can stir formula powder into the solids if need be. I do agree with lilabet that it seems like very little in the way of solids though ... obviously a great many babies without nursing and weight problems can do fine on just breastmilk at this age, but not all babies can, and the ones who can't probably do need more than just a few tablespoons per day. At a just slightly younger age when my son was developing some substantial weight issues the goal set out by me, my pediatrician, and my pediatric nutritionist really was to offer formula/solids as many times per day as needed to get as much into him as possible. Granted we were at the point of actively losing weight, not just a sharply drooping growth curve, but still, the days of a few tablespoons intake were the days that were tremendous diasappointments.

The other thing about introducing formula at this late age is that if the child was exclusively fed at the breast they might just not know what to do with bottles and cups. Obviously I don't know if that's a problem here, but if it is it can help to try different styles of bottles, different styles of cups, to offer very often, more often than you're really interested in him actually drinking, and to demonstrate -- to take a sip, then offer a sip, take a sip, offer again, that kind of thing, just to help him get the hang of things.

[lilabet]

Originally Posted by CookAMH

I would advise against the grains, esp white bread which is empty nutritionally. A 7 or 9 mo old doesn't need food other than breastmilk, imo.

That said, what about coconut oil? High fat, my 8mo loves eating chunks off my finger or a spoon, melts in his mouth. Maybe 1 1/2 tsp a day?

This baby seems to though, yes it would be true for a baby that was doing fine weight wise, but this baby isn't. At this point, you just need to get stuff in. Anything really.

Regarding bread, all our bread flour over here (UK) is vitamin fortified, and I've just checked my bread mix packet and it says 113 cals per slice. That's a fair wack, even if you can only get half a slice in at a time. Add butter spread onto that, and some kind of fruit puree or cheese or ham or something like that and you're upping it even more.

Other stats from bread packet (all per slice):

Protein 4.5g
carbs 19.6g
of which sugars 1.8g
fat 1.8g
fibre 0.8g

I agree about the advice re styles of cup with formula. Also, try having him lie on his changing mat (or similar) and hold the bottle himself. Obviously watch closely for choking if it goes down the wrong way, once he gets the hang of it it could be better to sit him in his bouncy chair so he's at a slight incline. Never leave a baby alone feeding themselves this way though. Ever!

It might also be worth getting a few kinds of organic baby jars of food (we have a massive selection over here) just so that you can get an idea of what flavours appeal. Fraser refused fish pie until he had a liberal squeeze of strawberry and tomato puree in it. It tasted totally rank to me but he chomped it down after that - he really has inherited his Dad's sweet tooth!

See if you can get either a book on baby led weaning if you want to go that way, or the Annabel Karmel book if you're more into purees. We do a mixture of both, I feed him purees and yoghurt (Also a big hit!) but he often feeds himself chunks of bread, fruit, whatever we're eating if I've prepared it with no salt. He enjoyed noodles last night, that was hysterically funny watching him try to shovel in long strands of slippy stuff! After he didn't eat much though and got a bit bored I topped him up with a couple of tiny yoghurts.

[hotharmony]

Although I don't agree with their guilines for starting solids with babies they do have a great chart on calorie content for common baby foods.

http://www.kellymom.com/nutrition/vi...dcalories.html

I would be feeding a 9 month old 3 times a day plus 1 or 2 snacks and breastfeeding on demand as often as possible.

[ourdayourjourney]

we were on a small amount of solids as my little one had been sick from halloween until 2 days before christmas (2 months). my ped wanted him to nurse as much as possible and i was nursing on demand. and i felt this was best for him as well.

after his sickness went on for so long, he had 2 rounds of blood work and other tests. this last time, his blood work came back normal my ped wanted to supplement with formula (milk based) and introduce soy yogurt. but i had already eliminated cow's milk products because i suspected my little one was reaction to it (spitting up a lot). my questions and concerns brought me to a ND. she believes that my little one is allergic/sensitive to something i am eating, so i am eliminating soy, wheat and egg (in addition to cow's milk products which i have already eliminated) and wants me to consume 80g protein a day.

my little one (9 months) will be eating 3 meals and 3 snacks and we will continue nursing on demand. with his meals we will continue to add 1/2 teaspoon of olive oil. we have also introduced goat's milk yogurt with his fruit which went very well. we will watch for any reaction over the next few days and if all goes well, we could give him goat's milk too. i will say that he really is liking his extra meal and snacks and maybe he was/is trying to wean. i am not sure, but i am hopeful that these new feeding plans for the baby and me with help him to thrive.

[lmclanahan]

These kinds of cases are always tricky. Is the baby really presenting with a problem? Is the doc overzealous? Could it be a serious problem ? If it is a problem, what do we do?

As far as the nursing goes, what is your goal? Are you planning on nursing for a year, or 3-4 years? If you want to have a nursing toddler later, protecting your nursing relationship should be a priority too. Is your baby happy? Is he healthy, besides the viral infection? Infections can cause slow weight gain. It could be the infection. This would be the best scenario, becasue when the infection resolves, the weight gain will rise again. It isn't cf, which is good.
Not saying that this is the case, but some babies also just fall off the chart naturally, and this is their pattern. These babies, of course, would be happy, healthy and meeting all developmental milestones while under a doc's care. It is often only in hindsight that you can determine that your child was just naturally like this. Are you and your husband small in stature or petite? What did you weigh as a baby? Were you a chunky baby or a skinny baby?
If your baby is eating three meals and three snacks, how many nursings is he getting? In the end of the first year, yes, many babies need the additional calories from solids, but breastmilk is still to be their MAIN source of nutrition. In other words, more than once or twice per day. I know you stated that you had supply issues, at the beginning. Do you have any signs of a low supply, besides the low weight gain?
What are his actual weights/weight gains? Babies, even nursing babies, naturally slow down, and often a rapid gainer will settle into their true pattern later. Again, happy, healthy, seen by docs.
What is your true intuition? When you look at your baby, do you feel like something is wrong with him? If you do, then follow your instincts. Mom knows better than anyone else, even doctors. This is YOUR child.
Have you looked into breast compressions while nursing? Stimulating a let-down can help deliver more hind milk, which can 1)promote weight gain and 2) promote milk supply and 3)give baby more satisfaction after nursing.
Sorry for all of the questions! I work with nursing moms, and often have heard this scenario. It is so hard to determine if the baby actually has a problem, when the weight gain is slow. Weight *loss* is obviously different, of course, but we are talking about slow weight gain here.
My main concern would be that you are trying all of these things, and your baby may wean early because of it. Preserving the nursing relationship that you want is always a priority for you, but not always for the docs or dieticians, etc. What you choose to do is of course your decision, and between you and your doc. I just would hate to see another mother whose baby weaned due to slow weight gain fears, and then stayed small later anyway. This is a frequent scenario.
The before and after feeds, with the right scale, could reassure you as to breast milk intake. The blood tests can reassure you as far as his health. Offering high calorie snacks and meals after nursings will assure you that he is getting a variety of foods from a variety of sources. Nursing first will help preserve your nursing.
Our advice is just that, advice. :-) You sound like a very loving mama who wants the best for your baby. Try to enjoy this time in your life too, it goes entirely too fast. It is easy to worry too much about their weight/height/issues and not enjoy the things that are also happening. Smile at baby, and drink him in. Cuddle and laugh, take naps together. It will make both of you feel better. :-)

[Liquesce]

Good luck. I definitely know how stressful it can be to feel like your child isn't getting what they need, but it sounds like you're trying to do everything right, and that's really commendable ... with a mom keeping on top of things I'm sure he'll be just fine.

[ourdayourjourney]

Originally Posted by lmclanahan

Try to enjoy this time in your life too, it goes entirely too fast. It is easy to worry too much about their weight/height/issues and not enjoy the things that are also happening. Smile at baby, and drink him in. Cuddle and laugh, take naps together. It will make both of you feel better. :-)

such nice words. thank you for those. we are so lucky to have family coming to help lately.

and i do appreciate your advise on preserving my nursing, which i hope to continue as long as i could. i always nurse first and will continue to. i know that there is such a fine line between nursing and solids offered. i do feel that there is a strong possibility that my ability to nurse him might end earlier than i would like. but i am so concerned over his growth.

i will say that he is not the best nurser either. i have had to build his supply up a few times by pumping after he nurses. he is so easily distracted during the day, so i nurse at home almost always, upstairs, in his darkened bedroom with a sound machine and i even found nursing necklaces helpful. and i suspect that he is leaving some hind milk. so that is why his night feeding are so important, as he empties my breasts on his own.

I am not even sure if i could add one more thing to my list, but would you recommend pumping after the day nursings? i did this a few times for 2-3 weeks to build up his supply and sometimes he would take the "extra" milk in a dropper and other times he had no interest.

[lmclanahan]

If you can find time to pump after the daytime nursings, it could help to increase/sustain supply. You can mix the milk into his solids. It could encourage him to try other solids, if they tasted familiar.
If you can't fit it in, do the best you can. You are doing a good job. Noone can follow every suggestion.
What are your son's weights/weight gains?

[ourdayourjourney]

yesterday was a busy day. we are working on getting him 3 meals and 3 snacks a day and i have been nursing before every meal or when he wants to nurse. yesterday, my breasts were fuller than normal and i know that he did not empty them until possibly the evening feedings. the few times, i had to pump after nursings to try and get my supply up for him, i did pump 2 teaspoons (sometimes 1 oz + ). At 9 months, weight is 16 lb 7 1/2 oz and height at 27 1/2", his height declined 90% to 25%.

Aside from that, I am feeling a little down on myself. I just did not associate all he was going through with a food allergy, his 2 month cough had me on a different search.

In his most recent blood work, they tested for the most common food allergens and they can back without having a food allergy. Maybe that is the difference between a food sensitivity and allergy. I guess I have to find out what other tests there are.

This is from kellymom.
Following are some reactions that may help you recognize an allergy in your baby:

* Bloating, gassiness
* Skin rashes (for example, a sandpaper-like raised red rash on the face), eczema, hives
* Runny nose, stuffiness, constant cold-type symptoms
* Red itchy eyes, swollen eyelids, dark circles under the eyes, constant tearing
* Diarrhea, mucousy stools, intestinal upset
* A red rash around the anus
* Generally cranky behavior, fussiness, irritability, colic
* Vomiting or increased spitting-up
* Asthma
* Ear infections
* Poor weight gain due to malabsorption of food

[Kailey's mom]

I didn't read all the posts.. but my dd was FTT from 6-9 months. Wish I knew then what I know now. Eosinophilic colitis ( rare allergic conditon that sucks!) anyway things we did to, well, keep her thriving.

We got a pacifeeder, so whenever she was playing, I would encourage her to drink from that, and it kindof tricked her because she thought it was a paci. Just put some EBM in there, or our favorite "fat smoothie". I'll write down the ingredients.

If this doesn't work, use a syringe! This was a life saver. In the meantime, get with an allergist, GI, to get some testing done. Make sure your ds is not malabsorbing also, and how severe the allergies are. Also sounds like some reflux is going on. This can also cause food adversions BTDT.



To simplify, what I would do is: breast on demand, and with a syringe give fat smoothie.

Fat smoothie. blend 1 avacado, 4 oz pinapple juice, 2 tbs flax or olive oil, 4 oz breast milk to make it thin, and either a banana or more avacado. Make it work to your baby's taste buds. My dd supplimented with this for the first 2 yrs.

If he refuses the syringe, than I would put the fat smoothie in a pacifeeder, and have it out, only when he has finished nursing.. kind of like a toy.. sounds odd, but it worked!!!

This should put some weight on the baby, but not comprimise the amount of breast milk he takes.

pic of pacifeeder: http://i28.photobucket.com/albums/c2...n/266ac90f.jpg

[gossamerwindweb]

[kdtmom2be]

Originally Posted by Kailey's mom

If he refuses the syringe, than I would put the fat smoothie in a pacifeeder, and have it out, only when he has finished nursing.. kind of like a toy.. sounds odd, but it worked!!!

This should put some weight on the baby, but not comprimise the amount of breast milk he takes.

pic of pacifeeder: http://i28.photobucket.com/albums/c2...n/266ac90f.jpg

This is another option The medicator by Munchkin it is not the best construction, but better for smaller amounts of liquids. We use it for gripe water around here.

And the only advice I have is that if YOU feel that there is a problem and you need more testing, keep asking until you get an answer about why your baby isn't gaining. Does your gut tell you that there is truly an issue here? Or is your paed trying to scare you because your baby doesn't stay on the paeds curves? (FWIW, the weight gain is not what concerns me, it's the height... unless you and baby's family are all small people to begin with.)

[Harmony96]

Originally Posted by lmclanahan

Not saying that this is the case, but some babies also just fall off the chart naturally, and this is their pattern. These babies, of course, would be happy, healthy and meeting all developmental milestones while under a doc's care. It is often only in hindsight that you can determine that your child was just naturally like this. Are you and your husband small in stature or petite? What did you weigh as a baby? Were you a chunky baby or a skinny baby?

I was going to say exactly this. DD was born at 39w3d at 7 lbs 3 oz. Her weight at 12 months old was 15 lbs, 2 oz. I am 5'0" now, and weighed about 16 lbs at a year. DD is way shorter than her peers. It's strange b/c she was such a skinny baby, and now that she's a toddler, she has a little more meat on her, LOL. But she always had a great appearance and was meeting milestones (though she WAS on the late end of normal) and was happy and everything. And she never "looked" skinny. She looked normal and healthy and "fleshy." She just didn't have the rolls that other babies had.

DS is the opposite, though... he is LONG and HEAVY. He already has a double chin and is probably about 13 lbs at nearly 3 months old. It'll be interesting to see what his growth curve does over the next several months.