weight gain, bf, and solids

[Rose-Roget]

Dd is 3mo, ebf, and continues to gain slowly. She started meds for reflux about a month ago, and she has strted eating a little more frequently, but my very rough, unscientific estimates of her intake are still below what she needs to gain more. Aside fromthose things, she seems like a healthy, normally developing baby.

Now that she's getting older, I'm thinking about the "when to start solids" question. In a case like this, would it be more or less beneficial to start her around 4mo or wait until later? I know breastmilk has the most nutrients, but would it be better to get something more caloric into her to help her grow (and maybe be heavier in her stomach to help the reflux)?

[PatioGardener]

That's not an easy decision. There is good evidence to say that introducing foods other than breastmilk before 6 months increases the risk of certain illnesses.

Your baby has unique needs - the reflux changes the picture and slow weight gain is an issue too. How much has she gained in the month since you started the meds? 5-7 oz/week is typical. Check out the WHO growth chart too (forgive me if I already suggested that in another thread!) http://www.who.int/childgrowth/stand...irls_p_0_6.pdf

Jack Newman supports introduction of high calorie/nutrient solids at 4 months over formula. He seems to be alone in this though. You can see his ideas on his website www.drjacknewman.com

You'll be limited in your choice of solids that are higher calorie than breastmilk, if you do decide to start solids early. Avocado and sweet potato are the only 2 that come to mind. kellymom has a nice list: http://kellymom.com/nutrition/vitami...dcalories.html Foods over 22 calories/oz that are low on the allergy list are not that common.

[CheriK]

Remember also that solids don't add calories to the diet, they displace breastmilk or formula. So unless your baby is slow-growing due to low milk available, introducing solids will reduce the amount of breastmilk she receives. So, as previously posted, unless you're carefully choosing foods that have more calories per volume than breastmilk, she'll actually be getting fewer calories. And if she ends up nursing less frequently due to slower digestion time of solids, she could get even less. Also, I'd be worried about ALL nutrients (not simply calories) if you're offering lots of solids early, since no food you offer will be as complete nutrition as your milk.

I went back and read some of your earlier posts, and I wouldn't trust estimates of how much she gets from nursing a particular length of time. Your milk supply varies based on time of day, baby's nursing effectiveness increases as she gets older and stronger, and one test weight does not prove anything. It sounds like her nursing pattern has been pretty normal, including frequency of nursing and acting satisfied after nursing. She's just not gaining as expected. I'd be cautious of block nursing unless you're seeing other signs of oversupply (frequent spitting up which also can be from reflux, green frothy poops, baby choking/coughing/gagging at the breast, feelings of engorgement and strong letdown/spraying milk). Babies don't have to nurse for any set length of time to get hindmilk. Fat content of milk gradually increases over the length of the feed, but it's not zero at the beginning and it's only a little higher at the end.

How has her weight gain been since starting reflux meds? Is she closer to that 5-7 oz *average* per week? If she's not gaining more, and your milk supply continues to be good, I'd really wonder if there is some other metabolic cause of slow growth. Or, just worth considering, some perfectly normal healthy children do grow more slowly (all of mine did). Do you know what your growth patterns were as a baby? Your daughter's father's?

[Rose-Roget]

She seems to be gaining about 4 oz per week. At the ped's last week, she'd gained about 13 oz. in 3 weeks. The ped said that she was on the same growth curve (I believe they are using the WHO chart) but that that was the very minimum she'd accept before recommending a supplementation. She chalks it up as dd being destined to just be a tall, skinny girl (not sure where those genes come from!). If it is that, I'm fine; but I worry nonetheless.

I don't know dh's growth pattern as a child. His mom never mentioned anything about him gaining slowly. Dh and I were both bottle-fed. My mom started me on solids ridiculously early (beyond ridiculous - like a matter of a few weeks old!) and I gained steadily. Ds didn't have any issues gaining, although he also had reflux.

Cheri, why would you be cautious of block nursing? What might the negatives of that be? It seems like my supply really fluctuates, some days I feel a lot fuller between feeds, other days I feel really soft/empty (I know I'm not empty, it just feels like it); I get some days when she gags/chokes sometimes or I spray, other days not at all.

PatioGardner, thank you for your continued support. I will look at those links. I agree that it would be hard to find nutritious, high-calorie, low-allergy foods to introduce.

[CherryBombMama]

as a child care worker (and not as a parent of those babies) i have seen a pattern in our reflux babies - usually the reflux is not affected by adding solids at an early age. even the whole "cereal in the bottle" (as prescribed by their dr) didnt do much for them. of course every LO is different, but i have seen lots of reflux babies, and usually it didnt get noticably better until the LO started moving around ....

but thats just my observations ...

[CheriK]

Originally Posted by Rose-Roget

Cheri, why would you be cautious of block nursing? What might the negatives of that be? It seems like my supply really fluctuates, some days I feel a lot fuller between feeds, other days I feel really soft/empty (I know I'm not empty, it just feels like it); I get some days when she gags/chokes sometimes or I spray, other days not at all.

Block nursing is appropriate if mom has a true oversupply, not just overactive let-down. It works by lowering supply - baby nurses on one breast for an extended time (so baby does get more hindmilk, but that's not all that's going on), the un-nursed breast fills up with milk and the presence of that milk signals the body to decrease productions. You have a baby who's not gaining well. Reflux and oversupply can mimic each other w/ symptoms (and I think a lot of babies are diagnosed w/ reflux when mom really has oversupply), but usually. . . not always, but usually. . . babies of moms w/ oversupply are uncomfortable and unhappy but gaining VERY fast, like over 2# a month. Unless you've worked with a breastfeeding counselor who really seems to know their stuff and have a really good idea that oversupply is a problem, block nursing could lower your supply and lead to even lower weight gain for your baby.

If overactive letdown is an issue, you might try some of the same things that are recommended for reflux - feeding with baby upright (one position that works for some babies is sitting baby on your thigh facing you) or above you (latch baby on, then lean back against pillows or in a recliner so gravity slows the flow).

4oz weight gain per week is considered low normal by some sources. Depends on who you talk to. One of the hallmarks of reflux is slow gain. It sounds more to me that your baby may still need some medication tweaking to find the best combination for her. You might consider a referral to a pediatric gastroenterologist if you're continued to be worried (warning- many are not breastfeeding friendly - worth asking around for recommendations). Mama instinct is worth listening to.

[PatioGardener]

If reflux is the reason for the slow weight gain, then a different combo of medications may be worth looking into. It would really suck if you introducted solids early and it didn't help.

Good luck and hang in there!

[Rose-Roget]

I have an appt with a pediatric chiropractor on Monday. Don't know if that could help. I worry about other meds, mostly because I don'y know much about them in babies. I'll give chiro a shot and then talk to the ped again at her 4 mo. appt in a few weeks. I bought an infant scale to help me monitor her gain.

I will hold off on solids. Thanks!