4mo at ~3rd Percentile for weight - what to expect at ped?

[Spiralshell]

Hello Mamas -- I need some wisdom and reassurance.
My son is 3 months and 3 weeks old, and by my best "bathroom scale" guess, now weighs 11lbs, 13oz.
He is exclusively breastfed on cue, we cosleep, and he never goes longer than about 2.5 hours between feedings (and frequently nurses much more frequently than that!) He's bright-eyed, alert, cooing, playing with hand-toys, smiling and starting to giggle, has great head control, and generally seems to be doing everything a baby his age should be doing. He has wet diapers all day, his fingernails grow at a ridiculous rate, his skin is practically luminous, and he has a cute little double chin and rolls on his thighs.
He was 8 lbs 10 oz at his 9 week checkup, so he has been gaining at about 6 oz per week. This is good! However, he has been and remains just at or just below the 3rd percentile line on the weight curve -- using the WHO charts. Apparently a 12lb 4mo is a REALLY little baby.

What can I expect at the pediatrician at his 4mo checkup? Is there any possibility of treating him as a failure-to-thrive baby just because he's on the small side, even though he's gaining ~6oz per week? I know he is healthy, but I am afraid that we will hear that he's just TOOOO SMALL and must be supplemented with artificial breastmilk. (DP just doesn't get the BF thing, and can't understand why we aren't just giving him lots and lots of artificial formula. He says "You are just not cutting it in nourishing our baby." I do NOT want to give him any unless I have to!)
If the ped is concerned my IBCLC recommended that we consider starting him on rich solids like avocado a month early at 5mo. Better to supplement with a whole food like avocado, or sweet potato with olive oil, than with formula with so many ingredients. (Plus formula is no better calorie-wise than my own milk.) Does anyone have any experience with early solids to avoid formula supplementation?
In general, doe anyone have any advice about how to get a little baby to climb up the percentiles? I know it means really ramping up the number of ounces he gains each week, but honestly I'm at my max output (already taking More Milk Plus and pumping to increase supply) and without solids I just don't think I can get him to grow any more than 6oz per week. To make matters worse, I have to go back to work in 3 weeks so I will be struggling to pump all day and then nurse him all night.

I'm really just trying to trust my gut on this, not feel guilty about DS being small, and just keep nursingnursingnursing. But it's hard when the charts are telling me I'm doing a bad job!

http://lutzspidle.blogspot.com/

[PatioGardener]

But the charts are telling you that you are doing a great job and baby is growing on a perfect curve! Was baby small at birth (on the 3rd percentile at birth?) - that would be about 5 lb 6 oz or so I think. As long as baby is following a curve then it's all good. If baby had been on a different curve until the 9 week weight and has since dropped then it is a concern.

Plus, bathroom scales - not the best place to get an accurte weight!

Take the WHO chart with all his weights into your ped visit so you are prepared! I personally would challenge the idea of starting solids early (evidence says waiting until 6 months prevents illness) and if a baby is not gowing typically (on a curve) I would look to increase breastmilk intake first. IF breastmilk intake cannot be increased, only then would I go to more high cal solids. Avocado is great! But it is a heck of a lot easier to get a couple more ounces of milk into a baby than an entire ounce of avocado when they aren't ready for solids in the first place. (one ounce avocado = about 2 ounces of breastmilk calorie-wise, but breastmilk is nutritionally much more complete.)

Best of luck with your ped visit. And remember (in the words of Jack Newman) any doctor who suggests formula supplementation without talking about increasing breastmilk intake is NOT breastfeeding friendly!

[Spiralshell]

I should have added that he was 6lbs 9oz at birth, and 6lbs 1 oz when we left the hospital. (I had a c-section, he was in the NICU due to me having a slightly elevated temperature, they fed him formula without my consent, it was a mess!)
But we got going with breastfeeding with the help of my LC, and he gained 4.7oz a week for the first 9 weeks. I do think that has increased to about 6oz, but like you say the bathroom scale's not too accurate! (I would have bought a baby scale, except that to have one in the house would probably make me weigh him twice a day and get all neurotic about it!)
He was below the 3rd percentile at 9 weeks, but the ped was not concerned because he looked well nourished and happy. We have to start going to a new ped due to insurance issues and this is part of what makes me worried. The original ped was "crunchy friendly". The new ped is at an Army hospital (DP is in the military) and I fear a less-breastfeeding-friendly environment.

Thank you for the advice patiogardener! Do you have any tips on getting more milk into him? I'm already nursing all day long, I do breast compressions, I let him finish one side before switching, I always give both breasts, and sometimes go back to the first one if he's still interested.

[PatioGardener]

Originally Posted by Spiralshell

I do breast compressions, I let him finish one side before switching, I always give both breasts, and sometimes go back to the first one if he's still interested.

First of all, good luck with the new ped and take the WHO chart with you!!! I will keep my fingers crossed that he has gained the 6 oz a week you measured at home (which is awesome - growth slows after about 3 months, so an average of 6 oz/week is super from 9-15 weeks!)

Going back to the first breast (or breast number 3 ) in a feed is also great - and so are breast compressions!

If weight gain were an issue, which it doesn't look like it is with 6 oz a week, but if it were, some things that may help (in general - you are doing some already!) include increasing Mama's supply, feeding on cue, feeding as many breasts per feed as baby will take, breast compressions, offering to nurse even just 10-15 minutes earlier (by cue) each time (getting another feed in), co-sleeping, evaluation for milk transfer issues (including posterior tongue-tie), and if really needed, pumping after a feed and supplementing at the breast during the next feed. Personally I wouldn't even go there until you get a weight at the peds, and even then, I would want a weight a week later on the same scale to be sure about weekly weight gain before moving forward.

Good luck, and be prepared to do some quick mental math when you get the weight to happily exclaim "that's 6 oz a week!! Perfect!" so that hopefully the new ped will look at weight gain and not frown at the 3rd percentile!

ps. I checked out your blog - your son is SO CUTE!

[kalamos23]

I had the opposite experience - my baby gained fast, and was off the charts, so of course they were all over me for my "overweight" baby. *rolls eyes*

I think the things you are looking at (the skin, weight gain, hitting milestones, etc) are far more important than a number on a chart. Someone has to be at the top and bottom of the charts!! What we did was nod and smile and nod and smile to the ped who was telling us our 4mo weighed too much and to nightwean her... and then just did what we wanted as far as nursing/feeding. Follow your mommy instincts!

Oh, are you or your husband smaller people? DH and I are both big people, so I wasn't expecting DD to be tiny, you know? 2 Great Danes aren't going to have a Chihuahua! If you or DH is small, or you have small people in your family, then it could explain some of it too.

And I agree, your baby is darling! He looks SO happy!

[kalamos23]

Oh, another tip to "boost" his weight gain for the doc at least is to nurse him right before he gets weighed... I know our appts were always in the morning and so DD weighed less, but always wanted to nurse right after she was weighed. I put her on once right after and she "gained" like 4 oz!

[blessedwithboys]

your ds looks healthy and happy to me, and plz tell your dp never to say such a horrible thing to you again! not cutting it nourishing your baby?! how rude!

[boobs4milk]

s cindy!

i agree with patio and rachel. i did the grin and nod thing before but now i go to the ped and just tell them what i think and what i'm willing to do.

my oldest dd was my biggest at birth, 7lb 1 oz. by 2 mos she was ftt and i was told my bmilk was bad for her etc. we had the worst gut /skin issues with that kid after she was put on formula! she had a floppy sphincter and at 2 mos she was 'only' 9 lbs and the ped flipped. she remained on the low end of the chart on weight until she was 12 or so. she's now 6'2" and 180. i *THINK* she turned out fine!!!

i also wanted to give you this to think about and to maybe print out to give to anyone who gives you grief. people come in all different shapes and sizes and being smaller than someone else (or bigger) doesn't make that the wrong size for that person. more s!!!

[groovyem]

Just because they're doctors doesn't mean we have to listen to them when it comes to the weight of our babies. We know if they are healthy, my dd is chubbalicious and my doc wanted me to cut down on her feedings. Well, she just jumped from the 50th to the 75th for her height. You know your child and you obviously are keeping a very close eye on them, keep doing what you are doing, he is obviously doing wonderfully! Put that scale away!

[PatioGardener]

Just re-read your post and wanted to send you supprt not only for dealing with the doc, but also for heading back to work soon. Why not stop by the pumpers thread and see if you can pick up some pointers that may help before you head back?

[Spiralshell]

Thank you for all the kind words and advice, Mamas!
I will let you know how the appointment goes -- here's hoping the scale says good stuff, and that the ped can see clearly that Nate's doing well even if he's just a bit wee!

[MeredithK]

Spiralshell, I hope that the appointment goes well. Just so you know, Dylan was also 6lbs 9 oz at birth. At his 4 month, he was 13lbs 1 oz. 5th percentile. Dr was totally okay with it. Not a big deal at all. He said that he looks really healthy...and he's gaining at a good pace for him. He's just small. So, maybe it will turn out to be okay for you.

ETA: My Ped. is just your average doctor and he did not suggest doing anything differently at all. Just keep doing what I'm doing...breastfeeding on demand (about every 2 hrs or so).

[Sharlla]

you can expect them to push formula and to want weekly weigh ins. there's a reason I stopped going to my Dr when DS2 was 6 months old. He went from the 95th at birth to 7th. I think that percentile stuff is BS.

[misstorri]

It really depends on the ped. My DS was 11.4 lbs at his 4 month checkup a few weeks ago. That puts him below the 3% mark. My doctor is so super breastfeeding friendly! He let me know that someone has to be the smaller baby and that BF babies tend to gain slower sometimes and that is okay and normal. What matters is some weight gain, keeping to a curve, and hitting milestones. I hope you have similar success at your appointment.

[hildare]

I would second that it depends on your physician.
Our dd is the opposite - she's at the top of the weight charts, etc.
but our pedi told us it was a trajectory when they look at the charts. ie, comparing this visit's weight to the weight at the last visit and making sure the weight gain has been significant (as your ds has! yay!)
plus, it wouldn't really make sense to look at the weight at the last visit and then expect enough weight gain to be on a different curve on that chart, and a very different percentile, right?
you're doing great, mama.

[MountainMamaGC]

My DD is a 3rd percentile baby. Well she started out in the 10th and dropped to the 3rd around 4 months. She is happy healthy and meeting milestones so I never worried about it. Even if a doctor did tell me to fatten her up I would not listen. At 2 years old she is still in the 3% and I am not concerned in the least. Look at the baby not the charts.

The percentiles are all normal weights, even the 1st percentile. As long as they are growing, eating, drinking, peeing, pooping, active, and healthy looking they are fine IMO.

[thumbel545]

You are describing my DS exactly! My DS was born 11/4 and he's always been at the bottom of the weight charts, but he eats well and seems healthy otherwise. It hadn't occurred to me to worry as I'm not a big person either. Hope your MD appt goes well!! Trust your mommy instincts!!

[tmwmommy]

I wouldn't worry! My dd was 12lbs at 4 months and was born at 7 1/2 pounds so she gained way less than your ds. Her dr never said a word about her weight being low. She said she was gaining beautifully. My ped never uses percentiles but uses my dd's individual growth. I don't know if you are on the small side or not but small parents generally have smaller children. Somebody has to be in the first percentile. Most peds will look at the whole baby before claiming that he is failure to thrive. My dd isn't even close to being on the charts at 19lbs and 18 months but she's still 100 percent healthy. So remember that every baby is different and thin is sometimes healthy if the baby is meeting other milestones and is healthy.

He may not be ready to start solids at 5 months. I understand you are concerned about weight gain but babies generally need to be able to sit unassisted to eat solids and many 5 month olds cannot do that. My dd wasn't ready for solids until 10 months when she could feed herself. She refused to open her mouth for a spoon. As long as he is still gaining solids might be able to wait a bit longer.

[Spiralshell]

Thank you again for all of the reassurance and advice!
We had our appointment today. It was supposed to have been last week, but we got hammered with 3 feet of snow the morning of his appointment! (I'm so ready for spring!)
His weight is 11 lbs 5.5 oz, which is less than I had expected/hoped. It means that he gained 4.6oz per week, which is on the low end but still OK.
So:
Week 0 - 6lbs 1oz (He was 6-9 at birth, but dropped to 6-1 when we left the hospital)
Week 9 - 8lbs 10 oz
Week 18.4 - 11lbs 5.5 oz

I was nervous as this was our first appointment with the new pediatrician and our first at the military hospital, but it went well. The doc said that he's barely on the curve at 2%, but she also said that he looks really healthy and is doing great with all of his milestones. She said that we could start solids any time, but didn't push it, saying that we could wait until 6 months if we want. She never mentioned supplementing with formula. I offered that I might visit with my lactation consultant again to see if there was a way to increase his weight gain, and she said that sounded like a good idea, but again didn't push anything.
I'm relieved that we didn't get any hassle about him being small. It's hard not to measure my mothering against the scale of pounds and ounces! But I know that I need to use the scale of how happy he is (very!), how well he looks (pink cheeked and glowing!), and how he's doing with milestones (perfect!).

http://lutzspidle.blogspot.com/

[PatioGardener]

Glad it went well! 4.6 oz/week after 3 months is good weight gain! Checking in with a good LC to see if you can increase milk transfer is not a bad idea. So glad your ped was supportive of breastfeeding! She got the starting solids before 6 months a bit mixed up, but no mention of formula is pretty good!