9mo DD needs to gain weight

[aet.tea]

DD is 9mo and has always been below the charts on both weight and height (5 lb 11 oz at birth, 3 weeks early, and a slow grower all along). She was EBF till somewhere around 7 mo and since then she's eaten more and more solids. We've mostly been doing BLW although I try her with spoon foods from time to time (she's not that into them).

At her 9 mo appointment last week she weighed in at 12 lbs 8 oz and 25 inches long. (which makes her quite possibly the smallest baby on MDC, at least that I've seen?). All along our pedi has not been worried about her small size, but since her growth seems to be slowing down (only 1 lb gain in 3 mo) he gave us a challenge to have her gain at least 12 oz per month for the next three months.

She is developing normally in motor and cognitive skills so we're not ready to rush to a specialist, but do want to see the weight gain pick up.

She's never been much of an eater. We still nurse 6-8x/day (I offer more often than that) and I think my supply is still pretty good, although not as good as it used to be (she used to take only one side per feeding, now she takes both).

She loves avocado, broccoli, rice cakes, oatios and bananas. She eats other veggies pretty well including sweet potato, butternut squash, zucchini. She's not been that interested in yogurt, egg yolk, cereal, or anything pureed. We are 90% vegetarian (I eat fish maybe 2x per month) and so far she has not had any fish or meat.

I am giving her cod liver oil daily, and have been trying to "sneak" fats into things like adding tahini to her broccoli, flax oil to her oatmeal w/ breastmilk (sometime she likes it) and yogurt to top her oatios. I am also giving her EBM in a sippy cup or bottle when she doesn't seem to want to take the breast.

What else can I do? It doesn't seem to me like she's eating much quantity - she has never seemed to have much of an appetite. any way to increase her appetite and interest in nourishing foods?

Thanks!!!

[leigh09]

I also had a small baby, I seen an infant feeding specialist for him. My infant feeding specialist believes strongly in breastfeeding, I loved her.

Her advice on solids:
Add fat to everything. Butter is good at gaining weight, so is coconut oil. Sneak extra calories into foods by making them with formula/breastmilk instead of water, etc. Think along those lines. She hasn't had any fish or meat, but red meat is a very nutrient dense source of fat and calories. I used to grind some up and mix it into ds's potatoes, squash, etc. It adds a lot of extra nutrients and calories to his meal.

A common meal for my ds at 9 months would be some type of veggies and meat ground up, usually formula/breastmilk added to it to make it the right consistency, and a touch of butter or other fat added into it for the calories. I would also sometimes mash egg yolks into other foods for the same purpose of adding protein/calories/fat into his meal. Instead of cheerios or crackers for finger foods, see if she will snack on cubes of cheese or something else higher in fat. Avocadoes are also great sources of fat.

This was opposite cooking strategy for me as I usually cook low fat, healthy, light meals for the family. To cook with the goal of making a high fat meal was quite the switch in thinking. He is currently 4 years old, healthy, but still a slender boy.

[texmati]

This is just an idea, but do you cosleep? would bringing her to bed encourage night nursing?

I also have heard of (on this board), letting the fat in the ebm seperate, and then skimming it off and adding that too another bottle of ebm, if that makes sense.

[ShwarmaQueen]

At that age DD loved oatmeal (the regular kind) with a touch of brown sugar and butter.

[aet.tea]

Thanks Mamas!

Forgot to mention, she doesn't have any teeth yet.

Yes, we do co-sleep and she usually nurses 1-3 times per night.

Thanks, Leigh for all the food prep ideas.

Any suggestions for helping her enjoy eating from a spoon? Seems like you can sneak more fat into foods that you mash up. She can get some of that in her mouth on her fingers, but it seems like a spoon would be more efficient. . .

[lmclanahan]

Just curious, but have you thought of just doing nothing differently? I have had four slow gainers and one chubby baby, all ebf. My current baby is 6 months, 13 lb. 8 oz. Her bw was 7 lb. 1 0z. Not doubled yet. She often eats after her older sister, so she gets the hind milk, and she is just happy, healthy, and SMALL.

I *did* do what was recommended for my first, adding butter and oils, high fat foods. I ended up with a child who had no portion/fullness control. Mealtime was stressful, not enjoyable. He is 16 now and a healthy weight. It was hard to *stop* adding butter/oils. It tastes better, and he was used to it. Oh, and it didn't help him gain weight as an infant, only once he weaned, at 4. He could eat a whole cow and still be skinny before then.

Anyway, if she is healthy, on track developmentally, etc., why try to fix what isn't broken?

For what it is worth, my fourth child was chubby, with huge rolls, and weighed more at 6 months than the others weighed at a year or more. Same mom, ebf, different build. It was fun to freak out my lactivist friends, lol. Noone believed she was mine, lol.

[leigh09]

Originally Posted by aet.tea

Any suggestions for helping her enjoy eating from a spoon? Seems like you can sneak more fat into foods that you mash up. She can get some of that in her mouth on her fingers, but it seems like a spoon would be more efficient. . .

Have you tried a baby safe feeder? My kids never liked them but some babies are really into them

[ktmama]

FWIW, I agree with lmclanahan. Dr. Sears has some great guidelines for a robust baby if he/she isn't gaining like the charts "say" he/she should. Check those out. I've reviewed them because I have a long, lean baby and sometimes I worry too.

Any suggestions for helping her enjoy eating from a spoon? Seems like you can sneak more fat into foods that you mash up. She can get some of that in her mouth on her fingers, but it seems like a spoon would be more efficient. . .

My trick is to give my baby a spoon to play with and then, when he grabs the spoon with the food, I take the other one and fill that with food and we just switch back and forth.

[starlein26]

Is it possible that she has a form of dwarfism? Are you or your husband small in stature?

[2boyzmama]

Originally Posted by texmati

I also have heard of (on this board), letting the fat in the ebm seperate, and then skimming it off and adding that too another bottle of ebm, if that makes sense.

I did this with my second son, who was very small (he was bigger than your daughter, but he started out 3 pounds bigger, so actually his weight was probably comparable) He just turned 3 and is oh-so-close to tripling his birth weight...finally!! Most kids triple in their first year!

When I pumped, I let the bottles of expressed milk sit in the fridge and separate. Then I would "skim" the separated fat off the top of one bottle and add it to another bottle. So the bottle now had extra fat in it. (the bottle I took the fat from I would give to my older son, or use it to cook with, or something)

And while your daughter sounds small, what's most important is overall development and overall demeanor. If she's happy, interactive, healthy (no illnesses? no signs of overall weakness?), and hitting milestones on target (gross motor, fine motor, cognitive, social) then that's a good indication that she is *overall* doing fine.

However, babies need to have stores in case of illness. Her height to weight ratio sounds pretty good!! Does she have a layer of fat?

Remember that it's very common for babies to slow down their rate of growth in the second half of the first year. Has she recently gotten mobile?

SO...I agree that you should keep an eye on her, and it sounds like you're doing all the right things with her diet (keep breastfeeding a LOT!!).

[PatioGardener]

Is your MD using the WHO growth chart? MANY babies whoare actually growing normally are labeled as 'failure to thrive' on the CDC charts around 6-12 months. Your DD may not make it onto a WHO growth chart, but she may follow the same pattern of growth (her own curve that matches the WHO curves more than the CDC curves).

Here is the WHO chart... it is meant for term babies, so you may want to plot weights as is (birth = day 0) and also adjusted (week 3 weight = day 0).

http://www.who.int/childgrowth/stand...irls_p_0_2.pdf

As for the suggestions for food intake, I agree with the PPs. And the encouragement to keep breastfeeding You also may want to have her seen by an IBCLC just to rule out a (never obvious) posterior tongue-tie that may be impeding milk transfer.

[Jayray]

Originally Posted by PatioGardener

Is your MD using the WHO growth chart? MANY babies whoare actually growing normally are labeled as 'failure to thrive' on the CDC charts around 6-12 months. Your DD may not make it onto a WHO growth chart, but she may follow the same pattern of growth (her own curve that matches the WHO curves more than the CDC curves).

Here is the WHO chart... it is meant for term babies, so you may want to plot weights as is (birth = day 0) and also adjusted (week 3 weight = day 0).

http://www.who.int/childgrowth/stand...irls_p_0_2.pdf

My 9 mo son had "dropped" in the charts at his last WBV. My ped told me to focus on nursing more and NOT giving more solids. I got all stressed about my supply, etc. until I found the WHO breastfed chart. He was at 50% at 6 months on both charts and is STILL at 50% on the breastfed chart. If you go to www.kellymom.com, she has a nice figure showing the difference between the CDC formula-fed chart and the WHO breastfed-only chart. Breastfed babies grow a little more slowly toward the end of the first year.