Advice on weaning 18 month old with feeding issues

[babyjonesmama]

I am looking for a little advice here...my 18 m/o ds is a very intense nurser. He wants to nurse all the time when I am home, and we cosleep, and he nurses all night long some nights.

I work close to full time (but am still home 3-4 days/week) and he stays home with dh when I go to work. When I am gone, he eats table foods pretty well, but on days when I am home he eats very little. He only gained about 8 ounces in the last 6 months, and has dropped to 10th percentile in weight (having started out at 97th). His is still 95th percentile in weight, though, and his head circumference is fine, too. So he appears to be growing well aside from the weight issue.

However, at his 18 month check up yesterday, our pediatrician states she feels it is necessary for his own health to wean him from the breast at this point. When I told her that he has always nursed to sleep and that I am NOT okay with cry-it-out, she said that we could try to allow him to nurse only at bedtime and maybe in the mornings. This would mean no nursing at naptime during the day, and therefore, probably no nap time anymore until he gets used to it.

I am feeling really mixed emotions about this. I don't want to wean him, I really treasure our bf relationship, and thinking about stopping it brings tears to my eyes. But I don't want to continue with this if it is the reason that he doesn't gain weight and get the nutrition that he needs.

Has anybody gone through this - weaning because the child doesn't eat anything else? Any thoughts? Advice?

[pbjmama]

I don't understand this - your child isn't gaining as much weight as the doctor would like so you should take away the food that offers the most fat and calories that he does accept? I would get a second opinion from someone who is more knowledgeable about breastfeeding.

If there are actual feeding issues like sensory or oral motor planning you need an evaluation with an occupational therapist.

[Parker'smommy]

I agree with pbjmama. Why would you take the most complete food away from him so that he could fill up on less complete, less nutritious, and less calorie foods? It just doesn't make sense.

Many providers like to blame breastfeeding on everything. I wouldn't wean him. But that's just my personal opinion. If he's still active, and meeting milestones, I wouldn't be concerned on weight gain. My now 8 year old started out in OVER the 100th percentile and is in the 10th percentile now. He's just a little guy. Just because they start out big, doesn't mean they have to stay big.

[TiredX2]

Find a new doctor.

The advice is completely wrong and dangerous.

Many children gain little to no weight (or even loose a few onces) for months. I know that DD gained no real weight from 10-15 months. At that point the pediatrician told me (and other pediatricians have backed this up and the research I have done has backed this up) that weight was the LAST indicator of health. In front of weight you should look at height, head growth and developmental milestones. If one of those is "off" then weight can be an additional indicator. If height, head circumfrance and development is right on track though weight is not an issue.

Other things to look for--- Is your DS' skin soft and taut? Does he have good color? How are his fingernails? Do they grow well and bend easily or are they brittle? How about his hair? Is he loosing it, is it brittle? If he has normal "tight" skin, healthy hair and nails he is probably healthy. Does he complain of pain? Does he have problems with pooping or peeing? If his body is working well for him he is probably healthy.

What are your proportions? Are you thin? Birthweight is primarily determined by health and nutrition of the mother *during pregnancy* (from what I understand). By 6 months, though, genetics take over. Information about averages across groups is often misapplied to individuals. I'll give you an example. The average weight for a newborn is 7-7.5 lbs. The average weight for a 1 year old is about 21 lbs. So, some doctors take that information and state "the average child triples their birth weight in one year." BUT THAT IS NOT TRUE GIVEN THE INFORMATION. There are children born at 5 lbs who will be 30 lbs at one year and children born at 11 lbs who will be 20 lbs at one year and both can be perfectly normal and perfectly healthy. Those averages don't follow individual children, but groups of children.

What is true is that bmilk is one of the highest (in good) fat, most nutrient dense, easiest to digest substances available. Exactly what could you replace it with that will help DS grow "better"? And even more, you are making the milk that is perfect for your DS.

Can there be reasons to wean prematurely? Of course. You just haven't said anything that convinces me that your son is one of them. I do not have the medical training of a doctor. BUT, I bet I actually do have more knowledge and information about normal growth and development of a breastfed child since most doctors have never taken a class in that subject or even read a book exclusively about it.

Good luck!

[averlee]

I think your pediatrician is crazy, but then again...if you wean now you'll possibly be making lots more visits to the pediatrician for colds, ear infections, and other cooties, which would be good for business. I know that's callous and hardened but it sounds like you need a new pediatrician. Weaning is likely to make your baby lose weight, become constipated, and/or dehydrated. Decent doctors do not recommend weaning from the breast until at least age 2. My daughter's doctor has said that he simply does not recommend weaning, because the healthiest kids he sees are those who stop nursing on their own, often around kindergarten age.

[TiredX2]

Oh, I just wanted to add:

From what I understand the *optimal* diet for a 12 month old child is a minimum of 75% of calories from bmilk. Both of my children were 95-99% bfed at one year.

I considered it a goal to have them under 75% of calories from bmilk at 2 years and that was no problem. I just wanted to say that a child can be getting the vast majority of calories from bmilk well into their 2nd (or even 3rd year) and still be healthy.

One last thought. Do you know what growth chart your doctor is using? If he is using the CDC ones versus the WHO ones (for breastfed children) you may want to replot your son's growth pattern and see if it is as extreme as is being presented.

Okay, seriously one last thing--- I am constantly surprised how often doctors scales OR their ability to plot on growth charts are seriously off. Was DS weighed on the same scale both times? Both times completely naked? Was the scale correctly calibrated? At one point the doctor thought DD had lost weight and then after getting weight checks realized that the scale had been off by 1/2 a lb.

[youngsoul]

My DD gained nothing from 10 months - 15 months. She's dropped off of the chart and at 19 months weighs only around 17.5 pounds. Our local ped recommended that we go to the children's hospital in Denver for a nutritional consultation with a specialist pediatrician. My DD is a nursaholic...she nurses many times throughout the day and night. The specialist encouraged me to keep breastfeeding - as much as DD wants - and to supplement w/zinc to stimulate her appetite. This specialist is a highly regarded MD, who ONLY sees kids with low weight gain. So, my advice (based on her advice) is to keep breastfeeding!

[bandgeek]

I agree with everything that's been said. I'll just add my own personal experience. My DS was not a good eater. He was getting probably 90-95% of his nutrition from me at age 2. I got pregnant again and my supply dropped and he lost weight and got super skinny. He was already starting to thin out, which is normal for kids that age, but the difference in just a couple of months was drastic and not normal. He also started getting constipated and wouldn't drink enough fluids. I finally did get him to eat a little better and he put one lb back on by the time DD was born, but he'd grown like 3" so he was still really skinny. When my milk came in, he started nursing like a newborn almost and put on 5 lbs FAST. And he evened out and looked good and didn't get constipated anymore.

Breastmilk doesn't keep children from growing. It's the one thing that's always there, always full of calories and fat, and always super nutritious. Taking it away from a child who's already struggling is just asking for trouble.

[babyjonesmama]

Thank you everyone for your responses. In my heart I really want to continue to breastfeed. I feel that my son is healthy. I am actually a pediatric nurse and have lots of experience working with children with failure to thrive, and I just never thought I'd find myself in this situation.

I discussed my case with a very dear and trusted friend, today, a pediatrician that I work with. After reviewing Jonah's growth chart, he does strongly feel that Jonah has failure to thrive, and while is a big advocate for breastfeeding, he strongly feels that it's holding him back from gaining weight at this point. So my decision is that I will try to cut down on nursing, but still allow him to breastfeed a few times a day. I'm going to see how this goes. I just want to trust what I feel is right, and in this case I'm being pulled internally in two different directions.

The other thing is that we do want to try to conceive again in the next 6 months or so, and I'm not really interested in tandem nursing, so I was hoping to try to be weaning in the relatively near future anyhow, although probably closer to when he was 2.

Anyhow, thanks very much for your support, I don't have a lot of external support for the extended breastfeeding that we've been doing up to this point.

[pbjmama]

Okay, I respect your decision to partial wean and I'm glad you chosen partial because you can always go back to more.I do wonder what the suggested food is that will equal or surpass breast milk fat and calories to make him gain weight? Has he been tested for anything, even a basic blood panel?