Dr Pushing Formula for 9 month old due to lack of weight gain

[katm]

My son is 16 lbs 2 oz at 9 months, was a the Doctors today and because he is not even in the 5th percentile she is recommending formula or Homogenized milk once a day saying my breastmilk is not enough (he is eating solids, all homemade). I told her that he has been crawling since 6 months that was our last appointment. My husband and I think because he is crawling a lot his metabolism is quick, we don't use baby food from the store which probably has more "stuff" in it, our two older girls are small (5 year old girl is only 37 lbs), we are small ourselves etc. It just frustrates me that this is what she told me to do (not that I am going to supplement I just agreed and figured I have 3 months til my next appt) It bothers me because these charts are based on formula fed babies also and don't take into account anything else. The Dr even said he is thriving and meeting milestones it doesn't seem to be affecting him but would still like to see him gain some more weight. Any thoughts on this, should I be concerned?

This is the first time I have written here, I appreciate any feedback

[smpayne]

I am by no means an expert, but could he possibly be getting too much solids and therefore not taking enough breastmilk.

Put more fat in the solids (butter, olive oil, avacodo, etc).

[weliveintheforest]

Is he nursing well and often? How big were you at that age? I would not be worried.

[katm]

Yes he nurses very well, and in the night too, twice usually. He nurses before he eats his solids. My husband is not big by any means I am not sure how much I weighed but I was formula fed and given cereal at 6 weeks I think so I can't really compare. My 2 older girls are very petite as well, the middle one was always 5th percentile and still is.

[CheriK]

This drives me crazy. It is so very common and so frustrating.

First, someone has to be in the 5th percentile or it wouldn't exist. What it means is that, among 100 healthy normally growing babies, 5 out of that 100 will be below that line. *IF* there are other concerns - not meeting developmental milestones, obvious feeding difficulties, other signs of illness, then it might be a concern. Weight gain is only one indicator of health. For a doctor to say "He's healthy and developing normally, but you should push calories so he'll weigh more" especially in this day and age with obesity running rampant, strikes me as bizarre. But unfortunately all too common.

You might be reassured by downloading the WHO growth charts. You're right; the charts most often used in the USA were developed by the CDC using children fed by a variety of means. Since the # of breastfed children drops rapidly in our country after the first few weeks, by the time you get out to the end of the first year most of those children are formula fed. The WHO charts use normal growth and biologically normal feeding (exclusive BF until 6 months, complimentary solids with continued BF until I believe 2 years). You can download WHO software that allows you to enter the data and get a chart or evaluation (http://www.who. int/childgrowth/ software/ en/).

FWIW, my DS was 16# 1 1/2oz at 9 months. He also crawled at 6 months, walked at 1 year. He's now a skinny 8-year old, still "small" for his age, developmentally normal thank you very much. We've been lucky to have a family practice doctor and now a pediatrician who look at the whole child, not a # on a scale, and have never suggested that he needs to gain weight. DH and I are both 5' 4", DH wrestled at 95# as a freshman in high school (and had to "bulk up" to reach that weight!). So my kids are never going to be huge.

[lach]

What percentile was he at the 6mo appointment? Is the doctor concerned because his percentile is falling? That is a cause for concern, IMO. I don't think that formula is the automatic answer, but if his percentile fell off a great deal, I would definitely try to bulk him back up somehow.

If his percentile has stayed roughly the same, though, I wouldn't change anything. Some babies just are small.

[Altair]

I would focus more on what exactly the solids are, and making sure you eat enough healthy fat also. How much fat/protein are in his solids? It's easy to focus too much on fruits/veggies at first and forget that their brains and bodies need fats and proteins so much now too. Just throwing that out there, this may not apply at all!

How much does he get-- full fat yogurt? olive oil? butter? egg yolk? avocado? At 9 months by boy was just eating whatever I was pretty much, so I made sure I was eating healthier and with more healthy fats than before.

Of course MM is your main food at that age, but you want the solids to count if you're doing them!

[CheriK]

Actually, dropping across % lines on growth charts (even crossing 2 lines between visits) is not abnormal. Breastfed babies tend to grow faster for the first 2-3 months and gain lines, especially if born at average or below-average weight. And they tend to gain more slowly than formula-fed infants between 6-12 months, so dropping lines is normal and expected. If you compare the 12 month line between the CDC and WHO charts, the mean (50% line) on the WHO charts is really close to the 25% line on the CDC charts.

An ongoing trend of crossing lines on the chart can be an indication of concern, but again, it must be evaluated in light of the child's development and overall well-being. If baby has crossed lines, then the best recommendation (unless other red flags are present) is to check weight again at next well baby check.

Good info on this at kellymom (although dated - does not include WHO charts): http://www.kellymom.com/babyconcerns...ts.html#growth and in the book "My Child Won't Eat" by Dr. Carlos(?) Gonsalez. Book is unfortunately out of print, but your LLL group library might have a copy. Also: In most children, serial height and weight measurements follow consistently along a ‘channel’ on or between the same percentile(s). It is normal for children to change one to two percentile lines during the first two to three years, usually moving toward the 50th percentile line. From position statement of the Canadian Pediatric Society.


FWIW, solids in the diet don't add calories. They replace milk (breast or formula). Most solids, especially those offered as first or weaning foods, are less calorie dense than breastmilk. So if baby is eating lots of solids and dropping milk intake rapidly, that will impact weight gain. That doesn't mean it's abnormal or a cause for concern, though, unless it's affecting baby's overall health. This is why nursing before offering solids is recommended, which it sounds like the OP is already doing.

[blessedwithboys]

under 12 months a baby doesnt even need solids, so keep on nursing before feeding solids. a good way to make sure your ds isnt getting too much solids is to never spoon feed. allow him to self regulate by eating soft lumps of food off of a plate. when he stops eating and starts playing, leave the table. and maybe limit solids to just once a day, for example when the family sits at the table to eat dinner. but at this age, he doesnt need breakfast and lunch.

from what you have typed, your ds does not need formula, and homogenized milk isnt good for anyone, so you certainly dont want to give it to a baby thats not even one yet. remember, any food or drink you give him takes away breastmilk, which the perfect and only food he needs for a few more months yet.

[equilibrium]

My son was barely 18 lbs at about 10 months and only weighed 20 lbs from about 1-2.5 years. He is now 3.5 and weighs 28 pounds but has grown upwards.

He nursed well, ate from homemade food as well. I ignored their advice and went with my intuition. He was in the lowest 10th percentile as well, for height too until about 3 when he started little itty bitty growth spurts. Now, about 3 ft a couple inches...he looks long and lean like his bio dad. He has never weighed much and my niece at 9 months is OVER 22 lbs and they feel about the same weight. So, every child is different.

My son was in 50th percentile or so and dropped to 10th but there wasn't a huge concern...he was growing, hungry, developing.

Trust your feeling. Does it feel like somethng is wrong and you want to cut down on BF'd? If so, try some other proteins.

I see NO reason to add formula or homo milk to his diet.

[phrogger]

My two oldest boys ate like pigs but were only in the 5th %. At 9 months they both were probably around 16/17 lbs. The oldest was not quite 19 at 12 months.

My baby now is 23 lbs at 10 months. A BIG boy. What can I say, all kids develop differently. I wouldn't worry about it. As long as he is growing, getting lots of breast milk and is developing, that is all you can ask for I think.

[nmelanson]

Ahhh! My son was 17 lbs at 16 mos. - they sent us to a pediatrician and the GP thought he was failing to thrive. The pediatrician thought she was nuts for sending us and said he was doing great, even though he wasn't even on the charts! You know your child best. Obviously, if he is active and happy - he is doing just fine!

[an_aurora]

My DS was 15 pounds 9.6 ounces on his 9 month birthday. He started out 50th percentile and is now under the 3rd. My younger DD did the same thing, and had a casein allergy that was causing her to have absorption problems, so we are having DS tested. The pediatrician gave us the referral for the testing more because of the strong family history than because of his lack of weight gain. Our pediatrician with DD2 was hideous and told me to wean her and give her 3 bottles of Pediasure a day (this was at 13 mos when she was 16 pounds 14 ounces). She refused to test her for food allergies and then threatened to call CPS for "medical neglect" when I opted not to wean her. Luckily we moved a couple thousand miles away, found the new pediatrician, had her tested, and she gained 6 pounds and grew 4 inches in 6 months.

[katm]

Thanks everyone for the great replies they are making me feel much more confident with this. He is my third and therefore I know to trust my instincts but it just bothered me the way my Dr was going on about how small he is. I wish they would just ingore those silly charts and go on how the child is developing in regard to milestones, genetics etc. I feel like plumping him up with formula or cow's milk is giving him false fat if anything. Our bodies produce the milk that they need. He loves nursing and does it a lot and also loves to eat, but along with that he is moving all the time! I only wish that I had his fast metabolism, I only need a few calories to put on the extra pounds!