failure to thrive. need ideas, support.

[maryjane]

my daughter is 12.5 months old. she was born at 6 lbs 13 ounces and gained quickly and well for the first 6 months of her life. my older two kids did the same -- shot up from birth weight by 50% in the first month, doubled weight by 3-4 months, etc. around 5 months, she had a series of colds, with a lot of nighttime coughing and spitting up of feeds. i started to be concerned about her weight, merely b/c she was spitting up SO much.

at 6 months we took her in for a 'well baby visit' and i mentioned the spitting up to our (very cool, laid back) FP, who said reflux. but he didn't think we needed to medicate as she didn't seem to be hurting and was otherwise really well. at 6 months, she weighed 16 lbs. at 7 months, 8 months and 9 months, she was still 16 lbs, at which point, we got referred to our local children's hospital for FTT (she had fallen from 50th to 25th to 10th percentile). we had to wait 2 months for an appointment, but then all of a sudden at 10 months, she gained three weeks in a row (at this point, we were bringing her in for weekly weight checks). she gained 6, 6 and 7 ounces. that was at 10 months, and we were doing absolutely nothing different in terms of feeding. she was bf on demand (at least 6 or 7 times a day and freely at night). didn't really take to solids, but offering once or twice a day.

after that back-to-back gain at 10 months, she has come to a standstill. she'll gain an ounce or two, lose an ounce or two. she is now 17 lbs 6 ounces, which is below the 3rd percentile. her linear growth has also fallen off -- from 75th down to about the 10th. as has her head circumference -- was 50th percentile, now 25th. we've met with nutritionists, OTs, social workers, developmental peds. she's had CF test (negative), celiacs panel (negative), blood work (all normal, except for slightly low vitamin d and slightly elevated calcium), and metabolic panel (normal).

her solid eating is lousy. she will put anything in her mouth -- seemingly has no aversions. will chew and swallow, but very, very small amounts. like maybe a fifth of a normal toddler bite size of hamburger, for example. or two teeny tiny little bites of quiche. they want me to get her take a cup, so we can supplement her that way, but other than water, she refuses. i've tried kids essential, pediasure, whole milk with cream and carnation instant breakfast mixed in. maybe a mini-sip or two. she hates the kids essential/pediasure. i've made her smoothies with the same result. she'll sometimes lick sour cream off her fingers. but it's all so piecemeal. solids just aren't happening. if she eats 50 calories of solid food a day, i'd be shocked.

the team that sees her now wants me to cut back on nursing to 3 or 4 times a day. they say that she is so attached to nursing that she hasn't made the transition to solid food. i get what they are saying and i do agree to some extent. she certainly doesn't get that what she 'eats' at the table will in anyway satiate her belly. if she's hungry, she thinks nurse. i'd happily nurse her for many more years, but obviously that's not giving her enough calories.

i feel as though i'm swimming in 'wait and see' here and it's starting to drive me insane. she is getting smaller and smaller -- for her age -- and now that her head circumference has dropped a percentile, i am even more concerned.

she's basically on target for her milestones... hardly precocious, but not behind either. she doesn't walk unsupported, but will push the 'walker' around the house in circles and cruises and walks holding hands. she can climb up and down stairs. she doesn't have real words yet, but clearly 'communicates' and gets the idea of language. her receptive language seems spotty.. sometimes i'll say, "say bye bye" and she'll wave right away. other times, it's like i'm speaking in jibberish and she has no response.

i just don't know where to go or what to do. i tried the limit-her-to-4-times-a-day nursing thing for a week and then she got sick, so i just couldn't refuse her when she's sick. we have a weigh-in again on wednesday. in any case, it made absolutely no appreciable difference in her intake of solids. could she have something 'intrinsic' going on or is this behavioral? what can i do to advocate for my daughter to the professionals? and any other thoughts about diagnoses, or just how to get her to eat more than a miniscule bit of something?

thanks for reading! i feel like it's starting to cause me to look at my daughter differently, and i feel so sad about that.

[changingseasons]

Have you considered food allergies or intolerances? Come on over to the allergy forum, or check out my blog.

[Bokonon]

I think you've gotten horrible advice to cut back on nursing, honestly. Some babies just don't take to solids until after a year. Why cut out her guaranteed calories when weight gain is a concern? And regarding that - slipping in percentiles is actually very normal. Were her weights plotted against the CDC charts that are based on formula-fed babies, or the WHO charts?

My baby was a preemie and started off under the charts, was 95th percentile at around 4 months, and at 13 months is around the 25th percentile. But she is growing and meeting milestones, and is following the exact same curve that my son did. And she was totally resistant to solids until just a couple of weeks ago. She still doesn't take many of her daily calories from solid food, but she's getting better at eating in general. I still nurse on demand so I don't worry about her overall calorie intake.

From 6-12 months, babies just don't gain a whole lot of weight. That's completely normal. Dropping from 50th to 25th percentile in head circumference doesn't sound all that concerning to me.

I'm not an expert, but your baby sounds pretty normal for a 12mo. A little on the small side, but not unheard of. I would also look into food allergies or sensitivities, but if the spitting up isn't happening anymore, she may have grown out of any sensitivities she had.

If your daughter is having an adequate number of wet and dirty diapers and is meeting milestones, which it sounds like she is, she may just be a small person! I was 17 pounds at 1 year and had no health issues, but I was genetically destined to be short, and am only 5' tall.

Please keep nursing your baby. She needs to eat, and I think your doctors are giving you misguided advice.

[2boyzmama]

You know, she doesn't seem that unusual to me, honestly! 17.5 pounds is nearly triple birth weight, which is what most kids reach by a year or so. Her pattern of weight gain isn't that uncommon either, it's very typical for a baby, particularly a breastfed baby, to plateau between 6-9 months, they usually get busy with developmental milestones and slow down or stop their growth for a period, then have a growth spurt (like she did) then might slow down again. I bet if you weigh most 12 month olds weekly you wouldn't see much change, until they hit a spurt again.

Her eating sounds very normal too. MANY 12 month olds aren't into solid foods much yet. I know many breastfeeding moms that don't even introduce solid foods until a year old. She does take food, she is interested, she doesn't appear to have any swallowing or oral motor issues...that's all great! I'd say just keep giving her tastes of many different things and wait her out. She'll get the idea, she's already half way there with her willingness to taste bites of food!

I think the recommendation of cutting back on her breastmilk intake is wrong. I was told the same thing. I was told to with hold breastmilk until my son ate solid food at meal time. I wrestled with that from an ethical standpoint for a long time. The truth is...no solid food is going to give her the fat, calories, and immune properties that breastmilk has. The best advice to give to a mom of a FTT baby is to nurse MORE, not LESS. Keep offering solid foods, but also keep offering the breast, as often as possible.

If she were showing oral aversions or having feeding issues (aside from the low intake) then it might be different, then there might be some stock to the thought that she's using breastfeeding as a crutch. But that doesn't appear to be the case from what you describe.

How does she look? Is her height/weight proportional? It sounds like it is. Is she alert? Interactive? Smiling/cooing/babbling? One thing that is frustrating is that there is no standard definition of FTT in medicine. Some drs will diagnose it purely from weight, some say it involves dropping percentile lines, some say it's height/weight ratio. But it's more accurate if things like development, alertness, activity level, etc are factored into the equation. What are her genetics? Are you small? YOur husband? Her grandparents?

So from your short description, I think that she doesn't sound like she's in major trouble. I do think it's wise to keep a closer eye on her since she did drop some percentile lines, but I wouldn't say it's panic time yet. Keep breastfeeding her on demand. Keep offering foods of varying tastes and textures. And definitely don't let the medical team freak you out. YOu have a small daughter. She's healthy. She's developing normally. Focus on that. I'm not saying walk away from them, it's worth monitoring her, but don't let them worry you.

[maryjane]

bless your hearts! i should have posted 2 weeks ago. we had one nutritionist who said basically she wasn't concerned, but this new team is saying they are concerned. they kept saying they were supportive of BF and are thrilled when any of their moms are nursing (it's a 'failure to thrive' multi-disciplinary clinic). but then they said that about limiting nursing. i told them i would try it for 2 weeks, but i have had a lot of qualms. especially since their routine is basically what a person would do to wean a baby. which i don't want to do (nursed my older sons for 2 and 3 years) in any case, and especially given that it's the only calories i can get her to eat. she was sleeping through until about 4 and then would come into our bed and nurse on and off from 4 to 6 or whenever we'd wake up. so, for example, they said, 'go to her at 4 and nurse for 20-30 minutes, but then put her back in her bed and don't keep her snacking for 2 hours.' they also said to not nurse her at all when she woke up for the day at 6 or 7, but instead to put her straight in the highchair for breakfast. we tried it for a week and it made no difference whatsoever. she eats NOTHING at breakfast. dinner is the best meal in the chair, but even that is super teeny tiny bits.

anyway, i'm just sort of venting here. i have some comments/questions below, if you don't mind.

Originally Posted by Bokonon

I think you've gotten horrible advice to cut back on nursing, honestly. Some babies just don't take to solids until after a year. Why cut out her guaranteed calories when weight gain is a concern? And regarding that - slipping in percentiles is actually very normal. Were her weights plotted against the CDC charts that are based on formula-fed babies, or the WHO charts? the doctors did it against regular cdc charts, but i pulled the WHO charts and she is also below the 3rd percentile there.

My baby was a preemie and started off under the charts, was 95th percentile at around 4 months, and at 13 months is around the 25th percentile. But she is growing and meeting milestones, and is following the exact same curve that my son did. And she was totally resistant to solids until just a couple of weeks ago. what do you mean by 'resistant'. would she eat, but not a lot, or just not eat anything?

She still doesn't take many of her daily calories from solid food, but she's getting better at eating in general. I still nurse on demand so I don't worry about her overall calorie intake. see, that's the other thing... for whatever reason, my bm alone doesn't seem to be growing her. i asked them why they think this could be, and they said something about her increased caloric need, but it just doesn't make sense to me. i mean, why would she gain from just over 9 lbs in the first 6 months and then less than 1.5 lbs in the second 6 months on the same milk. even taking into consideration mobility, etc?

From 6-12 months, babies just don't gain a whole lot of weight. That's completely normal. Dropping from 50th to 25th percentile in head circumference doesn't sound all that concerning to me. it doesn't? that's reassuring. we got this book "just take a bite" and i really got freaked out about developmental delays as connected to FTT.

I'm not an expert, but your baby sounds pretty normal for a 12mo. A little on the small side, but not unheard of. I would also look into food allergies or sensitivities, but if the spitting up isn't happening anymore, she may have grown out of any sensitivities she had. i did do a total elimination diet for 4 weeks and again, no difference in terms of weight gain or food intake. also, everyone i have ever said this to -- lc, nutritionist, ot, developmental ped, np -- everyone has looked at me like i have 2 heads when i say allergies. is it just not commonly accepted?

If your daughter is having an adequate number of wet and dirty diapers and is meeting milestones, which it sounds like she is, she may just be a small person! I was 17 pounds at 1 year and had no health issues, but I was genetically destined to be short, and am only 5' tall.

Please keep nursing your baby. She needs to eat, and I think your doctors are giving you misguided advice.

Originally Posted by 2boyzmama

You know, she doesn't seem that unusual to me, honestly! 17.5 pounds is nearly triple birth weight (20.5 lbs is tripling, which was another thing they brought up... she doubled by 3, but hasn't tripled by a year), which is what most kids reach by a year or so. Her pattern of weight gain isn't that uncommon either, it's very typical for a baby, particularly a breastfed baby, to plateau between 6-9 months, they usually get busy with developmental milestones and slow down or stop their growth for a period, then have a growth spurt (like she did) then might slow down again. I bet if you weigh most 12 month olds weekly you wouldn't see much change, until they hit a spurt again. this... i thought that, too. weighing her weekly made me a bit crazy, but now that we're only weighing her every 2-4 weeks, it's making me crazy, too.

Her eating sounds very normal too. MANY 12 month olds aren't into solid foods much yet. I know many breastfeeding moms that don't even introduce solid foods until a year old. She does take food, she is interested, she doesn't appear to have any swallowing or oral motor issues...yeah, at first, she wasn't chewing or swallowing... just putting in her mouth, moving it around, then spitting it out. now she seems to be swallowing... *very* small amounts, but does seem to be swallowing, so i'd say that's some progress. that's all great! I'd say just keep giving her tastes of many different things and wait her out. She'll get the idea, she's already half way there with her willingness to taste bites of food!

I think the recommendation of cutting back on her breastmilk intake is wrong. I was told the same thing. I was told to with hold breastmilk until my son ate solid food at meal time. I wrestled with that from an ethical standpoint for a long time. The truth is...no solid food is going to give her the fat, calories, and immune properties that breastmilk has. that's what i always said, but they started in with me that after 1, they need more calories and they can't get enough from bm ALONE. i don't know what to think about that.The best advice to give to a mom of a FTT baby is to nurse MORE, not LESS. Keep offering solid foods, but also keep offering the breast, as often as possible.

If she were showing oral aversions or having feeding issues (aside from the low intake) then it might be different, then there might be some stock to the thought that she's using breastfeeding as a crutch. explain more, i'm not sure i get what you mean. But that doesn't appear to be the case from what you describe.

How does she look? Is her height/weight proportional? uh, yes, basically, but her weight to height (height to weight?) percentile has also fallen from 50th to 25th and now i think it's at 10th. but to me, she looks proportionate. just tiny. i was looking at pixs of her from 5-6 months and honestly, she looked 'bigger' in some ways then than she does now. It sounds like it is. Is she alert? yes Interactive? yes Smiling/cooing/babbling? yes, yes, yesOne thing that is frustrating is that there is no standard definition of FTT in medicine. i know, i totally agree. she doesn't 'look' ftt, but by weight alone or percentiles alone or height to weight alone, she 'is' on all accounts. and i vascillate b/w thinking, but she doesn't 'look' ftt and thinking, 'she's going to start looking ftt if she doesn't gain'. Some drs will diagnose it purely from weight, some say it involves dropping percentile lines, some say it's height/weight ratio. But it's more accurate if things like development, alertness, activity level, etc are factored into the equation. What are her genetics? Are you small? no, i'm 5'4'', but i was small as a young baby, and i remember my parents saying they were shocked that i hit 5 feet. YOur husband? nope, he's 6 foot and our boys are big -- oldest son is 97th percentile for height and 2nd son is 60th for height, so definitely bigger.Her grandparents? my dad's parents were really short, but all other sets were tall for their gender.

So from your short description, I think that she doesn't sound like she's in major trouble. I do think it's wise to keep a closer eye on her since she did drop some percentile lines, but I wouldn't say it's panic time yet. Keep breastfeeding her on demand. Keep offering foods of varying tastes and textures. And definitely don't let the medical team freak you out. YOu have a small daughter. She's healthy. She's developing normally. Focus on that. I'm not saying walk away from them, it's worth monitoring her, but don't let them worry you.

one other thing... they told me they want to see her gained 10 ounces a month to 'catch up'. what do you think of that?

[alegna]

Hm, I agree that her eating and weight gain don't sound abnormal.

I would actually try to INCREASE her nursing. It's calories and nutrition she will take. I would offer every hour while awake and cosleep and encourage as much night nursing as possible (some studies show higher calorie milk at night)

I would offer nutritious, nutrient dense foods at meals and snacks.

-Angela

[Bokonon]

Originally Posted by maryjane

one other thing... they told me they want to see her gained 10 ounces a month to 'catch up'. what do you think of that?

I think it's unrealistic, honestly. If breastmilk alone didn't make her gain that much in the past few months, how could solid food, and what exactly is the goal - to make her unnaturally heavier? There is a pediatric obesity epidemic in this country and the "experts" are trying to fatten up babies who are naturally slender from breastmilk??

Your breastmilk is adequate, please don't doubt that. My baby gained 14 pounds in the first 6 months and 3 pounds in her second 6 months. And she's not walking yet, so that isn't the cause of her weight gain slowing. Again, this is normal.

When I said she was resistant to solids, I mean she would literally push food out of her mouth. She has a very sensitive gag reflex and has been known to vomit when I've tried spoon-feeding her. So I would give her bits of food, and she would put them in her mouth and then spit them out. Even now she won't let me spoon-feed her. Purees just never happened for us.

Your experts are just plain wrong about breastmilk. Please please please contact a certified lactation consultant - IBCLC - before any more specialists coerce you into doing something that is less than ideal with regards to your baby's nutrition!

[AndVeeGeeMakes3]

Put me in the FWIW camp because I don't have any experience except for a chronically FTT child.

That said, I would agree that it's ridiculous for them to sort of "blame" any of this on breastfeeding. Have they done a swallow study? A few of the points you made sort of made me think there may be aspiration issues: the colds, the tiny bites, the reluctance to try different fluids besides water and breastmilk.

My ped is constantly trying to reassure me that, with some kids, slow growth is just their normal. With us, there are other serious feeding issues, but in terms of growth, I'm trying really hard not to freak out. She's clearly *thriving* in most ways, as it sounds your dd is.

I suppose I'm not much help. I just know how freaky it is to have a FTT kid, and how much personal balance it takes to sort of keep it in perspective relative to how she's *growing* in other ways.

s

[dot1]

Breastmilk is one of the most calorie dense whole foods out there. I'd be concerned about losing milk supply by cutting back feedings....and would be trying to pump as much as possible during any experiments with cutting back nursings. Would she take breastmilk in a cup?

Interesting comment about the swallowing study - I work with the elderly population, and when there's disinterest in food, swallowing is sometimes the culprit. Have you seen a pediatric SLP who specialized in feeding and swallowing? The OT's tend to focus more on the sensory issues (e.g. aversion to various textures, tastes, etc.) and hand issues and positioning that might impact self feeding. Some OT's may have swallowing training. However, the SLP's are typically the experts in oral motor development and swallowing issues (speech and language muscles in the face are the same ones used for chewing, etc.) It's worth an opinion from an SLP who specialized in pediatrics/feeding/swallowing if you haven't already.

[annie2186]

I have a very very little baby She is about 18 1/2 months old now.

She was 6lbs 2ounces at birth. She never lost any weight and gained to be about the 95th percentile at her 2 month checkup.

I don't vaccinate, and there was a horrible snowstorm for her 4 month checkup and I never went back until she got a lump on the side of her neck (strep throat) about a month ago and she was either almost 18 pounds or almost 19 pounds (as you can tell, I'm not stressed :P)

I think you need to look at YOUR child. Does her bone structure look small or does it look like she's starving to death?

My DD3 does not have any problems - she's just small. You can't see her ribs and she even has SOME chub to her (just not alot )

I think half the reason I am not to concerned is that my sister has a son who is about 6 now and he is soooo small! She took him to the doctor and they ran all the blood tests and celiac disease tests etc. etc. and they all came back negative.

He is completely fine, eats a ton, is smart and meets all his milestones......he's just a skinny short little dude!

Also, my baby didn't eat at all around a year old. She never ate baby food and munched on banana's and prunes.

Now she eats all the time - some days more than others, but alot!

I nursed her until she was 15months old........and then I just couldn't do it anymore. I wish I was one of those momma's who can nurse forever but I just can't!!


ANYWAYS - I hope I am not rambling, but my main advice from someone who has a little "itty bitty" baby is just to follow your mother's instinct. If she/he (sorry, I can't remember the gender) SEEMS fine then they probably ARE!

[APToddlerMama]

I don't have any real experience, but just wanted to chime in that I have two close friends whose doctors are giving them the hardest times about their kids being tiny. Some kids are just small. My (preterm) son weighed at 4 months old what I weighed at a over a year... Just about a month ago we went to two medical apts in one week where they got his head circumfrence and height SO completely different that the numbers were literally about 50% point apart... Even the second doctor laughed about it. Weight is a little different but still. Also, kids do tend to thin out, and some more than others. I wouldn't for a second let them tell me to start denying my kid the one form of nutrition that she will readily accept. Sure you can start trying to add calories with table foods, but if she wasn't getting what she *needed* from breastfeeding, I would think she'd be willing to eat more solid foods.

All that said, if you feel deep down that something is "off", I would listen to my gut and pursue that. But, if you're really feeling like she is healthy and doing well, I wouldn't let it worry me or change my choice to continue to breastfeed. I have found that doctors seem to apparently be behind what you can find out from google sometimes... We have had to solve a lot of issues ourselves (and with the help of MDC mamas) when doctors told us things like food intolerences weren't real issues. good luck!

[blessedwithboys]

this may not be what you want to hear, and sorry if i come off sounding terse, but your LO sounds just like my ds1 did yrs ago. only difference was that we werent sent for tests, my ped (who i left immediately for a new one!) gave me 7 days to pack on 5 lbs or she would call CPS!!!

your babe sounds normal. please DONT limit nursing. its completely age appropriate for her to not gain a whole lot right now and also for her to get almost 100% of her calories from bm.

your team unfortunately is super uneducated about human lactation. you need LLL or a really good LC, maybe both.

i would say that exploring food allergies/intolerances is not a bad idea at all. but recommending cutting back on nursing is just plain irresponsible "medical" advice.

ETA: if your dd is hitting milestones like walking and babbling-turning-into-intelligble-words, she is NOT failing to thrive, she is just petite. FTT babies are listless and lethargic and are not hitting motor milestones.

[va_lkywmn]

I don't have any great advice as I was on the opposite side with my DS, but didn't want to read and not post.
I think you have gotten a lot of great advice. I would trust your instincts as a mother. You are the expert on this child and the only one that really knows what's going on. But the last thing I would do is limit breast milk. There seems to be a real mistrust of breast feeding here and it just makes me sad. No matter what the problem, if you are breastfeeding it must be the underlying cause. Child too small - give them food. Big baby (like my DS) - couldn't possibly be getting enough calories on breast milk, start him on food even though he is only 4.5 months old! Trust your instincts and if the advice seems off, find someone else!

[AndVeeGeeMakes3]

Originally Posted by APToddlerMama

if she wasn't getting what she *needed* from breastfeeding, I would think she'd be willing to eat more solid foods.

I just want to respectfully disagree. This is not always the case. Hopefully it is for you, but it, again, is not always the case.

I know that it's really popular to discount things that docs say, particularly when they comment on bfing. But, I encourage you to take *both* things with a grain of salt. I wouldn't freak out; I wouldn't stop breastfeeding; and I wouldn't assess some sinister anti-breastfeeding agenda to your docs. Follow the trail, and, hopefully, it will lead you back to a reality that she's just tiny. Swallow tests are really no big deal -- seriously, they're not. I would think it worth it.

[maryjane]

Thank you all SO much for your advice and experience!

We took her in today for a weigh-in. We first met with this team 13 days ago and were scheduled for a feeding eval and another team meeting next week. I asked for this weigh-in after 2 weeks, b/c I wasn't willing to go 3 weeks with restricted nursing.

As I strongly suspected, she lost weight -- 150 grams (which I think is about 5 ounces). About 6 weeks ago, her weight peaked at 17 pounds, 10 ounces. Then it dropped to 17#6 ounces, and now it's down to 17#, 1 ounce. Since this wasn't a formal appointment, we didn't have an actual sit-down with the NP, but she came into the weigh- in area when the nurse let her know that DD had dropped another 5 ounces.

I told her that I didn't feel I could continue with their advice to restrict nursings. She told me that it takes time to adjust feeding, etc. I told her that while I respect her professional advice and experience, I can not, in good conscious, deny my child the only guaranteed source of calories she has. I pointed out that cutting back for 2 weeks did nothing to increase her solid food intake and asked again about the swallow study. She said that at our feeding eval next week, she would have the OT carefully evaluate DD's swallowing, as well as other oral motor stuff. I brought up the fact that she won't drink anything but bm and a bit of water in a cup in terms of aspirating. She said pretty definitely that if she was aspirating, she'd aspirate with water, too. She did say that the OT would make that determination, but I will definitely push for it. (Though how they will get her to swallow the barium, I have no idea!) I also mentioned possible esophogeal issues.

I pointed out that scheduling and refusing is how one would wean, and I wouldn't wean (regardless of this issue) at one year -- and certainly not given her weight problems. I got a bit chocked up, b/c it's so not like me to 'go against authority,' but as I explained, I have to trust my instincts on this one, since that's all I have right now. I also told her than until we rule out everything else medical, oral motor, etc., it seems really premature to compromise the supply of my daughter's one nutritional source. The NP did suggest that I pump to maintain my supply, so I really don't think she's anti-breast, but for her, solid foods are the primary right now. I pretty much said we'll just have to agree to disagree, at least for now.

The NP was generally okay with it and said supportive things about wanting to help both us and respecting my opinion and perspective as her mom, and obviously that no one can force me to follow their recommendations. I do believe they are well-intentioned, I just don't think they make sense for me and my daughter. She said one thing that kind of annoyed me, which is that, "It's also possible that you [meaning me] just aren't ready to make the changes in her diet yet." It felt a little, I don't know, infantilizing. I told her that it wasn't a matter of readiness, but rather appropriateness of the course of action.

One thing I've noticed is that even when I'm not intentionally limiting DD's nursing, she is still not a big nurser. She often does not drain the breast, or will sort of snack feed, rather than 'meal' feed. Which makes me wonder about hind milk and how much she is getting. Could explain part of why she's not gaining on breastmilk (and in fact losing). Also, she was tongue tied as a baby, and we had it clipped at 8 weeks. The doctor said it was a broad-based complex tie, so he couldn't go as deep as he'd like. But she has good tongue lateralization and protrusion now and everyone who has observed / examined her (2 doctors, the NP, a speech pathologist, a LC, a craniosacral therapist, and an OT) all say that it's not an issue. I don't know, part of me can't stop wondering if she isn't transferring well and hasn't been since 5 or 6 months when the gain issues started. I have an abundant supply, but when it leveled off, she just may not be getting enough?

Phew, sorry for the book. One last thing, I really really appreciate your openness to me and my concerns. I feel badly posting here, as I know many of you are dealing with far more serious issues, but I didn't know where else to turn and I know you ladies are the true experts! Thank you.

[ellegoat]

I don't have any specific advice but I just wanted to send a hug out to you! It's a really stressful situation, when you're worried about your baby's growth and you don't feel like the medical team is on the same page with you about what to do about it.

My LO is in a very similar situation, 20 months and stuck at 19 lbs for several months now. It's hard not to get super worried at every meal.

[2boyzmama]

Goodness, I'm so sorry that you're being faced with all of this!!

DEFINITELY get her back on the breast, as much as possible, to get her weight back up. Obviously restricting her nursing is not working. I understand the catch 22 that the NP is describing...she thinks that she is failure to thrive because she doesn't eat, you need to restrict the nursing to get her to eat, and that it will take time to retrain her eating habits, and even though it will cause her to lose more weight (thus becoming more FTT), you need to just stick to it.

But there are flaws in her assumptions. The first flaw is that your daughter is being harmed by her low weight.

The second flaw is that it's the lack of solid foods causing your daughter to be underweight.

The third flaw is that your daughter is capable of eating other foods.

This last one is a potential flaw...no one knows yet if she CAN eat solid foods...yet at least...hopefully the OT will shed some light on that. And maybe it's a maturity thing, something she will overcome on her own, and there's nothing actually *wrong* with her anyway.

I'm very glad that you stood up for yourself (and I still remember the first time I did it, it was very scary, I was literally shaking afterwards!...it does get easier, I promise!)

Keep working with an LC. Focus on hind milk. Pump before a feeding if you can to make sure she gets more hind milk. Take her back to the dr or dentist that did her tongue tie and see if that is an issue at all.

Hang in there!!!!

[whoabethy]

have you thought of a nursing supplementer? i don't know if it would be appropriate, but maybe a lact-aid or SNS with something high calorie? she clearly LIKES getting calories from BFing, maybe a supplementer could just boost the calories?

[belltree]

I am glad I found this thread. It is very comforting to hear, that children sometimes fall off the charts. My child has just dropped from 60 percentile for length at 5 months to now 5 percentile at 8 months; weight has stayed in the 20 percentile all along, for us it does not seem a weight gain, but a growth issue? Also, his head went from 75 percentile to 25 percentile.

I should add, that my babe is walking since 7.5months. Our pediatrician did not seem to be concerned, he only suggested adding more protein to his food.

I've also read that breast massaging before and during feeding can increase the caloric intake from breast milk.

[sncmom]

Originally Posted by dot1

Breastmilk is one of the most calorie dense whole foods out there.

As the mom of an FTT child (because of oral motor issues), I would like to clarify that this is not true. Breastmilk is 20 cal/oz, same as whole milk. If you pump a little and just let her nurse the hindmilk, it increases some. This is not in any way to discourage breastfeeding, and I agree with other posters that BF on demand for your LO is probably a good idea. I think breast milk is amazing. My DD2 was unable to BF at all, and I exclusively pumped for her for over a year. BUT, there are higher calorie liquids out there.

I echo the swallow study and would perhaps suggest some reflux meds. She may not be super fussy, but if her esophagus hurts, that may discourage her from eating. You could also try a reflux study, but those are kind of a hassle, and often if thing improve with the meds, you have the diagnosis.

Good luck, and try not to worry (I know it sounds unrealistic). We find that being as relaxed as possible around our LO during mealtimes and not stressing about intake helps all of us. And she's 20.4 lbs at 2 y/o....