4 month old baby is in 2% for weight... should I be worried?

[Georgetown HB Mom]

So, everything I have ever read says that by the time a baby is 4 months they have doubled their birth weight. My baby was born April 16th. She weighed 7lbs 15oz. Weighed her today and she is 11 lbs 13oz. Looked it up and she is in the 2nd percentile for her weight. So, I know if she saw a doctor right now they would badger me about her being underweight. I breastfeed her on demand and she gets a small bowl of cereal when we are having dinner because she was showing strong cues that she was ready. We sit her in her bumbo on the dining table and every time we lifted the fork to our mouth she would open her mouth and lean forward. She is also reaching all of her milestones very early. She started rolling around the floor at 1 month and started crawling at 3.5 months. She is very happy, smiles all the time. So, should I be concerned that she is on the skinny side? I really don't want to supplement her with formula.

Lisa

[Devaskyla]

Opening her mouth & leaning forward isn't a cue she wants to eat, she's just imitating you. Cut out the cereal. Even if she were ready for solids, it would only be less than a tbsp a meal for quite some time. Her main nutrition should be milk for her entire first year. Food is just for fun before 12-18 months.

As for her weight, first of all, which charts did you check? Here's a great page about growth charts http://www.kellymom.com/babyconcerns...wthcharts.html

Some babies are just small. Ds3 is one of them, there are lots of babies half his age who weigh more than him. He's perfectly healthy and actually was very advanced physically (sitting on his own at 3/4 months, cruising & crawling at 6 months, etc). It sounds like your dd is doing great and you definitely don't need to supplement. Just make sure she continues having enough wet & dirty diapers and watch that she stays on the same curve on the growth chart.

[PatioGardener]

i agree - cut the cereal. it is about 6 cal/oz and breastmilk is 22! it replaces milk, and 4 month olds need all the milk they can get.

if a baby has fallen off her curve http://www.who.int/childgrowth/stand...irls_p_0_6.pdf, which it looks like she has (I got ~50% to ~5% : a big drop), the usual answer is more breastmilk - more nursing (not waiying for baby to ask), increasing mama's supply, and checking baby for tongue-tie. have you seen an LC?

[babygrey]

For reference, I have a petite babe, too (and a grown up skinny babe). DD was 7lbs, 6oz and now, at 16 1/2 months weighs just about 16lbs. That's not even in a percentile. She's healthy as can be and completely developmentally on target. For reference, she doubled her birthweight after a year.

My DS was 8lbs, 7oz at birth and he was around 18lbs at one year. (For ref, he is now 9 years old and in the 75th percentile for height, he's still skinny, tho ). I remember distinctly freaking around 3-4 months when he plummeted below the growth curve. He's grown up healthy as can be, too.

Here's the thing- I wouldn't get too caught up in growth charts. They're an aggregate of all babies- no matter the method of feeding, plus they're averages. Being not on the curve doesn't necessarily mean being unhealthy, kwim?

I'd tune into those momma senses and watch for three things with your DD- development/milestones, that she does actually gain weight (albeit slowly), and is she proportionate- ie, does she look malnourished or just plain small?

From what you've said, it sounds like your DD is doing just fine with milestones and that would certainly reassure me, as a mom.

Personally, like other pps, I'd cut the cereal, too, bc it might be masking hunger for milk.

(oh, and, FYI- we have a developmental pediatrician who doesn't care at all how tiny my DD is, as long as she's meeting the criteria I was talking about. He's a big breastfeeding supporter and believes the charts are skewed by formula fed babes. There are some reasonable docs out there )

[PatioGardener]

nak

i agree that some babies will not grow on a WHO curve and will be completely healthy. i have also seen some babies fall off the curve because they are not getting enough milk. weighing babies and growth charts are screening tools - just a flag that goes up to say "hey, take a closer look." if mama works to increase milk transfer and growth doesn't change then she knows it isn't a milk issue.

the WHO charts are a good representation of how babies typically grow in optimal conditions (breastfed, no smoking, healthy, etc), so if a baby is not having typical growth it is worth looking into a few things to make sure that this pattern is normal for this child.

[Georgetown HB Mom]

So how do I know if she is not getting enough milk? I think I am producing enough. She has soaking wet diapers, a poopy diaper once a day or once every other day. In the mornings I am over flowing with milk. And then throughout the day I am not as full but if she pulls off during nursing there is milk coming out. She has never seen a doctor because I think well baby checks are dumb unless something seems out of place. Would ya'll suggest I take her in or just keep weighing her at home?

Lisa

[PatioGardener]

Did you see how she's doing on the WHO curves? I have a 4 month old, so don't tust my math!!!

Are you guys cosleeping? How often is she nursing during the day?

[happysmileylady]

Originally Posted by Georgetown HB Mom

She has never seen a doctor because I think well baby checks are dumb unless something seems out of place. Would ya'll suggest I take her in or just keep weighing her at home?

Lisa

IMO, it's exactly this sort of situation that well baby checks are for...because if she had gone, the doc would have a history to compare against. As it stands, if you take her in, there's no record to show any type of pattern. I think the history of growth is what would help to indicate if there was any problem. I wouldn't suggest taking your little one in unless you notice that she continues to drop off her curve. With your doc not having a history to look back on, any info he suggests isn't going to be based on a whole picture.

Having said that, I have an itty bitty little one. She's 21, nearly 22 months old, and only weighs 22lbs. She's 3rd percentile and has been there for a while. Someone has to fill out the lower end of the charts, and my itty bitty is one of them. So, I don't think the size alone is enough to indicate a problem.

However, she was born at 6lbs, 5oz, so while she was always small, she wasn't always as small as 3rd percentile. When she was 8wks old, she went on a nursing strike because my cycles returned despite exclusively nursing on demand. We went through a rough couple of months with nursing, plus she caught RSV (thankfully a mild case) and those things really affected my supply. As a result, she did start to LOSE weight, which IS what concerned my doc-not that she was small, but that she started getting smaller instead of bigger. Ultimately, she landed on the 3rd percentile curve and has basically stayed there since.

I will say, my doc NEVER recommended formula, unless I simply couldn't pump anything. He did recommend, AFTER nursing, supplimenting the nursing with an additional bottle of pumped milk (when she was actually losing weight.) He only mentioned formula if I reached a point where I couldn't pump enough to be able to provide an additional bottle of pumped milk. And cereal, he recommended against it, saying that the breastmilk used to mix is actually where the majority of the calories and nutrition come from, so it's better to just provide more BM, than to do cereal.

[rhiOrion]

The only place I've seen say that they should double by four months is kellymom. I'm sure some other places say it, too, though. But I've seen other places say six months, which seems more plausible, to me. My DD was 7-9 at birth and was 13-5 at her 4 month appointment.

She's gone down a bit in percentiles, though not a whoooole lot. But I know she's getting milk.

I think the fact that your DD is meeting milestones early is a really good sign. Have you considered that maybe she uses a lot of calories to meet those milestones so early?

Of course, go with your gut. If you feel like there is an issue, take her to the pedi. Otherwise, maybe plot her on the curve yourself and watch for any more sudden drops?

[eclipse]

Well, I agree with the others that you should stop the cereal. Even if she really is ready for solid food, there are much better choices than cereal, esp for babies who are underweight. If she really want's to "eat" something while you guys eat, you might try slushy breastmilk or something like that. I'm not a stickler for the 6 month rule, myself, but it really doesn't sound like your dd is ready.

Now, on to my experience with a tiny one. My youngest was born pre-term at 35 weeks, and was in a high percentile based on his gestational age (I don't know the percentile, but he was 6lbs2 oz). He quickly dropped down to the 40th or so, and between 4 and 10 months he continued to plummet - at one point he was down around the 5th percentile. He was otherwise completely healthy and meeting milestones. Eventually, we did find out that he had a bad dairy sensitivity. We didn't find out until he started eating solids and vomiting everytime he had any dairy, but I suspect he had been quietly reacting through my milk for ages. The only clue up to that point was the weight issue and mucous in his poop. I went off dairy and so did he - the vomiting and poo issues stopped and his weight improved a bit. We also found out that he was allergic to our cats (I have no idea if that played into his weight issues, but until we rehomed them, he frequently needed allbuterol for wheezing) He can now (at almost 5) eat dairy (and be around cats for short periods!), but he's still a little guy. (Around 12th for weight and 5th for height). I suspect he was always destined to be a small guy (dh is 6-3, but I'm only 5-4ish and the tallest woman in my family and dh's brother is only around 5-9 - dh is the "freak" tall person in his family), but the food sensitivity didn't help. I guess my point is - when a child is off the normal range for anything, it's good to get it checked out. I'm not for trying to pack on weight for the sake of getting a kid to "normal" on the chart - for example, unless there's compelling evidence that gaining weight would help a situation, I don't think adding tons of butter and oil to food and feeding them ice cream every night is a good idea (and I heard all these suggestions with my son - not from his ped, but from WIC and from random busy bodies!). But getting to the bottom of the issue, if there is an issue, can't hurt. She could just be genetically small (what were your and dp's growth patterns as an infant? That can be very telling), or she could have a food sensitivity/allergy or a problem absorbing calories or a disorder of some sort. If she seems otherwise fine, it's probably just her pattern - but if it's not, you want to know, right? FTR, while my son met the technicaly definition of failure to thrive, his ped (who is awesome!) never gave him that dx. She was concerned because his growth pattern was SO different from my older two (they were pushing the other end of the chart for both height and weight) and because he had been pre-term, and because he had had RSV when he was 4 months, which was around when the big weight drop off started. But developmentally, he was doing just fine - a tad late on milestones, but as a pre-termer, that wasn't unexpected. She never recommended formula supplementation or stopping breastfeeding altogether (although she was the first one to suggest cutting dairy and soy from my diet - and it turns out it was the dairy). There ARE good peds out there that don't freak out at the drop of a hat and are pro-breastfeeding and willing to look at the child as a whole and not just the numbers in their charts. You might want to check in the "Finding Your Tribe" section and ask for ped recommendations from other MDC moms. They can tell you who your best bet is (and, probably more importantly, who to avoid at all costs!)

[Georgetown HB Mom]

Originally Posted by PatioGardener

Did you see how she's doing on the WHO curves? I have a 4 month old, so don't tust my math!!!

Are you guys cosleeping? How often is she nursing during the day?

Yes, you were correct. We do not co-sleep all night. I put her in the cradle next to my bed around midnight. She sleeps until around 5-6 am and then I bring her to bed with me. She will nurse on and off for a couple of hours and then sleep for a couple of hours. I don't know how often she nurses during the day. I have never counted. But I think she nurses about every 2-3 hours. Should I try to increase my milk supply with fenugreek or something like it?
I don't know if this makes a difference or not but she has grown 3 inches since birth.

Thanks,
Lisa

[Georgetown HB Mom]

Originally Posted by rhiOrion

The only place I've seen say that they should double by four months is kellymom. I'm sure some other places say it, too, though. But I've seen other places say six months, which seems more plausible, to me. My DD was 7-9 at birth and was 13-5 at her 4 month appointment.

She's gone down a bit in percentiles, though not a whoooole lot. But I know she's getting milk.

I think the fact that your DD is meeting milestones early is a really good sign. Have you considered that maybe she uses a lot of calories to meet those milestones so early?

Of course, go with your gut. If you feel like there is an issue, take her to the pedi. Otherwise, maybe plot her on the curve yourself and watch for any more sudden drops?

In my gut I think she is probably fine. I am going to start plotting her weight and see what happens. I think she probably does use a lot of calories during the day. She moves all over my living room chasing toys. I am just not use to having such a skinny baby. My first weighed 17lbs at 4 months, although she was formula fed so I am sure that makes a difference. That baby is now 14 and she is almost 5' 8" and is very skinny.

Thanks,
Lisa

[Georgetown HB Mom]

Originally Posted by eclipse

Well, I agree with the others that you should stop the cereal. Even if she really is ready for solid food, there are much better choices than cereal, esp for babies who are underweight. If she really want's to "eat" something while you guys eat, you might try slushy breastmilk or something like that. I'm not a stickler for the 6 month rule, myself, but it really doesn't sound like your dd is ready.

Now, on to my experience with a tiny one. My youngest was born pre-term at 35 weeks, and was in a high percentile based on his gestational age (I don't know the percentile, but he was 6lbs2 oz). He quickly dropped down to the 40th or so, and between 4 and 10 months he continued to plummet - at one point he was down around the 5th percentile. He was otherwise completely healthy and meeting milestones. Eventually, we did find out that he had a bad dairy sensitivity. We didn't find out until he started eating solids and vomiting everytime he had any dairy, but I suspect he had been quietly reacting through my milk for ages. The only clue up to that point was the weight issue and mucous in his poop. I went off dairy and so did he - the vomiting and poo issues stopped and his weight improved a bit. We also found out that he was allergic to our cats (I have no idea if that played into his weight issues, but until we rehomed them, he frequently needed allbuterol for wheezing) He can now (at almost 5) eat dairy (and be around cats for short periods!), but he's still a little guy. (Around 12th for weight and 5th for height). I suspect he was always destined to be a small guy (dh is 6-3, but I'm only 5-4ish and the tallest woman in my family and dh's brother is only around 5-9 - dh is the "freak" tall person in his family), but the food sensitivity didn't help. I guess my point is - when a child is off the normal range for anything, it's good to get it checked out. I'm not for trying to pack on weight for the sake of getting a kid to "normal" on the chart - for example, unless there's compelling evidence that gaining weight would help a situation, I don't think adding tons of butter and oil to food and feeding them ice cream every night is a good idea (and I heard all these suggestions with my son - not from his ped, but from WIC and from random busy bodies!). But getting to the bottom of the issue, if there is an issue, can't hurt. She could just be genetically small (what were your and dp's growth patterns as an infant? That can be very telling), or she could have a food sensitivity/allergy or a problem absorbing calories or a disorder of some sort. If she seems otherwise fine, it's probably just her pattern - but if it's not, you want to know, right? FTR, while my son met the technicaly definition of failure to thrive, his ped (who is awesome!) never gave him that dx. She was concerned because his growth pattern was SO different from my older two (they were pushing the other end of the chart for both height and weight) and because he had been pre-term, and because he had had RSV when he was 4 months, which was around when the big weight drop off started. But developmentally, he was doing just fine - a tad late on milestones, but as a pre-termer, that wasn't unexpected. She never recommended formula supplementation or stopping breastfeeding altogether (although she was the first one to suggest cutting dairy and soy from my diet - and it turns out it was the dairy). There ARE good peds out there that don't freak out at the drop of a hat and are pro-breastfeeding and willing to look at the child as a whole and not just the numbers in their charts. You might want to check in the "Finding Your Tribe" section and ask for ped recommendations from other MDC moms. They can tell you who your best bet is (and, probably more importantly, who to avoid at all costs!)

How do you make slushy breastmilk? Also, she does not have cereal every night. More like every 2-3 nights.
I am not a giant person. I am 5'5". My DH is only 5'10". My mom is 5'2" and I have a first cousin who is just 5 feet tall. So this baby might be my little one.

Thank you for your advice.

Lisa

[eclipse]

You can pump a bit and freeze it in ice cube trays. Take a cube out and just let it defrost a bit and smoosh it up until you can scoop it with a spoon. Some people also put the whole cube in a mesh feeder and just let the baby chomp on it - it's good for teething pain, too.