My 20 month old weighs 20lbs. and Ped yelled at me to wean. Please help!!! - Page 3

[mamakaikai]

Originally Posted by Marissamom 

Originally Posted by mamakaikai 

Aside from your distaste for being yelled at, makes sense, it sounds to me like your concerns are with regards to extended breastfeeding and the part about malnutrition. Firstly, many children are breastfed well beyond the age of your child, mine is one of them. Breastfeeding is known to complement nutrition for a child your sons age. So I see no need to wean your child. Weaning as far as I'm concerned is between you and your child and you can continue to see your Dr. and get decent care even if there is a disagreement about what age one should wean their child. I think it is possible that your Dr.'s intent may have been that sufficient nutrition is not being met  with a diet of mostly breastmilk. Therefore suggesting that nutritional needs may be more adequately met with a more substantial non-milk diet. So perhaps decreasing breastfeeding is not a bad idea, so that the child may be more interested in other food sources, thus gaining more sustenance from a variety of sources.

My concern for you is that your child's weight may actually be an indication of malnutrition. I know that may be a tough pill to swallow, and may not even be accurate...but I think by the sounds of your alarm, some part of you may be wondering if it actually may be factual. Have you looked at the WHO charts? Your child is very much way off the charts. If I were in your shoes, and I am not and don't actually know the whole picture...but since no one here has dared mention it...I would definitely reconsider my child's diet. If your child can't have dairy, I would look into other healthy sources of fats and calcium. Adding butter, or hemp seed oil to foods, or even by spoonful (I do this for my child and she loves it). There are alternatives for good sources of calcium too. I would also be concerned about iron, since it can impede growth and there is not enough available through breastmilk, particularly after 6 months of age.

As far as the comment about McDonalds, I think it might be fair to give the benefit of the doubt in this case. Maybe what her intent in saying that was more about acknowledging that kids can and should have fats in their diet and that sometimes it's ok to not give the healthiest of health foods. B for Balance. HCP are just people too and sometimes in a busy stressful day we say things that are not exactly what we mean, or we say things that come out the wrong way because we are tying to make a point which completely backfires on us. I think your Dr. might have your kids best interest at heart, but it's hard to see that when you feel under attack.

I'm just offering a different, perhaps harder to accept, point of view.

BTW, I'm tandem nursing a 2.5 yr old and a 5 month old. We're vegetarians, also lactose intolerant and would never *ever* eat at McD or anywhere like it...we cook from scratch and eat organic.(just to give you an idea of where my thoughts are coming from) My dd1 was about 85% breastfed at about 15 months old and she's always been in the 99% for weight, and height. My DP is 6F and weighs 145 soaking wet, I'm 5'5 and 135 postpartum...so I don't think we can always count on genetics to tell us what size our babes will be.

Wishing you and your kiddo all the best.

that link is to the CDC growth charts, not the WHO growth charts, and he's doing a lot better according to the WHO growth charts. 

Actually, it IS the WHO chart. Look at the bottom of the  chart on the left where it says Source. It's also indicated in the webaddress too that it's a WHO chart. The WHO growth charts can also be accessed from this website, which comments about the importance of using growth charts representative of the difference between breastfed babies and formula fed babies. If you were to actually print the chart and plot a 20 pound 20 month old, you would see that the point would be made completely off the chart.

[dancingWNC]

I really agree with what Mamakaikai said. I hope you can find the time and energy to look for a new ped right away.

As well, there may be some concern about getting reported if you do not comply. What many people are unaware of is the H.E.A.V.Y. pressure being put on docs to force compliance with the medical standards. Docs are being encouraged (actually if you read the med articles it's more like scaring them) to fire patients who do not comply. It's completely backwards to the "informed patient" attitude that we here employ. So shopping for a good doc is something you want to do sooner rather than later.

That said, *hug*!! I have a dd who dropped off the WHO charts entirely between 18 months and 2 years. She actually DID get lean and start to look too thin, and almost sickly. We tried feeding her everything at all hours of the day. My DH even got up at night to feed her a bowl of peanut butter and honey (which he often inserted hemp seeds, acidophilus, etc into) when she woke fussing that she was hungry. I think she at as much at 3 & 4 am as she did in the day altogether. .... sigh. It was a very difficult time.

Some suggestions:

- use almond milk - but make sure it's one of the ones that has lots of calcium. or even switch from peanut butter to almond butter. Ours eat it by the spoonful.

- sit with your little one and try making eating time a social time. ours eats much better if we let her sit on our lap to snuggle and feed bites - she comes and

- eat playfully - my DH plays a mouse game with our girls - they get under the table, and he puts a spoon of food under the table and says, "I hope a mouse doesn't eat my bites." "Noooo! Don't eat my bites!" (reverse psychology). He also pretends that his food is so good and "begs" them not to eat his food.

gotta go - baby is waking!

[rebecca_n]

my son is 24 months old and 21 and a half pounds. his doctor is finally laying off us about his weight after this last round of blood tests where they checked for celiac disease as well as thyroid and vitamin problems. he's always met his milestones and is active active active. if your son is healthy, and you would know if he wasn't, then keep doing what you're doing. i get so frustrated at doctors who know next to nothing about breastfeeding. you're son is very lucky to have you for a momma

[flightgoddess]

Well, my kid is a string bean too, he's 26 months and 25-26 lbs. We finished BF around 18 mo? Anyway, keep BF if you want to. YOU eat as much nutrient and fat dense foods too, butter, whole milk, nuts, etc. The foods you feed your son sound healthy, keep doing it.

Definatley get any related blood tests: anemia, lead, thyroid, also ask about celiac blood tests. One 'symptom' for babies is often 'failure to thrive, malnourishment, or slow growth'. It can't hurt to check.

[Spring Lily]

Here's the thing: weaning has nothing to do with the real issues here.  If he's not eating well yet and the ped is concerned, her job is to make the appropriate referral.  If he has issues with texture or aversions to trying new food, maybe get him evaluated by an OT or something.  Ask that you check witht he allergist about further testing.  Send you to a dietician about the food choices.  Talking to you about cutting down the number of times you nurse during the day, or coming up with a plan to offer x, y, and z foods before you nurse him.  Those are all plans to get to the root of the problem.  Telling you to wean is not.  So, even if for a second you ignore the inappropriate way she told you, it does concern me that she chose that approach.  Has she done blood tests to determine if he truly is lacking in nutrients? 

I can really relate in a lot of ways because my twins are small, were born small (like 1/2 the weight of your son) and weren't close to 20 pounds at 18 mos, and were on limited food as well, and no dairy at all.  Oh, and we're vegetarian.  I'll tell you my experience, because sometimes it's nice to know how other doctors handle similar situations. My pediatrician was glad that I was nursing because it was giving them that little bit of extra that they needed.  We did blood tests to check on their iron levels, in part.  We wanted to get the whole picture.  I went to an allergist who ran celiac tests and quite a few others.  Iron-deficiency, celiac disease, and wheat sensitivities can cause kids to be really underweight.  I also met with a dietician, twice, to discuss in depth the foods and meals I was giving them.  She came up with a bunch of ideas for me, including mixing in oils to certain foods, to give them extra calories.  She also took my limited list of foods they could eat at the time and thought of a few other recipes I could make, with plenty of oil added in.  Fats are so important, especially when dairy isn't an option.  When all of that only made a small dent in the problem, my ped said they are just metabolizing everything they eat.  That isn't a bad thing.  She was more concerned with family history of sizes and metabolism, and the babies sticking to their own healthy curve, regardless of if they're on the charts or not. 

Edited to add: I forgot to mention that the main focus of the dietician was actually protein rather than fat.  They're both important, but each meal or snack should ideally include a good amount of each of those things.  If you focus on getting him bigger proportions of protein, it could help make a difference.

Edited by Spring Lily - 12/2/10 at 4:25pm

[AKislandgirl]

It can be hard having a baby/toddler off of the charts. My daughter is also tiny. At 22 months she weighs 20.8 pounds. What we looked for was her dropping off of her own curve not off of general charts. We did track her weight every month for a while and when we saw that she was maintaining her own curve we relaxed a bit about it. We have also focused on adding fats to just about everything she eats. Almost everything gets flax oil, butter, coconut milk, etc... Another thing was that she had some terrible skin issues that we thought was food/allergy related. It took some time to figure out but now that she (and me!) is gluten free her skin has cleared and she is gaining at a more steady rate. We also looked at her other milestones. She was and is meeting and exceeding them.

My Dr told me she weaned her son at 20 months and looking back she wishes she had nursed him longer. She is glad that we are still nursing! She said that as long as I am comfortable with it she encourages me to stick with it. I'm sorry for the way your Dr is treating you but I would take some of her advise about tracking weight and such. It would be great for you to find a Dr you were more comfortable with who could help you. I didn't know if my daughters weight was something to be concerned about or just the way she was. I am soo glad that we followed through in keeping track of things so that I can be assured that she is healthy and growing on her own pace.

Good luck Mama!

[Toposlonoshlep]

Well, here is the update...Because I got quite a few responses with concerns over the Dr. calling CPS on me (which would be a silly thing to do...), I was really set in not closing myself off to her and explaining to her that I am not ready to wean. She recommended a blood test for lead/anemia, as well as a cardiologist visit (she heard a murmur at the last visit that she thinks is innocent, but she wants to be sure and rule it out). My concern is that the heart murmur is from anemia and potentially also responsible for slow weight gain. I didn't know that anemia could restrict growth before I posted this. Just in case, I am giving him some Floradix (which is supposed to be more bio-available than the PolyViSol I was previously giving him). I have scheduled both appointments. I told her I am not AGAINST her, but that I am defensive about breast feeding and using healthy foods to boost my kid's growth. She apologized that she came down hard on me (although she was still indignant) and told me that she has seen a lot of low-weight kids and was able to get them back on the curve. She repeated that a lot of her kids with allergies are skinny and that genetics certainly play a large part in it. She recommended we make mealtime more ceremonious and fun for him, and I think that's a great idea. Most importantly, she said that I could cut down on daytime nursing to allow him to get a taste for a variety of foods. She said to think variety, not quantity. She said she would like to see us every 2 months to monitor his growth and I agreed. Overall, I am glad I called to talk to her, because I feel as though I could work with her better without it getting "personal" like that again. Next time she gets personal, I am certainly out for good. 

I cannot thank you all enough for all of your fabulous advice and for the love. I really feel encouraged to approach this with love, patience, and instinct. You guys rock!

[belltree]

That sounds like you found a great solution. I am happy for you. I know it is so hard to not worry, when your child does not seem to be growing well. It is great you are paying attention, and most kids, that fall out of their growth curve eventually catch up again.

[weliveintheforest]

I'm glad to read your positive update!  I hope you get good info from the tests.

[shanniesue2]

Originally Posted by Toposlonoshlep 

Well, here is the update...Because I got quite a few responses with concerns over the Dr. calling CPS on me (which would be a silly thing to do...), I was really set in not closing myself off to her and explaining to her that I am not ready to wean. She recommended a blood test for lead/anemia, as well as a cardiologist visit (she heard a murmur at the last visit that she thinks is innocent, but she wants to be sure and rule it out). My concern is that the heart murmur is from anemia and potentially also responsible for slow weight gain. I didn't know that anemia could restrict growth before I posted this. Just in case, I am giving him some Floradix (which is supposed to be more bio-available than the PolyViSol I was previously giving him). I have scheduled both appointments. I told her I am not AGAINST her, but that I am defensive about breast feeding and using healthy foods to boost my kid's growth. She apologized that she came down hard on me (although she was still indignant) and told me that she has seen a lot of low-weight kids and was able to get them back on the curve. She repeated that a lot of her kids with allergies are skinny and that genetics certainly play a large part in it. She recommended we make mealtime more ceremonious and fun for him, and I think that's a great idea. Most importantly, she said that I could cut down on daytime nursing to allow him to get a taste for a variety of foods. She said to think variety, not quantity. She said she would like to see us every 2 months to monitor his growth and I agreed. Overall, I am glad I called to talk to her, because I feel as though I could work with her better without it getting "personal" like that again. Next time she gets personal, I am certainly out for good. 

I cannot thank you all enough for all of your fabulous advice and for the love. I really feel encouraged to approach this with love, patience, and instinct. You guys rock!

I'm glad you talked with her.  I think that if you want to stick with her, all parties involved are going to need to work on some relationship re-building... it soulnd like things in that area have gotten off track.

As for the cardio appt. if she thought she heard a murmur, then it's a good thing to check it out.  Our new doc heard a murmur in DS and that's how we found the cause for his weight plateau (he only gaind 4 pounds btw 5 months and 17 months).  So that is a good thing to look into.

I think that it sounds like you guys are getting things worked out and coming to a good solution.  I hope that it continues in a good direction.
 

[mamaofthree]

coming from a medical background, my biggest issue with the medical profession as a whole is the idea that they know best and some can get so bullying to the people they are suppose to care for. it takes alot for people to stand up and question their doctor. i am glad you did. and she needs to say she is sorry. she can be concerned but bullying and being disrespectful is just a no go in my book. it makes me mad when doctors get all nasty and then refuse to say what they said or how they said it was wrong.

it is so important for people to be educated and to question even the best doctor if you don't agree with what they said or understand it.

h

[klk197]

Another option (and the one we used with my small fry): find out if there is a lactation consultant/nutritionist in your city.  If one is available, it would take the weight and breastfeeding issues out of your ped's hands, and you could maintain your relationship for the other reasons you selected that doc.  In my case, the children's hospital has one on staff, and since it was classified under "nutrition" rather than "LC", my insurance covered it.  It was the best decision we made to get my son back on the growth curves.

[Toposlonoshlep]

Originally Posted by klk197 

Another option (and the one we used with my small fry): find out if there is a lactation consultant/nutritionist in your city.  If one is available, it would take the weight and breastfeeding issues out of your ped's hands, and you could maintain your relationship for the other reasons you selected that doc.  In my case, the children's hospital has one on staff, and since it was classified under "nutrition" rather than "LC", my insurance covered it.  It was the best decision we made to get my son back on the growth curves.

Huh. I like the idea A LOT. She did recommend I see a nutritionist, but I really feel I have a grasp on what foods to be offering him these days. It would be very cool to have an LC/nutritionist to talk to, though. What did you search for? I can probably look on my insurance's web site for something of the sort, but would she be called a nutritionist?

[klk197]

Originally Posted by Toposlonoshlep 

Huh. I like the idea A LOT. She did recommend I see a nutritionist, but I really feel I have a grasp on what foods to be offering him these days. It would be very cool to have an LC/nutritionist to talk to, though. What did you search for? I can probably look on my insurance's web site for something of the sort, but would she be called a nutritionist?

I have friends who work at our local children's hospital and alerted me to this option.  Only later did I find out she's a rock-star in her field (both relative to my own experience with her and in her broader professional work).  Hopefully you'll be able to find an equivalent "angel"--I'd first investigate your local hospital if there is one.  This LC floated among several departments.  I think I was billed through the GI dept, but she was often in the NICU, allergy, and developmental delays areas of the hospital.  good luck!

[cart-kay16]

i wouldnt worry i think breast feeding is great ifu dnt wanna stop then dnt i knw a friend of mine that still breat feeds he 3 year old

[holothuroidea]

You're not doing anything wrong and your baby isn't malnourished if he is gaining some weight, meeting his milestones and is generally happy. 

I make tiny babies, too. My first DD was 19lbs at her 2nd birthday. She also fell off her curve a little bit, first at 9 months then again at 18. They did some tests to rule out malabsorption issues but she tested fine and nobody's worried. 

Why did she yell at you? I don't know, maybe she just had a thorn in her paw that day. 

[waiyi]

My 18-months son is less than 21lbs, he is picky eater, so nursing is a MUST.  Everyone comments how small he is, but I was underweight even though I ate like a cow when I was young, I think he just got my genes, so I don't have problem with him underweight, as soon as he is happy and active, and he seldom gets sick.  I don't see the weight should be an issue. 

[nia82]

Granted, my son is not little, but he gained 6lbs in 2 years. He weighed 31lbs at 12 months (and that was EBF with some yogurt started at 11 months) and now at 3 years (he'll be 3 in 3 weeks) he weighs 37lbs. It's common for toddlers to not gain much. His cousin, who has always been tall but super lean (pants fall off of him) weighs 24lbs at 3 years. And yes, he nurses still and eats foods just like your son. His pediatrician is not concerned at all. Some children are just more petite than others. Goodness I weighed as much as an average 3 year old when I was 6! As long as your child is healthy and meets milestones, I wouldn't worry.