Devastated to Wean my Tiny 2 year old

[HSaunders]

My daughter's pediatrician asked me to wean her because of her low weight. The doctor is concerned about her weight because she has dropped off her curve and has always been below the 3rd percentile. We will be going in for a weight check again to let her regain any weight she lost with a bout of flu at Thanksgiving. If she hasn't gained enough we will start testing for failure to thrive. 

We decided to try giving her Pediasure and to stop nursing to see if we can get her appetite up enough to gain some weight. (she will not drink the Pediasure)

She seems healthy in every other conceivable way... She has hit almost every major development milestone through the 3 year lists and the doctor says she is speaking at a 4 year old level. I just don't understand how she isn't "thriving." 

Although the doctor has been very kind and generous with her time, I don't agree with the assessment that bf is equivalent to filling up on juice. 

I feel like everyone, the doctor, my husband, my mother, my mother in law, my dad... everyone I know has been dropping negative remarks about nursing for months now. I don't have any supporters of bf to talk to.

We are supposed to start weaning tomorrow as my husband is on Christmas break and can help out. I am feeling depressed, confused and generally heartbroken about taking bf away from Lilly. She just loves it so much. And I love being able to snuggle all her stress away. She just melts. 

Any advice? Or just understanding? 

[lookatreestar]

what would not bfing help? i would rather my kid have the calories from bm rather than pediasure. can you add some fat to her diet? what is your family like, genetics as far as size go? some people are not meant to be big or weigh a lot, for instance i am short but i am not petite. just average weight/stature kwim?

[lookatreestar]

also i'd go with your mommy instinct on this one... if it seems off or not right then don't start the weaning process. you said she is meeting milestones etc.

[prothyraia]

I bet you that if you came in and your child was too far ahead of the growth curve, they'd also be telling you to wean.

My theory is that the thinking goes something like this:  'This child is not growing normally (too slow, too fast, whatever).  Let's see...what's abnormal about their diet?  A toddler nursing??? That must be part of the problem!!' :eyeroll

Did you get any dietary advice other than weaning and trying pedisure?  What does she eat now?  Is there a reason you couldn't focus on other dietary adjustments first?

[madcap150]

BF is just not, nutritionally speaking, equivalent to filling up on juice. Although breast milk isn't ALL she needs anymore, it contains fat, protein, immunities. . . juice contains sugar. Your doctor doesn't sound well educated about breastfeeding past infancy.

Pediasure will give similar nutrition to breast milk-- in highly processed form. Why, exactly, does your doctor think that's preferable to breast milk? Does she have any medical evidence to give about what is preferable in Pediasure vs breast milk? I suspect that she just thinks breastfeeding past infancy is weird and may really not understand that breast milk still has nutritional as well as comfort value for your daughter. If you switch her to Pediasure, she loses the comfort aspect and probably gains very little nutrition-wise.

You said she has "dropped off her curve" but that she has always been at the 3rd percentile-- which suggests to me that she is naturally small. SOMEONE has to be at the 3rd percentile. That's what percentiles mean. How dramatically has she dropped off and over what time period? If this is just a very recent development, is there any reason to suspect that there is any cause other than the flu? It seems that if she's been tracking steadily at the 3rd and only now dropped off, she probably just lost weight while sick. (For some perspective, my son seemed to gain nothing in a month or two when he was less than a year old. The ped just said "he's been sick? I'm sure he's fine. He just lost some from the illness. His weight will be back up when he comes back for his well child check." Sure enough, that's what happened). Does your ped want your daughter ABOVE the 3rd percentile? Why? If she's been there all along, doesn't that suggest that's her natural pattern?

I'm also confused about the failure to thrive. I believe failure to thrive includes some kind of developmental issue and not JUST slow weight gain.

I know this is a really tough situation for you. You are under so much pressure from everyone, and are questioning what is right. But if your daughter loves nursing and you want to continue, it sounds like this is a really unnecessarily dramatic and traumatic step at this point. Your doctor looks to weaning as the "easy answer"-- but in fact it's the hard, irreversible possibly non-answer. What will happen if your daughter isn't gaining once she is weaned? How will you feel if the doctor then says "feed her avocado" or something and you think "why didn't we try that BEFORE weaning?"

If you are trying to increase her appetite for other foods (many of which, BTW, are not as caloric or nutrient-rich as breast milk), can you consider cutting back on nursing rather than weaning? You could have set times to nurse, for example (wake up and sleep times, before and after nap, etc) and push food at other times.

I know it's so hard to get pushed to wean. Follow your instincts, mama. If you feel it's not right for you and your daughter to wean, you're right.

[PatioGardener]

Have you plotted her on the WHO chart?  http://www.who.int/childgrowth/standards/cht_wfa_girls_p_0_5.pdf

Personally, I would start there.  If my baby had fallen below the curve I would want a complete health check - including things like thyroid and lead levels - and I would work to encourage highly nutrient and good fat dense foods. 

No way would I consider weaning.  Nursing is not just food.  It is immune boosting, brain growing, emotional development encouraging, jaw developing, warm cuddly happiness.  And breastfeeding a 2 year old is biologically normal.

I agree with the PPs here - follow your instincts, Mama

[D_McG]

I wouldn't wean although depending on her nursing pattern I'd look at ways to tweak it to encourage her to eat.  How much is she nursing?  

[HSaunders]

Thanks for all the replies.

I was small as a child. Never on the chart but active and always developed ahead of schedule. The doctor has never been concerned about her being small although she wanted to keep an eye on it. The concern is that she jumped off her curve. She has dropped from the third to just below the 0 percentile in the past year. Failure to Thrive is defined as crossing three percentiles and being below the 5th percentile. She has done both so I definitely want to rule out any nasty disorders like lead (we live in a very old house) or celiac disease or any of the other issues they look for. 

The other reason people are encouraging me to quit is that I have a boy due in February. I am comfortable with the idea of tandem bf them, but my husband is really not supportive. 

Before she was sick she would nurse in the morning, before and after her nap, and if she needed comforting. Since she has gotten over her flu she has ramped up and asks very frequently... up to every hour. Maybe we could keep the am bf session and just eliminate the daytime to encourage her to eat more solids. I would like her to be able to go down for a nap without bf before the new baby arrives. 

[LaurieG]

Originally Posted by HSaunders 

Thanks for all the replies.

I was small as a child. Never on the chart but active and always developed ahead of schedule. The doctor has never been concerned about her being small although she wanted to keep an eye on it. The concern is that she jumped off her curve. She has dropped from the third to just below the 0 percentile in the past year. Failure to Thrive is defined as crossing three percentiles and being below the 5th percentile. She has done both so I definitely want to rule out any nasty disorders like lead (we live in a very old house) or celiac disease or any of the other issues they look for. 

The other reason people are encouraging me to quit is that I have a boy due in February. I am comfortable with the idea of tandem bf them, but my husband is really not supportive. 

Before she was sick she would nurse in the morning, before and after her nap, and if she needed comforting. Since she has gotten over her flu she has ramped up and asks very frequently... up to every hour. Maybe we could keep the am bf session and just eliminate the daytime to encourage her to eat more solids. I would like her to be able to go down for a nap without bf before the new baby arrives. 

A work up to rule out medical reasons for the drop in percentile seems reasonable.  As you are looking at possible explanations you might read up on Turner Syndrome.  My daughter has TS and a child who is small at birth and through infancy and then drops off the curve in toddlerhood but appears to be otherwise healthy and developing well fits the profile.  Many docs don't think to test for it.  http://www.turnersyndrome.org/what_is_ts.htm  if you want to read more.  

As for weaning, given the adjustments she will be going through in a short time with having a new baby I would consider whether now is the right time to wean as well.  Can you educate your husband on the benefits of tandem nursing?  Maybe have him do some reading to get used to the idea?  One other thing to mention to him is that toddlers who are weaning when a new baby is born often plump up some when mom's milk comes in.   I agree with the pp's about tweaking the nursing schedule so that she is hungry for other foods, although to be honest when people gave me that same advise I found it nearly impossible to implement as my DD was not willing to be redirected.  But maybe your DD is more easy going in that respect.

Good luck.

Edited to add:  When I re-read your original post I realized the percentiles you are giving are for weight where I was thinking weight and height were both an issue.  What is her height doing?  That would be a clue as to whether the reason for the drop is nutritional.

[Bebe's Mom]

Just my two cents...My neighbor FF her child and he has similar problems. I don't think weaning would really help if your child is just small. I would get another opinion. I had an interesting discussion re doctors and their knowledge of BF at my last LLL meeting. Turns out that most doctors get less than 8 hours of BF education during their entire schooling..which means they know next to nothing about BF and its affect on children and the nutritional aspects. this info came from a speech by a doctor at an LLL convention in DC. This doctor is a pediatrician who bf's her toddler(!) and has done lots of research into this matter. It seems like to me anyway, that many doctors do not understand breastfeeding at all, and are likely to discount its benefits..they say they support it, but in most cases it is lip service. I agree, you should try to get DD to eat more solids, and maybe do a supplement? But it seems counterproductive to wean her just to put her on formula, which does not have the antibodies that she needs to fight infections. I don't blame her for not wanting to drink Pediasure, that stuff is gross. Good luck, and follow your instincts on this one.

[D_McG]

OK so it's not like she was nursing 20 times a day.   Because that plus your pregnancy (little or no milk) might I think explain a poor appetite/poor habits.  ( I'm assuming she is nightweaned?).  

Can you give us an idea of what her day looks like, eating wise?  Somebody might be able to give you ideas about how to get some extra calories into her.

I don't think weaning 100% is the answer here. And I'm quicker than more here to support weaning, I think.

[etsdtm99]

I don't see how weaning could possibly help - i think if anything getting more calories into her in addition to nursing is the answer .. IF there is even a question since you were small i wouldnt even be thinking about this.. it seems obvious she is taking after you?! .. because you are pregnant and possibly dont have much milk anyway, nursing cuold be no different than using a pacifier (i completely lose my milk in the 2nd & 3rd trimester)- would your pedi tell you to take away a pacifier because that is keeping a 2 year old from eating? most likely not. if that is the case maybe cut back to just bedtime/morning for a while until your new baby comes and your milk supply is in full force again.. at that point i would be very confident in nursing them both ..you will likely have gobs of milk at that point more than you would normally nursing a 2 year old - because you'll be nursing a baby too ..i would watch her weight carefully at that point just to see if she gains on more of your milk .. if they do some tests and she doesn't have any current health problems other than not gaining like they want her to what is the rush?  february is only a couple months away (as i'm sure you know!) ..if she DOES have another health problem i would want to see some very solid evidence that breastfeeding would make it worse before i would wean..  in my experience it can take a while to get over a flu (i assume you mean stomach flu) when my kids have had bad bugs it takes them upt o 3-4 weeks to go back to eating normally..

[haydn'smommy]

Keep in mind I'm a PNP, so this is written from that perspective as well as from the mommy view.

I'm seriously confused here. Your child isn't growing and gaining and your ped just automatically goes to weaning rather than doing testing to find out WHY? That's just plain bad medicine. Sure, look at diet, but other areas need to be checked as well. I'd be looking for a second opinion at least, and possibly a new ped.

First, the type of milk you choose to give to your child is none of our business really. If your child is eating a decent amount of solid food, then the milk is a non-issue. If nursing her was really the equivalent of filling up on juice, then your child would be a big fat kid cause juice is just nothing but sugar. So, your ped is dead wrong on that.

If your child was my patient, I would encourage high calorie, healthy fat meals and snacks, making every bite count. I'd encourage you to continue to nurse and to supplement with the milk of your choice or pediasure via cup if your child needed or wanted liquids other than breastmilk. I'd order some tests to look at her iron, her electrolytes and kidney function, her thyroid (CBC, BMP, T4, TSH) and I'd do a UA. I might even do some RAST testing to make sure we weren't dealing with an allergy that might be affecting absorption.

Keep your chin up, mama. I know how hard it is to continue to nurse in the face of negativity. :hugs:

[lynsage]

Time to get a new pediatrician!

[AislinCarys]

Below 5th percentile is NOT FTR!

This makes me so angry to hear that drs think. The WHO weight chart includes optimal growth for healthy babies. It isn't any better to be on the 50th percentile or 97th than to be on the 3rd. DD was 3 percent, and dropped off it for a while, so we've been there.

Someone asked how her height is doing. I'd be interested in that too. And have you charted her on the WHO charts? Have your child lost weight or just been standing still?

And also, for weight gain to stall or even to lose weight in illness is common, and expected. It is also common for very mobile toddlers to stall in weight. When DD was 18 months, long after everyone had stopped worrying about her, she lost weight after a cold. The (very mainstream) dr was totally relaxed about it, just told me that if I was worried I could bring DD to their Open Weighing (once a week, free access to their scales), in a couple of months, as she was sure DD would be gaining again by then.

[PGTlatte]

You do not have to do what this doctor says. 

You also do not have to be truthful with a doctor who has displayed such staggering ignorance - breast milk = juice ?  This person needs to do some research.

Me, frankly, I would not bother arguing with a doctor like this.  I have a friend who openly opposed a doctor on weaning a low-weight child and the doctor called CPS.  For this reason, I would continue nursing, but tell the doctor what he wants to hear.  I would sincerely look for ways to get more calories into her diet...but I would not stop nursing at this doctor's orders. 

If nobody has mentioned it, the Kellymom site has a fact sheet on toddler nursing that would clear up any questions about its nutritional value.  I would give this to your DH, family, anyone else who gives you grief about it...but not the doctor, at least not until you are on the other side of this situation.

[kalamos23]

I have a kid on the opposite end of the charts and am also pregnant with a nursing 2 year old - DD was always way above the 97th percentile - like a half inch above for weight and height - I was told that she was gaining too fast and that she weighed too much even though she is proportionate. She hit 36lbs and 36in at 18m, and then at her 2yo appt she was 36 lbs and 38.25 in. I'm not sure how tall she is now, but she is STILL around 36 lbs almost a year later. I think some of this has to do with the pregnancy (almost 6m pregnant here, and right after a m/c so I've been pregnant for about 7m in a row) drying up my milk, because she did not really start eating any major quantity of solids until I got pregnant and my supply dropped. I would bet anything, if your DD is a booby monster like mine, that she is probably just not eating as solids as she used to get from breastmilk and also it is a VERY common time for kids to thin out what with how active they are.

I honestly think that if DD had not been so big in the first place, we would probably be getting the same talk from our ped as you are. If your DD is hitting milestones, I wouldn't be too concerned. In all honesty, I would just push more healthy fats and see if she will snack more often, I know DD eats a lot more (and she is incredibly picky) if I just keep offering it to her all the time so she can graze. Also, my DD doesn't drink milk due to a dairy allergy and not liking the taste even though she outgrew the allergy, but will eat cheeses and yogurts, which are good types of calcium/proteins. She might like those over the Pediasure.

The other thing is, if you continue nursing, and end up tandem nursing, I have heard of MANY toddlers who gain like crazy once the newborn fatty milk comes in, so she might be a little on the thin side now, but I bet she gains a bunch when you have the baby in February. I would delay your doctor and DH until after the baby comes for sure, because that milk is the good creamy weight gaining stuff.

[kalamos23]

Originally Posted by laundrycrisis 

You do not have to do what this doctor says. 

You also do not have to be truthful with a doctor who has displayed such staggering ignorance - breast milk = juice ?  This person needs to do some research.

Me, frankly, I would not bother arguing with a doctor like this.  I have a friend who openly opposed a doctor on weaning a low-weight child and the doctor called CPS.  For this reason, I would continue nursing, but tell the doctor what he wants to hear.  I would sincerely look for ways to get more calories into her diet...but I would not stop nursing at this doctor's orders. 

If nobody has mentioned it, the Kellymom site has a fact sheet on toddler nursing that would clear up any questions about its nutritional value.  I would give this to your DH, family, anyone else who gives you grief about it...but not the doctor, at least not until you are on the other side of this situation.

True dat to all of the above.
 

[PGTlatte]

I came back this morning to add some thoughts.  I would consider listening to advice along the lines of, "perhaps your child is choosing to nurse instead of eat....she may eat more food if you limit her access to nursing at times you know she is hungry, and then nurse after she has eaten some food."  That would be reasonable.  It really is not different than a child who chooses to drink a lot of cow's milk instead of eating.  A doctor might suggest limiting access to the cow's milk to encourage more eating....but would not equate cow's milk to juice.  That is not reasonable at all ... of course breast milk is at least equal to cow's milk in value.  We know it's worth more than that, but even a doctor who doesn't believe there is any value in extended nursing can't argue that breast milk has less value than cow's milk...seriously.

[HSaunders]

Hi All,

Thanks again for your insight and encouragement! I am so glad I posted here!

I have been able to get Lilly to eat more since I posted. This involves me chasing her around with food for a portion of the day since she is too active to be interested in eating at the table for very long. She has been gobbling a variety of foods and eating a lot more protein than she ever has in the past! And she seems to be gaining weight! Hopefully she will have gained enough to not need any testing. Everyone who knows her believes she is healthy...

We are continuing to nurse, just altering the schedule to encourage her to eat more solids. With daddy's help, I am hoping to get Lily to the point where she can nap without nursing before the new baby arrives in a few weeks. I agree with you all that nursing is in her best interest... and mine! I am feeling a lot more sane now that we've made the decision to continue. 

I have considered switching doctors, but feel that I can nurse Lilly with or without her support. Plus, she has been very cooperative with me in the immunization department! The reason the ped recommended waiting on the testing is that Lilly was just getting over the flu and she didn't want to put Lilly through the blood-work without cause. She wanted to give us time to get her weight back up (which it seems to be) before jumping to conclusions. Hence the nutrition recommendations... which we have cherry picked to what I believe is right for us. (no Pediasure, still nursing)

Our weight check is on the 23rd. I will let you all know how it goes!