Another "Please talk to me about weight gain and growth curves" thread

[marinak1977]

Hi Mamas, I just need some reassurance and advice from BTDT mamas.

DS just went to his 12 month check up and he has fallen from around 25th percentile down to 5th. His height went from 25th percentile to 11th as well. He gained just under a pound in 3 month. My pediatrician who I normally love is concerned and wants him to gain faster. Surprisingly (or not?) her suggestion for getting him to eat during the day was to nightwean. I disagree, but I am also second-guessing myself.

Here is the situation. DS is 12.5 months
DS is in daycare full time, is still primarily BF and he eats mostly in the evening, he doesn't drink much from the sippy or a bottle during the day. He goes to sleep around 8pm, nurses to sleep usually, nurses again before I get to bed around 11 at least once. He then wakes me up once to nurse on good nights or more frequently if he is off (teething, cold, whatever). We nurse on demand. My approach to solids has been baby led all the way, so DS doesn't really eat purees and we never made it our goal to get food into him, but rather focused on him experiencing textures and flavors. Now I'm wondering if I need to change my attitude towards solids. Currently he gets a few bites for breakfast (dried fruit, cheese, yogurt, whole grain cracker), is usually mildly interested but not ravenous, he then gets a snack, a lunch, and another snack at daycare. His interest in solids wanes during the day. He gets BM in his sippy but drinks only a couple of ounces. He is usually very hungry when I pick him up and nurses for a long time, then he may dabble with solids for dinner then get more breastfeeding before starting the bedtime.
DS has 2 teeth out on the bottom and 4 just through on the top. He was gaining steadily until he was 9 months, he became truly mobile at about 10 months.
He is full of energy, is in a great mood, and is meeting his milestones well. I think he burns a lot of energy now that he can get places and that's why he is not gaining as fast. He also slowed down in his growth in length, but that feels normal to me. But I do not want him to get inadequate nutrition.
My current strategy would be to encourage solids while BFing on demand, and increasing foods rich in calories. DS likes meat, fish, greek yogurt, ice cream (yum! but I don't want him to get used to eating only rich sweet food). He likes bread. I was thinking I can start making nice eggy pancakes and buttery food and up his fish and meat. I also asked his DCP to pay special care to getting DS to eat and to help him with drinking a little more.

So, please tell me, should I worry? Do I need to feed him purees? Should I nightwean? (please say no)
Any BTDT tips on getting more good calories into a busy toddler?
Thank you for reading all this!

[ryan'smom]

Another mama of a "petite" toddler here.  My ds is 17 months and hasn't broken the 20# barrier yet.  It is a constant source of worry for me, but the only thing that I am sure of is the nursing.  My ds wakes up frequently to night nurse and I almost WELCOME it because I've read that breastmilk has a higher fat content at night....and I want him to get those extra calories. 

My family doctor is concerned about my ds's weight and besides encourageing more solids intake he has ordered a battery of tests for him that all keep coming back normal.  He is a very active guy and I think he is just going to be naturally petite and slim.  I will continue to keep a close eye on him and just take it day by day.

One thing that has worked for us in feeding a busy toddler is feeding him when he is distracted....like in the bathtub, or while he's playing with blocks, etc.  I know that when he is truely not hungry, he will even refuse in these situations and I just have to let myself trust this.

I will be checking this thread for ideas/opinions of others as well.

Good luck mama!!   

[Courtney-Ostaff]

I used to really worry about it, but my pediatrician always said, "She's just petite!"  I kept a food diary for a while, and realized that she was actually eating a fairly normal amount. Remember, 2 tablespoons is a serving at that age!  It's not that my daughter wasn't interested in food, it's just that she never ate much, and slid around anywhere from the 5th to the 25% percentile for weight, and the 50%-75% for height.  So, I got one of those kidco food grinders, and just let her eat what I was eating. No chocolate, but everything else was fair game.

http://www.amazon.com/KidCo-Baby-Steps-Food-Carrying/dp/B00006G9LI

We finally had to wean at 2 1/2, due to caries, but her weight has stayed the same, and she's been remarkably healthy.  I've had lots of friends with kids who've had eating problems, and usually it comes down to an unknown food allergy.  Thank goodness I've not had to worry about that.

The FTT kids have specific markers:

Infants or children who fail to thrive have a height, weight, and head circumference that do not match standard growth charts. The person's weight falls lower than 3rd percentile (as outlined in standard growth charts) or 20% below the ideal weight for their height. Growing may have slowed or stopped after a previously established growth curve.

The following are delayed or slow to develop:

• Physical skills such as rolling over, sitting, standing and walking
• Mental and social skills
• Secondary sexual characteristics (delayed in adolescents)

http://www.cdc.gov/ncbddd/actearly/milestones/milestones-1yr.html

[AnnaNova]

i could have written your post when my son was that age (almost 2 now), his dr never seemed to worry to much and said he'd prefer him on this end of spectrum than on the other. additionally, i fished out a growth chart from WHO and not AAP and my son was right in the 50th % according to that. which is about where your son is now. he also did a lot of exploration / was starting to walk at that time and i think he burned more calories and was less interested in food. he went back up to 20-30% in a few months. i was worried too, but i let it go and let him nurse at night and eat as much as he wanted.

we did go to see my mom in october and stayed for a month and he gained a fair amount of weight while we were there because grandma's solution to every problem is food. food was offered nearly every 2 hrs, it was all delicious and home made, soups were meat-broth based and very hearty. she always made sure he ate if we were about to go somewhere and every time we came back home from somewhere. it wasnt forced on him, just offered and ecouraged. i dont do that as much not that we are back home, it more of breakfast-lunch-dinner and a snack in between kind of deal.

[mckittre]

I have an almost 2 yr old in the 3rd %.  Maybe 10th or so for height, with a big head.  He's fine.  He dropped down from around 25th at about a year too, learning to walk, and settling into his own curve.  I was a tiny toddler too, and am also fine. 

[RaeDyCo]

We don't do 9 month WBV here, just 6 and 12 month. Both my boys gained maybe 2-3 lbs between 6 & 12 months though and both ended up dropping on the curve -- from around 50% to 25%. They both grew in height (kept on their curve - 85-90%), head circ also grew. However, they both started walking pretty early (DS1 at 10 months and DS2 at 8 1/2 months) so they were constantly moving. It's no wonder that the weight didn't pile on!

While my doctor fills out the growth charts, she believes they really aren't accurate until a child is a year old. Both my boys put on weight like crazy in the first 4 months (75 - 90%) and then they dropped at 6 months, then again at 12 months. Well, DS1 is still at the 25% at 3 1/2... he is tall and skinny (obviously inherited from his dad, not me ). I'm assuming DS2 is going to follow a similar path.

I wouldn't stress about offering more food but maybe just make the foods you offer count... olive oil on pasta, avocado, add wheat germ or flax oil to yogurt. I also give the boys smoothies with strawberries, bananas, avocado and yogurt.

I definitely don't agree with nightweaning!

[ellemenope]

Born-             7lbs

12 months-    13lbs   Completely weaned at 12 months.

18 months-    19lbs

24 months-    21lbs

30 months-    24lbs

DD eats like a bird, but is as healthy as can be.  We have never forced her to eat.  She would eat a lot one week and gain 2 lbs, and then for the next 6 months, eat like a bird again.  We balance calories and nutrition on a daily basis, to keep her both happy in the short term and healthy in the long term.  She has tiny feet and a huge bum.

[marinak1977]

Thank you everyone for sharing your experiences and advice. I'm glad that my instincts that everything is ok and there is no need to panic appear to be accurate. DS is so active and happy and is constantly moving, he must burn tons of energy. I am letting him breastfeed as much as possible, as long as he stops moving.
I did start to offer more calorie rich foods yyesterday night and ones that are easier to swallow (I think a lot of big chunks he would just suck on and taste but not really injest). I sent him to daycare with pancakes, chicken liver, eggs and blueberries. Hopefully he likes some of the high calorie stuff. Fingers crossed. He did go to town on greek yogurt last night and the whole house was covered in it
I think part of the freakout for me was the guilt in not being near him to breastfeed during the day combined with my pediatrician's awful bedside manner (which was shocking ).
I gotta go now but will post more later.

[kittywitty]

Sounds like my 3yo. I always believed she was just petite- dh's family are super small, all the women around 5' tall. I was petite until Junior High. However. I would look into getting a thyroid test if any other symptoms-low energy, poor appetite, rough dry skin, etc. appear. We thought my 6 yo was just petite for years and it turns out she has a severely diseased thyroid causing the problems. So we brushed it off for 4 years as just family smallness until a doctor mistook her for a 3 year old and listened to our concerns over her eating issues. Many children have no symptoms at all besides height/weight. So please keep that in mind. Don't panic though, a ton of kids are just small (like me as a kid! I could bathe in our kitchen sink at age 5!).

[beebalmmama]

My little guy is about the same too. He was growing so much up until about 9 months and then dropped down to the 5% in weight around 11 months. If he's not drinking much BM during the day then I definitely would keep nursing at night. I've been giving ds more fatty rich foods, buttered toast, whole milk yogurt, he'll now eat avacado. He also eats a lot of beans and sweet potatoes, some pasta, pancakes. He loves fruit and hasn't gone for a lot of other proteins, so I do make sure to offer beans every couple of days. I think it is wise to get your DCP involved to encourage him to eat. But even my little guy has been so distracted lately that he often won't eat much breakfast which used to be the one meal I could count on. He's teething too which seems to affect how much he'll eat. But he's always been on the lean side. It's hard for me to keep a good perspective when his brother was such a chunker at that age and was nursing a whole lot more at night than ds 2 does. So I really don't think night nursing has anything to do with it.

[marinak1977]

thank you for the reassurance mamas, I've been definitely offering food more to DS and feeling less guilty when he chomped down a chunk of a croissant. I went to the store today and got a bunch of coconut milk, coconut oil, and other hearty food.
I'm going to make millet in coconut milk with maple syrup tonight for DH to feed DS tomorrow during the day when I'm gone. I also got wheat germ to add to the yogurt.
In the last day DS seems to have eaten lots of food and breastfed a lot. So maybe he just needed to hear that he needs to gain weight.
I am shocked that after the very limited discussion on DS's feeding habits my pediatrician came out with the nightweaning recommendation. Just shoked She didn't even bother suggesting food richer in calories or encouraging more solids during the day. So weird. In addition she presented it in a really gruff (I need you to stop breastfeeding ... (long pause as my jaw drops to the floor ) ... ... at night. talk about a shocker.
I was too flabbergasted to argue but right away I knew I won't be following that advice.
And she is generally so breastfeeding, AP, selective vax friendly. Such a shame.

[Nicole730]

Just wanted to reassure you some more.  My son was 50th for weight and 75th for height until his 12 month check up.  He went down to 10th for weight and 25th for height.  He didn't get teeth until after his 1st birthday and barely ate solids at that point.  He's pretty much stayed skinny since then and I don't have his stats anymore.  From one year to two years he gained 4lbs and from 2years to now (he turns 3 in April) he's gained 3lbs.

[Abraisme]

This all sounds really normal to me.  Most of the kids in my parenting group have small toddlers, many of which started out as normal sized babies.

My DD was:

Birth: 7lbs 8oz

4mo: 14lbs

9mo: 19lbs

17mo: 21lbs

She's really hardly gained any weight at all since she was 9mo.  She used to be all plump and covered in rolls, now she's a stretched out version of her former self.  ;)  At 17mo she's now in the 15th% in both height and weight.  She comes from small people, so it's what I expect.  I always look at how healthy a kid is, not what size they are!  :) 

[titania8]

did she mention what benefit your son would have with being heavier? its clear that you are taking good care of him, so that's not a concern, which leaves us wondering WHAT the problem actually IS. will he be healthier if he's 2 pounds heavier? happier? smarter? he's nursing and eating what interests him from the healthy options you are offering. sounds prefect to me.

[marinak1977]

Titania, that's a really good point. I think DS is very healthy and developing well. I also think it's fair to have a re-weigh just to make sure that he hasn't stopped growing completely or started losing weight for some underlying reason. It was also a good wake up call to me to adjust to his new daycare situation where there are no bottles by offering him tastier/easier to eat food during the day so that he doesn't go hungry in daycare, but sheesh. Nightweaning seemed harsh and unnessessary.

[mckittre]

I guess I think about this with my small kid too.  I think that the potential issue isn't being small or skinny.  The potential issue is missing some underlying health issue that's causing the small size.  So I mostly feel OK about my healthy 3 percenter, but do have a little worry in the back of my mind occasionally.

[AKislandgirl]

My DD who will be 2 next week is also very tiny and always has been. She weighs 21 pounds now and is not on the growth chart. We took her in to do weight checks monthly for a bit and saw that she was slowly gaining. We also pinned down a gluten allergy. I have noticed that her weight gain has increased now that we understand her allergy and she and I (still bf) are gluten free.  What we did is concentrate on increasing the fats in anything she was eating. We do lots of butter, avocado, coconut oil, flax oil, whole milk yogurt, peanut butter, etc... Cooking with coconut milk (from the can not from the milk section) is another way to add healthy fats.  SOme days she till doesn't eat much and I worry about it but other days she eats a ton. I also let her nurse as much as she wants at night until recently. Nightweaning will not help!

Good luck!

[Tattooed Hand]

I just went to my DD's 12 month and she only gained 13 oz in 3 months. But she held steady in the 10% for weight. She is very small but started walking at 10 months. My doctor was not at all worried. My doctor uses the WHO chart. Maybe your doctor uses another chart?

Anyway, it sounds like you've got it figured out and threw out your ped's bad adivce and began offering your DS more solids. Mine was later in eating but when she began walking, she became an enthusiastic eater and remained a champion nurser.