Help - Borderline Low Prealbumin in 15 month old girl

[Cybercere]

I'm so upset. My DD is 15 1/2 months old. she is 2% weight and 5-7% height. Was 7 lb 15 oz at birth and growing more in the 20th percentile until she was 4 months old. Then she slowed down. She is now 18.6 pounds and 28.75". Did all the "failure to thrive" blood work. All  normal except the prealbumin levels which were borderline low. We have to go see a pediatric nutritionist. I'm scared. I'm also blaming myself as she's been about 75% breastfed. she still won't drink cow's milk and nurses during the night (we co-sleep). I do have wine with dinner (just a small glass - probably 3 oz) and now I'm convinced that is the problem. Ped says no. I don't know what to do. She gets distracted when she's eating and is EXTERMELY active. Walked at 10 months. All of her developmental milestones were on time or early. Help! I will do any kind of diet that would help.

[crunchy_mommy]

My first thought would be allergies/intolerances -- perhaps dairy or wheat. That could theoretically cause inflammation & slight malnutrition which could lead to the low levels.

However, 'borderline low' wouldn't even be on the radar if she were otherwise healthy/growing on track. I'd be hesitant to focus exclusively on those low levels if they are still technically in 'normal' range.

I doubt a small glass of wine would cause any problems (I could be wrong, I'm not a doctor, but it just doesn't sound likely to me)... And given that she is very very active, the only other thing I would question is how your milk supply is.

Also, is your doc using the charts for breastfed babies (the WHO charts) or the CDC charts?

Another thought, did you receive an IV when she was born? If so, her birth weight could be inflated which might affect the chart of her overall pattern of growth. Has the drop off been slow & steady or was it a sudden drop at 4mos? Did she start solids at 4mos or later?

[Cybercere]

Thank you for the post and the questions/support. I did have an IV before she was born (was Group B Strep positive) and she ended up in NICU for 10 days at birth but she was 8 lbs 2 oz when she left NICU so pretty good (She had meconium aspiration -related pneumonia). She was in the 20th percentile for both height and weight until she was about 3 1/2 months and then started dropping slowly and then leveling off about 8 months to the 2-5% on both. Ped wasn't concerned. Lots of stress happened in our lives when the drop off started and then continued. (found out her dad was having an affair with the live-in nanny and then he left and becaming threatening of custody and then basically offered no support, financial or otherwise) -- so I'm convinced that the stress contributed, both through cortisol in my breast milk and through just general stress on the family. Anyway, Ped uses the CDC charts. Milk supply is pretty good still but it's a minimal part of her diet. She doesn't like cow milk. She started solids about 5 - 5/12 months ( offered around 4 1/2 but she refused). SHe loves to eat, but is easily distracted. She was on "high calorie" diet for last 6 months but really hasn't helped much. She's slowly gaining but I guess it shoudl be more.  I am trying not to worry but it's just yet another thing, know what I mean?

I guess they will test for Celiac, etc. She certainly hasn't had a reaction to any foods that I've noticed.  Thanks again,

[LROM]

I'm also not a doc, but just my mama gut says it's more the stress you went through that has affected her, and it's probably a good sign that they haven't found anything obviously wrong.  If she's slowly starting to gain again and your ped isn't worried, I'd say keep trying not to freak out.

I went through a lot of stress with DH both while pregnant and after DD was born, and even now (as recently as earlier this week when DH and I got into it) DD has always had an AMAZING ability to totally mellow herself out and just kinda be there when the stress gets high. 

Not that it's ok that she notices it and it affects her - really we should be trying to deal with our stress and not stress her out which is what we try to do.  But stress does still happen.

I guess what I'm trying to say is, babes have an amazing sensitivity and connection usually to our emotions and there's no way if you found out your DH was having an affair with the live-in nanny and then he left, no way that that stress wouldn't totally affect you and have an impact on your baby.

Do everything you can to take care of YOURSELF and your wellbeing.  That is the best thing you can do for your little one, because the stronger and healthier you are, the better able you are and will be to see to all her needs.

Best of luck to you!  Update us if you find out more!

[crunchy_mommy]

OK the first thing I would do is chart her on the WHO growth charts... because the CDC charts are based on formula-fed babies and thus skewed toward the high end in both height & weight. I looked briefly at her weight on the WHO chart and it looks like she's actually somewhere around 15% for weight on their charts (my eyes are tired so I'm having trouble following the lines lol). Here are the WHO charts http://www.who.int/childgrowth/standards/en/ and you can convert to metric with http://www.trueknowledge.com/q/18.6_lbs_in_kilograms It might be worth plotting her growth on this chart to see if she's even truly losing percentiles.

Because of the IV at birth, her actual birth weight could be a bit lower... which would mean that the high percentiles from 0-3.5 months may actually have been growth spurts/random highs... though of course this wouldn't explain height because that wouldn't be affected by an IV... I guess what I'm saying is that it's possible there really isn't even a true 'problem' here. Obviously I'm not a doctor and I have no idea if she's generally healthy or if something more serious is at play... but I have seen a lot of friends stress and worry and go through (possibly unnecessary) testing between 12-18 months and their kids turned out to be fine... So just some thoughts, good luck on figuring this out!

[belltree]

I just wanted to add, that our son was in a higher growth percentile during the first 5 months (50th Percentile) after which he dropped into the 3rd and his now back on the 25th and has been there since he's about 11 months old. Our pediatrician said, that sometimes kids establish their growth curve later on.