6-month old not gaining weight since 4 months

[TarynDickey]

My 6-month-old  daughter (exclusively breastfed) hasn't gained weight since her 4 month check up, in fact she has lost a couple of ounces. She has only grown 1.25 in in length and 1 cm in head circumference. She had been in between the 10th and 25th &ile for weight, and had been close to the 50th %ile for length and head. Around 4 months, she moved lower in %iles for all, and now (at 6 months) she is <1st %ile for weight, 5th %ile for length, and 10th %ile for head 

She had been sleeping great up until about 4 months and then sleep went a little haywire - I chalked it up to teething, developmental, etc. She had been able to do 6-9 hour stretches at night with 1 feeding, and now can only do 3-4 hour stretches with 2-3 feedings (totaling 12 hours of nighttime sleep both before and now).

She does spit up frequently, and I know a lot of people think how much their baby spits up is much more than it actually is, but she typically spits up a good amount sometimes 3-4 times after a feeding.

About 2 weeks ago, we started solids and introduced avocado, sweet potato, and oatmeal. She seems to have a reaction to avocado on her hands (turned red and got a little swollen) and then with oatmeal (raised pink rash - many dots collected to make the rash) all over her abdomen, chest, and back. For the last two weeks, I have noticed (it could have been longer) that she arches her back and throws her head back at times (more so at night) after feedings. The last two days, I have tried having her in a more upright position while nursing and keeping her upright for at least 30 minutes after feeding, and it has seemed to help with spitting up issues.

She seems to have plenty of wet diapers, but only has dirty ones 1-2 times a week and sometimes we have to give her some prune juice, because she appears to be uncomfortable, and it usually does the trick. When she does have dirty diapers, they appear to be pretty normal in color and in texture. 

She also has a mild case of eczema and currently has a yeast infection, both of which are being treating with hydrocortisone and nystatin, respectively.

Lastly, she appears to be meeting milestones just fine. She seems happy almost always, is interactive, babbles and giggles, sits up on her own, stands with assistance, grabs and pulls toys/items with both hands and with one hand to her body and her mouth, can roll over (doesn't do it frequently, but can do it), puts her butt up in the air and turns her toes under to try and scoot while on her tummy...

The pediatrician wants us to see a GI specialist and used the words "failure to thrive"...we have an appt with the specialist on Nov. 8th. 

What are your thoughts about her growth pattern? Is it truly of great concern? Any insight you can offer is greatly appreciated. As you can imagine, not only am I not sleeping because my kiddo doesn't sleep for more than 3-4 hour stretches at night, but also I am now losing sleep over my worry for her and her growth.

[lfpalmer]

Please clarify one thing for me… when did you begin the prune juice? It’s fine; I’m just looking for a full picture.

Three to 4 hour stretches of sleep at night between nursings is very common among naturally fed babies; even shorter stretches, and night feeding sometimes becomes even more intensive at older months. If this were the only symptom, I’d not be concerned, but your baby does present some other symptoms of concern. As you said, all her milestones are met and so you’re doing great, but maybe we can make her nutrition and comfort more optimal to be sure her weight is where her genes want it to be.

Your daughter has definite signs of food allergy: the spitting up, irregular bowel movements, eczema, candida and arching her back, along with the definite reactions you witnessed when starting solids. My recommendation would be to forego the solid foods, unless there are any you are sure she’s fine with, and start yourself on a full elimination diet in order to eliminate any possible foods that your daughter may be reacting to in your milk. There are simpler, more gradual ways to go, but your baby has reacted to uncommon allergens and you also have only two weeks to come up with something positive to report to the GI doctor.

An example diet for you would be to eat nothing but lamb, rice (the oatmeal reaction makes me even a little wary of rice – you could use amaranth and tapioca for even less potential for reaction), dark greens, refined oils (no healthfood store oils), persimmons, maple syrup, maybe fortified hemp milk, and any foods you feel sure your baby tolerates. (You can find elimination diet info online or in my book “The Baby Bond.”) Hopefully after a few days your baby’s symptoms will reduce. Once she’s doing well you can begin adding foods back into your diet one at a time and watching your daughter for reactions.

Many moms choose to use the hydrocortisone very sparingly for eczema, or not at all. You might want to use it only if the rash is causing your child great discomfort or scratching. It does not address the cause of the eczema and it can make your baby fussier as it absorbs into the blood stream and stimulates the adrenals.

[TarynDickey]

Thank you so much for getting back to me and sharing your thoughts.

We started the prune juice about 3 weeks ago and have only used it sparingly, perhaps 4 times total.

How likely is it that she just developed an allergy to something I am eating after four months of no issue? She had been following her growth pattern and gained about 5.5 lbs in the first 4 months. As I said, she slept very well. She spit up probably as much as other babies who spit up and was pooping regularly and not exhibiting any colicky signs. I haven't changed anything in my diet (creature of habit!). I am, however, certainly for trying anything that will help my daughter feel better and for her growth to get back on track. 

Along similar lines, a friend of mine's pediatrician mentioned to her when her daughter was having similar issues that her working out may have something to do with it. Something about the hormones and chemical make up of the breastmilk changing and affecting the baby. Have you ever heard of a such of thing? Interestingly enough, I started running again when my daughter was about 16 weeks about 3 times a week (not for very far, though!), where we started having some problems and then a month ago I changed to yoga 1x and weight training 2x a week, which is when she really started having an issue and was uncomfortable and waking every 1-2 hours. In the last two months, my husband and I have been walking just about every night with our daughter for 40-60 min - it had been an effort to keep her awake a little longer in the evening. Oddly enough, I haven't worked out since last Wednesday - and since Sunday, she has consistently gone to bed at the same time, awoken only twice in the night, and her nap schedule has been normal... 

I may be completely grasping at straws, but when I look at her growth charts, it seems rather coincidental, if anything.

Once again, thank you so much for your time and all of the information you provided.

[lfpalmer]

It is quite common for food allergies to develop over the first months in babies, and also for them to go away randomly in the first couple of years. That doesn’t mean this IS your child’s challenge. I do trust what moms observe and you sound pretty sure that you observed allergic reactions to some solid foods. Any child who’s going to truly react to those low-allergen foods is very likely to have been having other reactions. Reflux is very much a food sensitivity thing. Sure, it could just be a new spit-up habit that is inconsequential. Maybe the rashes are just from topical contact with the foods? Or some fluky coincidence?

Even the drop in the weight curve can just be your daughter directing more toward her genetic destiny. Are mom and dad on the smaller side? Very different factors affect a child’s birth weight than those leading to their eventual genetic destiny. Some babies go up on the curves, some go down; they are averages for each age. What I’d really like to see is for someone to make curves for the rates of babies rising or falling on the charts over time.

There’s no one symptom you describe that gives me any concern. It does seem to suggest an allergy picture when you put the factors all together, but not a bad one, and maybe not at all. Eczema is more certainly a food reaction but it may not be bad enough to worry much about.

I have heard the rumors about breastfeeding and exercise. There could be a little more cortisol going through you…

I don’t feel your child is in any kind of urgent danger. She sounds healthy and happy. You can decide any day to go to or not go to an elimination diet. Maybe you’d prefer to spend some more time observing and experimenting. I see no reason not to. My sense of urgency was your upcoming GI consult. I don’t want to see your child have to go through a bunch of invasive diagnostic tests or given medications for things that might be easily resolved. I also know the GI will tell you that food allergies are not worth looking for (in any child’s case), may order tests that will most likely come out negative, or “find” some excess acid or loose sphincter, diagnose your child with reflux and prescribe proton pump inhibitor medications (that are not proven by research to reduce symptoms) without looking for a cause (other than the loose sphincter theory), and very probably tell you that your baby needs to be supplemented with artificial breastmilk (formula); another non-evidence-based move.

If you can go to the GI and evaluate what he/she says with your same analytical mind, and maybe ask whether some of the suggestions can wait if things don’t look urgent, it can’t hurt to go.

[TarynDickey]

Thank you for your response. I can absolutely appreciate the concerns about the GI specialist. My nephew went to see one and they want to knock him out for a procedure and start him on hypoallergenic formula - fortunately, my sister said "No!" and figured out that it was a foremilk/hindmilk issue that was causing the green/mucousy stool issue.

Looking at my husband when he was a baby - his pictures where he was a 12-month-old and walking...he looks like a 6-month-old! He was a total peanut, and even now barely weighs 155 soaking wet. I, too, am on the smaller side.

In any case, I officially started my elimination diet today, so we will see what we discover over the next few weeks.

Thanks again for your help.

[TarynDickey]

Just wanted to update you a bit...I officially started my total elimination diet on October 28th and since then my daughter's eczema has cleared up (even her cradle cap is significantly less), her yeast infection/diaper rash is nearly gone and  her spitting up has gone from 2-3 times after a feeding to maybe 2-3 times a day, and much less in the amount of spit up when she does. We just had a doctor's appt yesterday and she gained 6 ounces in 15 days! She also grew 0.5" in three weeks. She's sleeping better (although, she's definitely cutting her bottom teeth, so we've had a little disruption there the last two days) and even her stools are becoming more regular.

 

I have to believe that she was having a reaction to something I was eating - I'll be reintroducing foods starting this weekend and going slow so we can be sure about what really bothers her - starting with foods that are least likely to offend. I'll probably continue to be dairy- soy- and gluten-free for some time. We have the appointment with the GI specialist on Monday and I'm hopeful that we can address her reflux issues and apparent tummy troubles with the knowledge that she probably has some allergies to certain foods.

 

Thanks again for your help and suggestions!

[lfpalmer]

woohoo