I have a question that I would really love some help with -- research, experience, personal preference... anything... just trying to sort out what I should do.
I am practicing baby led weaning with my daughter, who is just over 2 years old. She's a very happy, apparently healthy child. She has always been on the skinny side (as am I, and my other child, so seems normal to me), but we just had her first checkup in a year -- I skipped her 18 mo one -- and she is 20-25th% for weight and closer to 50th% for height. Our new pediatritian, who I really like, as questioned whether she might be getting enough solid food given her size. Since I am trying to follow her lead, she nurses at will and has solid foods during our meals -- as much as she wants of whatever she wants -- usually vegetables and beans... she's not much of a starch eater (though LOVES to lick butter off the bread).
We have not yet checked her iron levels -- should I do this? Is it worth it, and is there any other way to know if she's deficient than a blood test? She is very active and very happy, and very rarely gets a cold (even though others in the household do).
And lastly -- she still nurses at least two times a night, and sometimes as many as five or six times between 9 p.m. and 8 a.m. Is this "normal" for blw, or is this a sign that she's hungry and I need to push more foods her way? She nurses throughout the day, but not for long as she is an active toddler -- her "big" feeds are when she wakes up, mid-morning, at nap, when she wakes from nap, and before bed.
Is night weaning reasonable for a baby being nursed on demand? Should I nudge her this direction? It doesn't feel like CLD to do that... but I wonder if her sleep/growth/eating patterns are perhaps affected by this pattern (I know my own sleep is suffering! Trying to nap almost daily... but I'm still exhausted much of the time)? My first stopped nursing at 9 months, so this is all new territory for me!
OH -- and one more bit that might be relevant -- we eat a plant based, vegetarian diet. I purchased a bit of goat milk for the kids just recently and they seemed to like it so we may add that into our diet in addition to the nut milks I make at home... wondering if there's anything else that she would benefit from?
The very first thing to do before getting concerned about height or weight issues is to actually look at the charts. I literally cannot count the number of times that a mom has come on MDC concerned about their child's weight only to actually look at the chart and realize that the pediatrician (or other healthcare provider) either charted it wrong OR was using the wrong chart.
The current recommendation is that all children are charted on the WHO charts until 24 months of age. Here is that chart for girls:
Some doctors *still* use the CDC charts (which even the CDC recommends against!) for that age. Here is the CDC growth chart for 0-36 month old girls:
(A problem to be aware of, but that does not apply yet that I have begun seeing pop up is that when doctors switch from the WHO charts to the CDC charts at 2 years the child's growth percentiles may suddenly change rather abruptly. That is NOT because the child's growth has changed but because the chart itself has changed. I'm seeing a lot more parents with kids who are 25+ months be informed that their child has suddenly "dropped in the charts" when, in reality, it is a function of the chart NOT the child. For example, a girl who weighed 25 lbs at 24 months would be close to the 50th percentile on the WHO chart but under the 25th percentile on the CDC chart. If the doctor was using the WHO chart at the 18 month appointment and then the CDC chart at the 24 months appointment--- even if her growth was exactly staying level on the chart--- it would look like a MAJOR percentile drop).
It sounds like you are aware that some children and some families don't fit the charts very well. If a child has short parents no one should be surprised if they are short. Same thing with tall, thin parents. I have a friend who's son has consistently been under the 3rd percentile for height. His mom is 4'8" and his dad is 5'7". There is no surprise that this is a tiny child!
I was in very much the same position with my DD, except with a more supportive pediatrician it sounds like.
Her percentiles were definately over 50 apart and may have even been 60 percentiles apart at one point (85th percentile height, 25th percentile weight). You know what we call *adults* who are naturally tall and thin? LUCKY!
According to my pediatricians (we moved when she was 15 months so this is coming from her pediatrician in both places) as well as the research I have done, weight is one of the *last* predictors of health in small children. Before you look at weight you should look at:
2) Head circumfrence
3) Developmental Milestones.
So, if a child stops growing in height (for a significant period) there is probably an underlying problem. If the head stops growing--- same thing: look for a problem. If a child stops progressing (or even worse, starts to regress) on developmentile milestones: major warning. With developmental milestones, of course, it is not only important that they keep progressing but that they are meeting age appropriate milestones. You can have a healthy two year old that is the size of an average one year old. You can have a healthy two year old that is the size of an average three year old. For most developmentile milestones that is not true (going backwards of course: a two year old with the abilities of a three year old is not of concern, a two year old with the abilities of a one year old can be a concern).
So, the first thing to ask yourself--- how does this apply to your DD? It sounds like she is tall--- is she still growing? Have her height percentiles also been dropping off? You said she is active. If she were malnourished in any way, she would *not* be active. How is her hair? Sparse? Brittle? Those are sometimes signs of nutritional deficiency. Her skin? Does it hang off her body at all? Not "snap" back if pinched or stretched? Bad tone or texture?
Of course, it's hard to not worry when it's your child. I know! I read that the optimal diet for a 12 month old would be getting at least 75% of daily calories from breastmilk. DD & DS both were getting well more than that (more in the 95%+ range). For DD, my goal was *under* 75% of calories from breast milk at 2 years of age. We made that and I was comfortable with it. She was also nursing throughout the day and every 60-90 minutes during the night.
It is very important for young children to have enough fat in their diet. Since DD did have a large difference in percentiles we went ahead and had her drink whole milk (when she drank non human milk) until she was closer to 3.5. Her percentiles were still different at that point, but not as different. Whole fat goats milk is an excellent choice if you want to use an alternate milk (we started pushing cows milk while I was pregnant because I knew she wasn't getting the amount she needed). I'm sure you already do this, but wanted to mention for others, that you might want to encourage more fatty vegetarian options: nuts, avacados, oils, butters, etc... Because you eat a primarily plant based diet, though, I wonder what foods *exactly* your pediatrician feels will pack a more nutritionally dense (protein & fat) punch?
At that age I don't think it is "bad" or developmentally inappropriate to night wean, but I also don't think it is necessary. If your purpose for doing it is to pack on some extra weight, I think it will probably not work (milk during night hours has been shown to be more nutrient dense than during waking hours). If *you* are feeling exhausted or feel like your DD needs more sleep, it is definatley an option to consider.
Lastly, sorry for not replying earlier. I somehow missed your post! Thanks to doulawoman for bumping it :)
We're vegetarian- too. DD is a picky eater and we just nightweaned (for my sanity) her appetite increased a little but still everyday is different. Sometimes she'll love almond butter on Graham crackers or eat a whole avocado. She'll always drink a green smoothie and I throw in chia, nut milk, yogurt, nut butter etc to make sure she's getting something in her body.
Good luck! I'm sure its fine
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My 2 year old (2 in march) has been a very picky eater, small kid (way off the chart at one point, like in smallest 3-5% for weight). We're also a vegetarian family. I follow her lead with nursing and eating. Just before her birthday, she was eating a lot less food and nursing more. Only recently, for us, has that really switched. I make the effort to make sure she's getting good fats - butter, full-fat yogurt - especially when she was eating smaller quantities of solid foods.
I absolutely agree that what really matters is whether she's growing well in comparison to past growth - and tiredx2 has given you a lot of good information.
As for the iron test - both of our kids did have them, around 2 y/o and sometime before 3, at least. I think it considered important (by doctors) to keep tabs on for vegetarians and that's probably why your doctor recommends it. Neither of our kids was deficient, we never supplemented their iron - I was anemic for a period as a child, however, so it's kinda on my radar.
We did have doctors that postponed the test by one or two appointments until our kids were slightly less terrified by the blood test, so IMO it isn't immediately crucial (especially with no other symptoms).
I've read somewhere that the reason why toddlers eat butter is because they need fat in their diet. I don't know a lot about vegetarian based diets, but can you incorporate more fat in your meals?
That is a reason to continue nursing, not to stop. Breastmilk is full fat milk, so it is good for her.
My ds was a slim toddler and even slimmer 7 y/o. Dd is a chunky toddler. They are (were) both breastfed, and we did blw. In my experience, if you push a kid to eat more or less, they will do just the opposite.
TiredX2 and others -- thanks so much for your responses! You've all helped me consider this -- and I've looked at the charts myself... I asked her practitioner and she wasn't sure which chart they were using, but by my read of the WHO charts, DD appears to be about equal in the charts (I did re-weigh her at home, so I am also wondering if she might have just finished a growth spurt and been slightly thinner/taller than when I weighed her at home -- that seems to be her normal pattern).
She has always been low for weight and high for height -- so I think the overall curve on the charts is pretty steady. We did just switch doctors though, so it's possible that they have used different charts (traditional doc. at first, now using a naturopath).
You've all helped me think through the important pieces of this... thank you! :) I'll make sure I'm offering her good fats, and relax about the rest.
Allthough my 2 yo DS is not small he wasn't untill very recently all that interested in solid foods and still has days where he doesn't eat much and mostly wants to nurse. We are also vegetarian - mostly vegan. He nurses quite frequently still and stopped night nursing on his own after he got all his molars in (around 22 months) He does sometimes wake up once in the night to nurse. I too was wondering about iron and we had it tested at his 2 year apointment and it was great! despite the fact that according to many sources he wouldn't have been getting enough based on his diet. Also between 1 and 2 yo he only gained 1 - 1/2lbs. This is actually quite common because kids this age are so active - even kids who don't nurse and eat tons of solids **** may gain very little weight during this age. I think as long as your child is active and generally happy and seems healthy that there is nothing to worry about especially if you are breastfeeding. Breastmilk is the most nutritious food you can give your child and is also fairly calorie dense. I read somewhere that even children who are exclusively breastfed for 2 years (no solids at all) still rarely become iron deficient. Still it doesn't hurt to check. The bloodtest is simple - instant results and painless. The needle they use is so fine that they can't really even feel it. My son barely noticed it happened. Though the sight of blood could bother some kids. As far as night weaning goes there is nothing wrong with continuing to nurse at night as long as you are able to reasonably cope with it - however if sleep deprivation goes too far and it is affecting your ability to function and be in a good mood it may be the best thing for the whole family to move towards night weaning. I worried about all these things only to realize now that there really wasn't anything to be concerned about. I think that despite all the studies that say that breastmilk is lacking in this or that, that really it is a perfect food. Also I think that children know what their bodies need and don't need so if they are not eating many solids there may be a good reason for it.
I definitely agree. I've been thinking about this topic of food vs. breast milk lately too. My son, now 26 months, was very slow to start eating solids and still does not eat nearly as much food as his peers do. He nurses at least 6-10x during the day and usually 3-6x during the night. Our situation is opposite of yours, however, in that he's always been off the charts on the high end for height and weight. What I keep coming back to is trust. Trust his body to tell him what he needs. Trust him to communicate those needs to me. Trust myself to listen to my son and be observant of any changes that could indicate a problem. And trust my body to supply him with milk that is full of SO many good things his body does need - specially tailored to him.
I'd say just keep following your gut. If there are foods you think would be a good idea to try to encourage into her diet, go for it! If not, it doesn't sound like there's really anything to worry about as much as just be aware of.
I was thinking about this again and I remembered back to DD being newly two. We were in a playgroup at the time and I remember thinking DD wasn't a great eater. But then I realized (looking at the other kids' diets) that she was actually pretty normal PLUS she had breastmilk to fall back on! There was one kid in the playgroup who went through a stage where he was only eating marshmellows and pretzels (don't get me started on how a 2 year old figures out that is even an option). Anyway, not only was DD eating better than *that* but she also had a great source of healthy protein & fat in my milk. I tried to keep that in mind going forward--- two year olds are just notoriously picky and a breastfed two year old is better off than their peers. I also tried to remember that they don't grow nearly as much in the third year, so it makes sense for them to cut down on their calorie intake.
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