Devastated to Wean my TINY 2 year old - Mothering Forums

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#1 of 19 Old 12-17-2010, 10:54 PM - Thread Starter
 
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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? 

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#2 of 19 Old 12-17-2010, 11:27 PM
 
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what is weaning going to accomplish? my kids are all very small.  when DS2 was little the dr suggested we come in for weekly weigh ins, that was the last time we went in :)  he's 5.5, healthy and weighs 36 lbs.  What percentile is your DD on the WHO chart? 


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#3 of 19 Old 12-18-2010, 12:19 AM
 
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Have you considered getting a second opinion?

When my son fell off the growth chart at 12 months old, his doctor didn't even discuss that he was still nursing. She ordered blood work (which can give an idea of general nutrition), a urine test for kidney disorder, a sweat chloride test for cystic fibrosis, and a stool sample. He was fine, but we had the testing done to find out if there was an underlying cause to his small size.

It sounds like your doctor is unaware of the benefits of extended breastfeeding. It isn't like juice, though ironically, juice can contribute to obesity since it fills you up on empty calories. Breastmilk has far more nutrients in it than cows milk, even as a child gets older. Breastmilk isn't fattening, but it also isn't a cause of malnutrition.

This is where testing comes in if there is concern about her health. Cutting out breastmilk and hoping for the best will not resolve any underlying problems. That sounds like a crude trial-and-error method based on misinformation on the role of breastmilk in an older child's diet.
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#4 of 19 Old 12-18-2010, 05:35 PM
 
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Breastmilk is one of the most nutritionally AND calorically dense things your 2 yo. can consume. I honestly wouldn't wean--actually, I was in your place when DD was that age. The ped did a bunch of bloodwork, got it through his head that her father is only 5'7" and kids run skinny in our family, and concluded she's just on her own curve. Also, the immunological protection afforded by continued breastfeeding can reduce how often/severely she gets sick, which if she's like my DD could result in weight gain setbacks (or losing a bit she can't afford to lose).

 

At 7 my DD is still at about the 5th percentile (she crept back up from below that 3rd percentile mark sometime between 3 and 4) for height and weight. She's 40 lbs. soaking wet, and quite healthy.

 

FTT should be based on more than just weight gain. Is her height and head circumference good/increasing at a reasonable rate? Is she hitting developmental milestones?

 

Have you looked at food intolerances/allergies? That was one thing we did find--DD tested allergic to eggs on bloodwork, and taking them out of her diet helped her weight gain (if for no other reason than that she stopped vomiting at random a couple of times a week).


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#5 of 19 Old 12-18-2010, 05:39 PM
 
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If my ped suggested denying my child her one reliable source of fat and calories, I would fire that ped and find a new one.

 

Oh, wait a minute...that's exactly what I did do!


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#6 of 19 Old 12-19-2010, 02:27 PM
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Any doctor who knows anything about infant nutrition, breastfeeding and FTT, should know that you do the tests before you take away the one sure source of nutrition. What if it turns out there are medical reasons the child is loosing weight/won't eat solid etc.? Your child would have to be put on formula, a substitute for breastmilk, which seems rather silly. And Pediasure really can't be said to be nutritious toddler food (Maybe I should live permanently on that Gastrolyte I needed when I had a really bad tummy upset a while back?). Breast milk on the other hand is very nutritious. It doesn't have everything your 2 yo needs, but few foods do! Check this study out:

Dewey KG. Nutrition, Growth, and Complementary Feeding of the Breastfed Infant. Pediatric Clinics of North American. February 2001;48(1).

http://www.ncbi.nlm.nih.gov/pubmed/11236735

Contents: “Complementary foods offered before 6 months of age tend to displace breast milk and do not confer any growth advantage over exclusive breastfeeding. Breast milk continues to provide substantial amounts of key nutrients well beyond the first year of life, especially protein, fat, and most vitamins. Breastfed infants tend to gain less weight and usually are leaner than are formula-fed infants in the second half of infancy. This difference does not seem to be the result of nutritional deficits but rather infant self-regulation of energy intake.” “The nutrients most likely to be limiting in the diets of breastfed infants are minerals, such as iron, zinc, and calcium.”

“In the second year (12-23 months), 448 mL of breastmilk provides:
29% of energy requirements
43% of protein requirements
36% of calcium requirements
75% of vitamin A requirements
76% of folate requirements
94% of vitamin B12 requirements
60% of vitamin C requirements”
-- Dewey 2001"

I'd get a second opinion too!
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#7 of 19 Old 12-19-2010, 02:41 PM
 
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I would look for a second opinion too. The idea of taking away real and good nutrition (breast milk) and adding artificial "nutrition" (Pedisure) would send me running out of the office.


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#8 of 19 Old 12-19-2010, 03:23 PM
 
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Taking away the one thing she will eat is counter-intuitive.  Especially if it is beautiful nutritious breastmilk specially made for your baby!  Unfortunately, pediatricians are not often the best advisors of breastfeeding best practices.

 

Please look around at more resources and research!!

 

Good luck mama!!

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#9 of 19 Old 12-19-2010, 08:07 PM
 
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I find it unconscionable that a ped could compare breastmilk to juice and in the same breath suggest Pediasure instead!!!! The first two ingredients in Pediasure are water and sugar!!!! I would say it is WORSE than juice and is in no way better than breastmilk which has fat and bio-available nutrients!

I would tell the ped you will be feeding her more nutrient-dense foods like egg yolks and avocado, and then say that until there is a real reason for concern (failure to thrive involves more than just low weight--there would also be developmental delays) that you willcontinue feeding your child healthy whole foods (including breastmilk) and NOT processed junk full of sugar and soy!!

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#10 of 19 Old 12-19-2010, 08:29 PM
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i would be livid! breast milk is by far the best thing you can feed a child that age, and if a child isn't gaining well, add a lot of higher-fat options (avocado, peanut butter, etc) to the rest of the diet. pediasure is a very poor substitute for real milk.

 

my nephew is very small too. that's just the way he is. he's sitting around the 3-5 percentile, always has.. my daughter was always the 97-98th percentile. it's called a bell curve.. some kids are going to be on one end or the other, not everybody's going to be in the middle! as long as they're developmentally normal why assume there's a problem?! 


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#11 of 19 Old 12-19-2010, 08:51 PM
 
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Quote:
“In the second year (12-23 months), 448 mL of breastmilk provides:
29% of energy requirements
43% of protein requirements
36% of calcium requirements
75% of vitamin A requirements
76% of folate requirements
94% of vitamin B12 requirements
60% of vitamin C requirements”
-- Dewey 2001"

 

Here's the problem:  448 ml of breastmilk is more than 15 oz.  According to this info, in order to meet all of a two year-old's energy requirements, you'd need upwards of 45 oz of breast milk. 

 

I wouldn't wean an underweight child either, but I would look good and hard at some high-fat, high-protein additional foods.  Chicken.  Salmon.  Avocado.  Greek yogurt.  Cheese.  I'd put cream on her oatmeal, and peanut butter on her crackers.  There are a lot of foods that provide more than 20 calories an ounce, and at this stage, she needs to be eating some of them.

 

I would also continue to nurse.  The cuddles are great, and it lets you continue to top her off throughout the night with minimal effort and no crumbs on the sheets.  But solids are also an important part of a healthy diet for toddlers.

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#12 of 19 Old 12-19-2010, 10:35 PM
 
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Meepycat, this isn't necessarily a problem unless the 2 year old is breastfeeding exclusively. When the OP's doctor is recommending that she wean and replace breastmilk with pediasure, I don't think the doctor had in mind for this child to drink 45 oz of pediasure per day either. This doctor apparantly believes breastmilk is non-nutritious and wants to see it removed from the child's diet in favor of a nutritious and caloric supplement. This simply isn't true.

If diet is really the cause of her small size, I agree that the solid food she eats are what will make a difference. But they still need to at least do a metabolic panel (blood test) to determine whether there are nutritional issues at all.
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#13 of 19 Old 12-19-2010, 10:58 PM
 
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#14 of 19 Old 12-20-2010, 08:35 AM - Thread Starter
 
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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! 

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#15 of 19 Old 12-20-2010, 10:21 AM
 
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Quote:
Originally Posted by Ravin View Post

Breastmilk is one of the most nutritionally AND calorically dense things your 2 yo. can consume. I honestly wouldn't wean--actually, I was in your place when DD was that age. The ped did a bunch of bloodwork, got it through his head that her father is only 5'7" and kids run skinny in our family, and concluded she's just on her own curve. Also, the immunological protection afforded by continued breastfeeding can reduce how often/severely she gets sick, which if she's like my DD could result in weight gain setbacks (or losing a bit she can't afford to lose).

 

At 7 my DD is still at about the 5th percentile (she crept back up from below that 3rd percentile mark sometime between 3 and 4) for height and weight. She's 40 lbs. soaking wet, and quite healthy.

 

FTT should be based on more than just weight gain. Is her height and head circumference good/increasing at a reasonable rate? Is she hitting developmental milestones?

 

Have you looked at food intolerances/allergies? That was one thing we did find--DD tested allergic to eggs on bloodwork, and taking them out of her diet helped her weight gain (if for no other reason than that she stopped vomiting at random a couple of times a week).


agreeing with all the others - we went through that when DD was 12-18 months ... testing was normal, we didn't wean and did pursue higher fat foods ... today I have a tiny but perfectly healthy 8 year old  (who weighs 47 lbs)


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#16 of 19 Old 12-20-2010, 10:34 AM
 
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OP, we went through a similar thing when my oldest was a toddler. She was not quite that low on the growth charts, but the family doc was concerned that she had dropped from 90%ile at birth down to 10%ile at around 18 mos. She strongly encouraged me to wean, but I kept nursing until DD was nearly 3 and I don't regret that at all. I did night-wean her though, and she seemed to have a better appetite during the day after that. We did a lot of snack trays and just leaving food out at all times, and that helped too.

 

Hope the weight check goes well!


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#17 of 19 Old 12-20-2010, 11:34 AM
 
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my son is 26 months old and weighed in at 22lbs 1oz today. completely healthy and still nursing. our doctors office finally realized its just how he is. we did some extra bloodwork to check for vitamin deficiencies and celiac disease and when the tests came back fine that was that. dont wean if you dont think its the problem. trust yourself!


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#18 of 19 Old 12-20-2010, 04:05 PM
 
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My daughter went 8 months without gaining an ounce from the time she started eating food, until we cut out gluten at around 15 months.  She was so skinny and tiny - I think at 15 months she was 17 pounds?  In *one* month she gained an entire pound.  The tooth decay that had been progressing at record speed *stopped* dead in it's tracks.   Our entire family is gluten intolerant, and I don't regret cutting it out even a tiny bit - it helped every single one of us with various health issues - some quite extreme.  

 

Good for you for sticking to your guns :)

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#19 of 19 Old 12-21-2010, 11:55 AM
 
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well, I'm very glad that you have decided to keep nursing your little one. That's the best thing you could ever do for her!

And I'm proud of you for being able to disern good/bad advice from your doctor instead of simply "trusting" everything she says. Even the "experts" get it wrong now and then!

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