[Lousli]

I have been going head to head with my ped's office about this. My daughter has plateaued (sp?) in her weight gain over the last few months. I have met with two different ped's (it is a different one every time) who are badgering me about her size. She weighed 19 pounds and 5 ounces at 19 months of age. At 16 months she was 18 pounds 11 ounces. She used to be at about the 10% for weight, but she is dropping off the chart now.

She was 4 pounds 1 ounce at birth, and I'm very small, 5 feet tall and 105 pounds (after 2 kids, I used to be more like 100). My dh is not huge, about 5'9'' and I don't know, 155? My whole family is small, and most of his is average to small.

During this time period, she learned to walk, run, and climb, so obviously she is more active than before. We had an amnio before she was born, all the tests in the NICU, blood work for iron and lead at 12 months, and just recently they did more blood work and urine (all were normal). She eats pretty well, aside from being a picky toddler, and nurses.

Here's what I think, she's totally normal. She speaks in 2-3 word sentences, follows directions, understands people, her head is huge 75%

The thing is, the a$$hole peds were questioning me a lot about nursing, wanting to know how many times a day, was she just filling up on breastmilk and not solids, knocking co-sleeping, and at 16 months she "should" be sleeping through the night without nursing and I should think about CIO.

The second ped we saw was no so hostile, but asked about the nursing again. But they also suggested Pediasure. Like I'm supposed to cut out breastmilk so she won't fill up on it, and give her Pediasure instead?

:

So, is her size related to her prematurity maybe? Genetics? Just a normal slowdown that will even itself out? Is it possible there is a medical problem that hasn't yet shown up developmentally and with all those tests? We have a weight check coming up, and i want to be prepared with good info, because if she hasn't gained enough I think they're going to start pushing the FTT label and it has me really pissed.

 

[WannabeaFarmer]

I had this problem with my dd too, but I really just had to kinda avoid the questions about nursing. They at one point wanted her on formula cause they said she wasn't growing enough. I said H#[email protected] NO to that...LOL...I think you are right about your daughter being healthy and ok. I think that some of it has to do with prematurity, also some can be due to genetics as well. Look at it this way; is she getting more acitve? Is she eating ok during the day? You know that if she is doing that, then she is ok. I was also told that increase in activity(along with shorter or no naps) can lower their weight for awhile cause they are workin it off. Also I think they should be telling you to nurse more frequently if they are hassling you about weight, cause short frequent nursings made my daughter shoot up and gain weight. Some times too, when they get taller/longer they tend to plateu in weight for awhile I was told by my ped too. I wouldnt worry too much, as long as she eats well and looks healthy then she should be fine...

 

[wonderwahine]

my nephews all caught up to full term babies really fast and surpased them eventually, but there is a woman in my LLL group that was full term and her 21mth old is VERY tiny and petite, and she eats a huge load of food, and BM. They are just naturally very petite people.

If shes still eating normally, and seems otherwise healthy and normal, I wouldn't worry. Also remember that the growth charts are done from a formula feeding POV.

 

[kondonis]

Developmentally she sounds great. William had NEC so they took out a bunch of his small intestine so we had a gtube and a GI specialist following us closely.

One of the things our GI doc was really happy about was the breastfeeding. HE said that even though breastmilk only has 20 calories per oz, it is infused with so many good things, including growth hormones, that it is the best thing (as we all know) a child, esp. a preemie, can get.

The other thing he told me is that it doesn't matter where William was on the charts, as long as they saw he was a) on his OWN curve, b) not LOSING weight, and c) not dropping percentiles.

it sounds to me that your ped is most concerned about C.

If I were in your shoes, I would honestly ask myself how my child was eating - was she eating appropriate portions a few times a day? what other liquids was she consuming (other than breastmilk) and was her diet balanced?

if she is eating well, doens't lack energy, and is otherwise healthy, then that is a good thing and would guess that she is just going to be petite.

however, that being said, I would consider the flipside too, just to make sure you were covering all your bases. for instance,

I would worry if my child refused food other than breastmilk because that might make me wonder about oral adversion or eating issues that might be around, if that was the issue.

with regards to breastfeeding, I might choose to feed her after her meal, rather than before to see if it made a difference.

I also breastfeed my son at 18 months and he occassionally wakes in the night, but it's rare. We used to co-sleep really well- and then at some point he started waking every few hours and the only way he could go down was breastfeeding. I found that we both got better quality sleep when we moved him to a crib next to our bed, rather than between us. he was still close, but was not disturbed as much by us.

I can tell you are not a supporter of CIO, but may I reccommend something inbetween? What really changed our lives was the book, healthy sleep habits, healthy child. it really opened my eyes to sleep in general, and what I should expect from Will at various develomental ages and how the body works with regards to sleep and wake issues. I didn't do classic cio, but I was able to work with Will so that he was able to recognize his own sleep cues so he could help himself to sleep, even if I woke him up by coughing or going to the bathroom in the middle of the night. I never left him alone, but talked him down to sleep (because at this age, she probably understands a lot of what you are saying).

sleep is vital for growth, and if she is not sleeping, all things being equal diet-wise, that might make a difference somewhere.

 

[sweetpeasmom]

She sounds normal to me. This age they normally plateau anyways. SOunds very similiar to our situation except no mention of ftt at all. Her weight seems similar to my dd's. From 15 mths to 21 mths she only gained about 1 pd and they weren't at all concerned about that. Plus you said most your family is "small" so genetics also, which they never seem to put into perspective.
honestly i don't even know what mine is on the charts, i know she's never even made the charts for quite some time, she's always been negative. But she nurses and i try to get some good quality food and some good high fats in her, so nutrition wise she's doing good.

Mine also nurses quite frequently at night, doesn't sleep through the night. Probably nurses more than solids but i think it's her choice.She just loves it too much but she's extremely active, healthy and is developing quite nicely. My ped didn't even flince when I said we were nursing and she still wakes at night (and he's a "mainstream" ped ) never once told me she's suppose to sleep through the night or doesn't need to nurse etc.. never suggested pediasure. So I think you'll just get varying opinions and if you went elsewhere they may not be concerned versus those that are, kwim?

 

[Kathi13]

My DD is small (@ 2y appt 23lbs) - her weight/height has always been around the 5% mark (her head is in the 80th%....but that is another story

). I think from just what you said that she may be just small...

Our Ped is not overly concerned about DD because her curve is normal - she did a small platau around 18m when she was becoming much more active but at her 2y appt her curve was going up again. She still BFs 0-2x a day. Frankly her Ped said that he has no idea if her smallness is related to her being a preemie (28wks 2lb @ birth) or just genetics. I'm only 5'2" her g-grandma was only 4'11" and her other g-g & my Mom never topped 5'4" - so it could just be her. The only suggestion our Ped gave was to keep her on whole milk & whole milk products until she is 3y (besides BF as long as we both want).

DD I don't think slept through the night (in other words from 7:30ish at night to 7ish am) until she was around 16 m or so. Before that she would still wake around 4am to nurse. A lot of that I think had to do with her being so small - which means her stomach is small which means that she needs to eat a little more frequently than bigger kids.

I think first do as pp's suggested and truly evaluate what your DD eats and how much you think she is getting - keep a record if that will help. Just so when you do talk to a Ped you can say here - this is what she is eating in a normal week.

And then frankly I think you need to shop around for a Ped who you feel more comfortable with - he/she still might be concerned about DD's size but should have suggestions that you are more intune with.

 

[Amys1st]

Sounds like you have a petite family. If she is developing normal, I dont see the issue but then again I am like that.

I second finding a Dr you are comfortable with who is on the same page with you.

DD1 nursed until she was 2 1/2 and then did a CLW and was done. She got up nightly until she was about 15 mos old. Then after here and there she would get out of her bed and join us until she was older. Sometimes she still does that at 4.

Both of my girls were never "chunky babies" and dd1 was right at the scale on the percentile as she grew. We had people comment that she was "tiny" but that was about it. With both my girls they seem to get an increase in sleep and appetite just before they grow and then they grow!!
I noticed during both pregncys the same thing- I would sleep a lot and eat enough for both DH and I and then my belly would grow.

NOW,
w MAggie, she is tiny for her age at 6 mos but she is catching up and quickly! We get that she is so little all the time by people who just met her. From people who know her story- we get Wow is she big!

My friend who also had a preemie. Her daughter is just over 2 now. She is tiny for her age. But another friends whose boy was preemie a year later than the 2 year old is a few pounds lighter at 13 mos than the 2 year old. Both are developing just fine now.

 

[Lousli]

I forgot to explain a couple of things. We're no longer night nursing between about 9 and 4 or 5. She still wakes, but my dh comforts her. Her waking patterns have gotten better, but we're still looking into ways to help her sleep longer stretches at night.

She doesn't drink cow's milk at all, but does eat yogurt, cheese, and ice cream. As far as solid food goes, as I said, she's a little picky, but she does eat solids at three meals a day and snacks in between. No oral aversions that I can see. She eats what we eat, pasta, fruits, veggies, meat, chicken, etc. She drinks water and juice in addition to breastmilk. I do think she's eating enough.

I measured and weighed her yesterday, 19.75 months and it looks like she has grown about 3/4 inch and weighs nearly 20 pounds. The scale was flickering between 19 lb 14-15 ounces and 20 lbs. So she is continuing to grow, just not as quickly as they want her to. They have not actually said anything about FTT, but I'm worried that they will.

 

[myjulybabes]

I'd think the drop in percentile is something to keep an eye on, but not freak out about just yet, since she's developing normally in all other ways. Odds are, she'll hit a growth spurt and catch back up to her normal curve soon.

Sometimes preemies just stay small. My birth son was a 32 wker, 3lbs, 16.5 inches. He's going on 10 now, and only in the past couple years finally got on the charts. He's only a few inches taller, and couple lbs heavier than my 7 yr old. It's not genetics. My brothers are all over 6ft, I'm average height at 5'6" and his bio-dad is around 5'10". His doctor was slightly concerned, but he's more or less stayed on the same curve, so after awhile, and I think some minor testing, she concluded he's just small.

OTOH, my youngest, also a preemie--36 wks, but with respiratory problems-- had trouble gaining at first, but now at 5 is topping the charts. He's about as big as the 7 yr old too.

All kids are different.

 

[alegna]

Not the mom of a preemie, but I thought I'd add my non-preemie experience. I think it may just be perfectly normal. My dd did not gain any weight from about 9 or 10 months until about 22 months. She was 25 lbs for a year basically. We don't do WBV so I don't know her percentages, but I'm sure she was dropping down the chart in that time. You're small. Your dh is small. Your daughter is small. Seems logical to me.

-Angela

 

[kondonis]

Quote:

Originally Posted by Lousli I forgot to explain a couple of things. We're no longer night nursing between about 9 and 4 or 5. She still wakes, but my dh comforts her. Her waking patterns have gotten better, but we're still looking into ways to help her sleep longer stretches at night. She doesn't drink cow's milk at all, but does eat yogurt, cheese, and ice cream. As far as solid food goes, as I said, she's a little picky, but she does eat solids at three meals a day and snacks in between. No oral aversions that I can see. She eats what we eat, pasta, fruits, veggies, meat, chicken, etc. She drinks water and juice in addition to breastmilk. I do think she's eating enough. I measured and weighed her yesterday, 19.75 months and it looks like she has grown about 3/4 inch and weighs nearly 20 pounds. The scale was flickering between 19 lb 14-15 ounces and 20 lbs. So she is continuing to grow, just not as quickly as they want her to. They have not actually said anything about FTT, but I'm worried that they will.

with all that, I second getting another ped, one that is on the same page with you. she sounds like she is doing great, and growing, so who knows what his issue is?

you're obviously doing a great job - and your daughter is proof of that!

 

[boscopup]

It sounds like genetics to me. You and your family are small, and she's just following in your footsteps! Do you have any records of your own weight at that age? I looked in my own baby book, and in the first year of life, DS followed my weight *exactly* - comparing my actual age to his adjusted age. I mean, we were oz for oz the same at each visit! Amazing. And at 9 months, they had said *I* was underweight. The growth charts are different now (they are formula AND breastfed, so better than the formula-only charts of 30 years ago - I was breastfed), so he wasn't considered underweight, but he did stay 20-25% for adjusted age the entire first year. Now in the second year, he shot up. At 2 years old, he was 70% for weight ACTUAL age. He just didn't even get on the actual age chart until 1 year, and then he was only 5% at that! So he's really grown in the last year, but I expect him to be a big boy. I'm 5'9" and tend to be around 180ish lbs, and DH is 6'5" and is around 260 lbs. DS has always been at least 50% for height actual age, and now is usually 80-90%. I fully expect him to be tall like his daddy, and weight just goes along with that.

On my due date list for DS, there are at least 2 or 3 girls on there that were full term and at 21 months, STILL hadn't hit 20 lbs yet. They're just petite girls. All of them are developing normally, and it's obvious they aren't FTT. Remember that FTT involves more than just weight loss. Your girl is ahead of my almost 26 month old in the language department by far! He's just starting to put 2 words together literally in the last few days!

So all in all, she sounds normal to me. You did say she had a little weight loss in there, and I would watch that, but not freak out about it right now. My best friend's full term daughter lost weight between 15 and 18 months - like a lb or 2. She gained it back later though. She had just gotten more active at that point!

Oh, and on the mama milk thing... At this point, I think your milk is pretty high in fat anyway - like 50% or more? I forget. You might talk to an LLL leader. One thing I would recommend is limiting the juice. Sometimes, juice can cause kids to not eat enough, even if you're appropriately watering it down.

And definitely ditch the peds that are telling you to replace breastmilk with Pediasure. Yuck.

:

 

[Lousli]

She never lost weight. She just gained really slowly, or one time in between visits (a month or so I think) she had not gained any.

Just out of curiosity, I have been seeing what she eats so far and trying to note the calories. Some things are a little iffy, since I haven't measured the portions on them, but I gave my best guess. We haven't yet had dinner, dessert, or late night snack, lol, and she has already consumed almost 600 calories by my estimate. It is about 3 here, so i fully expect by 9 tonight she will get in 400 more, or even more than that. The AAP says at least 1000 calories a day. I didn't count breastmilk in with that, since I have no idea how much she is getting.

 

[crysmomofthree]

My daughter (who was born iugr at 36 weeks) has weighed 22lbs since she was six months (she's now 14 months) we haven't been to a well baby visit.

But I have been getting lots of comments about how little she is (she's not very little at all, just a lot smaller than all of my boys)

It sounds like your daughter is growing just fine

 

[boscopup]

Quote:

Originally Posted by Lousli She never lost weight. She just gained really slowly, or one time in between visits (a month or so I think) she had not gained any.

Whoops... I misread your original post. You posted about 19 months and then 16 months, and I had it backward.

Yeah, during that timeframe, I wouldn't worry about a 1 lb gain. She DID gain, and some kids at that stage don't. As I mentioned earlier, my friend's daughter (who tends to be around 50% weight, btw) lost a lb between 15-18 months, but she gained it back and her ped wasn't concerned.

On the calories thing... I won't even touch that, since DS probably majorly exceeds it. He's not picky at all (is this MY child?!?!?), and eats and eats and eats... But it sounds like your daughter is no different from some of the petite full term girls on my due date list (including the picky eating habits), and they are all very healthy and doing everything at the right time developmentally, as your daughter seems to be doing.

 

[Lousli]

Well, with the calories thing I just was curious because I thought, "What if I'm wrong and she isn't eating enough?" So we've now had dinner and she is over 1000. I know she'll snack before bed at least once, and we may still have ice cream. I'm no longer worried about if she is eating enough since she clearly is getting at least 1000 today, which is a pretty typical food day here.

 

[crissei]

My DS is small too. He's 19 months and at 22lbs. and 30 inches. But he eats great, and is developmentally on track.

I'm 5' 2", and DH is 5' 9".

Preemie or not, NBA was never really in the cards for him.

 

[GatorNNP]

The number one reason for a baby with a big head, is parents with a big head as babies, ha! Sounds like you need a better pediatrician who is educated on breastfeeding and growth. Sounds like your child is thriving, just not growing very fast. Instead of attacking your breastfeeding, any concerns about weight should be taken seriously, and a detailed history from you should be taken. A simple food diary for a week or so would solve that one. There are some things that could be a problem causing delayed growth/weight gain, for example an undiagnosed heart problem, but there should be other symptoms with a careful history. Height of the parents should be taken into account. Hope you can find someone who will work with you respectfully as the parent.

 

[Lousli]

Would a heart defect be undetected on ultrasound? They scanned her in the NICU, as well as a detailed biophysical ultrasound on the day she was born. I'm wondering if she wouldn't have other symptoms too, like turning blue in her extremities or something, lacking energy to run and climb? She hasn't shown any unusal symptoms that I have noticed.

 

[GatorNNP]

An Echocardiogram or ultrasound of the heart should have picked up any major problems like an ASD or VSD, and yeah running and such might show up with trouble breathing or sweating alot etc. It is much more likely that you just have a small kid and a good dr. would confirm that for you.