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Please help me prove to my ped. that BM is the best for my slim 12 m/o: UPDATE!

1409 Views 27 Replies 19 Participants Last post by  gothmommy
(For update, see post #24)

My almost 13-month-old's growth curve is "drooping." The ped. is concerned and suggests that I cut out a feeding in order to encourage solids more. My DS nibbles here and there, but is not a big solids eater. I told the ped. that he nurses 6-7 times a day, and she thought that was a lot
, but now that I've started to keep track, he nurses even more than that, esp. when I consider the short night-nursing sessions.

I feel that my supply is fine and that DS is getting all that he needs, he is just slender like his parents. He is meeting milestones and appears very healthy and energetic, and he continues to grow length-wise. He is at the 93rd % for length, 6th % for weight, and 82nd % for head circumference. I know that the growth charts are based on formula-fed babies so that's another reason I'm not concerned.

Please - can anyone point me to any documented sources than we should continue to BF as we have and that BM is still the perfect food for my DS? I have the WHO BF growth chart, but it looks like that is based on a small sample. I want as much good, solid (pardon the pun :LOL ) info to take to the ped. as possible. We go back for a weight check in 1 1/2 weeks and I am concerned that she might try to encourage more dairy or fat in his diet, and I don't think that's necessary.

BTW, if you think I'm off-base, here, it's OK to let me know that too.
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Instead of percentiles, would you be willing to post actual measurements?

One of the last people who was told by her ped that her child was too thin--- the ped had actually read the growth charts wrong
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Sure, although the figures are entered on the computer, so errors aren't likely but I suppose still possible. I actually have the growth chart, w/ DS's measurements, printed off from their computer.

12-mo measurements:
length - 31.25"
weight - 18#10 oz.
head circ - 47 cm

Side note: Here's a history of his weight percentages:
2 mos: 50%
4 mos: 50%
6 mos: "above 25%" (they didn't indicate exact %)
9 mos: 25%
12 mos: 6%

The ped. said it wasn't his weight that concerned her per se, but the fact that his curve has been dropping in comparison to the growth chart - for example, the 6th percentile wouldn't be bad if that is how he had been tracking all along.

One weird thing was that, at this last visit, he was weighed w/o diaper and had always been weighed with one before. A nursing student did it this time so that was probably how she had learned to do it. I would have protested, had I known it could turn out to be an issue. Still, that's only a few ounces' difference so I guess it probably didn't impact too much.

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First off- I don't think you need to convince your ped of your decision. Simply tell him that you are hearing his advice and choosing your own path. It's your child- you don't have to convince him of anything.

That said- ask him to show that what he wants your child to eat has more calories and nutrition than breastmilk.

good luck!

First, I just wanted to mention that you are absotely correct that children plateu w/regards to weight sometime late in their first year. This is especially obvious among bfed infants, who not only stop gaining as fast, but go down in percentiles as well.

This is for a very clear reason: That is how Humans are SUPPOSED to grow. While the common report is that babies double birth weight at six months and triple it at twelve months. This stat is, of course, based on formula fed middle class white infants from before 1970. If you deviate on *any* of those paremeters, you are likely to get skewed results. It is much more common among bfed babies to double birth weight by 4 months but still only triple by one year, which leads to the drop off the chart.

Additionally, birth weight is influenced by many factors. I have known several women who had large infants (9lbs) who then dropped off the charts. It was obvious that would happen--- both they and their partners were tiny. Just statistically improbably that a 5'1" mother and a 5'6" father is going to produce a 250lb 6'4" child--- possible, yes, but don't be surprised by a child who is 5'4" instead, kwim? Do DS's measurements seem to be coming in line with what you would expect.


Originally Posted by rosie29
12-mo measurements:
length - 31.25"
weight - 18#10 oz.
head circ - 47 cm
According to the CDC growth chart, 18lb 10oz would actually be a bit lower than 6%, so you probably don't want to use that as ammunition, lol.


Originally Posted by rosie29
One weird thing was that, at this last visit, he was weighed w/o diaper and had always been weighed with one before. A nursing student did it this time so that was probably how she had learned to do it. I would have protested, had I known it could turn out to be an issue. Still, that's only a few ounces' difference so I guess it probably didn't impact too much.
Wow, odd. Babies are supposed to be weighted w/out diaper until they reach two when it is assumed they will be being weighed in underwear only. The average NEWBORN disposable diaper & onsie adds 5 ounces, average NEWBORN cloth diaper and onsie adds 8 ounces. You have to assume those numbers go up accordingly. If you have been weighing DS in a diaper all along (and especially if one ever was wet at all) his weight has been artificially inflated until now. That actually really could make a difference.

Lastly, according to the pediatricians I have seen (we moved when DD was 15 months) weight is the LAST predictor of a problem. Head, developmental milestones & length are all more indicative. If you have *no* problems with those three and weight is dropping off, there is generally no reason for concern.

DD was at one point in the 90+% for weight and height. Then, over months she was down to the 75% for height and 25% for weight.
It's not uncommon. I also notice that your DS has done a slow shift downwards which is usually seen as healthy (compared to a sudden shift many percentiles in the course of a month or two.

Both of my children were appx 95% bfed at 12 months (DS 90-95%, DD 99%) and they are now, at 3.5 & 6 perfectly normal eaters, perfectly normal sized, etc... There is absolutely nothing better for a child than bmilk, emotionally, physically.... If your DS is happy with them, definately add complimentary solids, but they still do not, IMO, need to be *replacing* bmilk.
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We go back for a weight check in 1 1/2 weeks and I am concerned that she might try to encourage more dairy or fat in his diet, and I don't think that's necessary.
Make sure to have him weighed naked again, and definately alert your doctor to the fact that he has been weighed differently at different times.

Additionally, for most children in 2 weeks at 12 months there will have been virtually no weight gain. My DD dropped way down and we tracked her weight on a monthly basis (and btw, her weight didn't actually increase for 5 months from 10-13 months). Boys gain something like 5 lbs on average their second year. So, in 1.5 weeks you might only see a few ounces. Honestly, if you just want the pediatrician off your back, you could just have DS weighed in a diaper and it would come back "into line" (since he would "gain" 5 ounces plus his "real" weight gain).

Also, has he *always* be weighed on the very same scale? Individual scales can be several ounces off (even the accurate digital ones--- we ran into this with DD, she was off my over 8 ounces on one digital scale). They can also become uncalibrated, and be unaccurate for one day, one week... When you are paying attention to ounces that can make a difference.
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Breastfed babies tend to way more than FF babies at 3 and 6 months, but by 12 months they tend to weight less than FF babies. This is very important, because in order for their weight to go from above average to below average (assuming FF babies are the "average, unfortunately) they would have to have a more significant "droop" than FF babies. And even if *your* baby wasn't ever above average, he is still going to go through the slimming down stage more quickly than a FF baby, so *of course* he will "droop". It would be totally abnormal for him to stay at the same percentage weight-wise. Your baby is normal, your ped is uneducated about breastfeeding. Most of the BF babies she sees were probably only nursed until 6 months or less, so they wouldn't go through that same slimming down, but she probably isn't even aware of how it works, so she just looks at your baby and thinks he's got something wrong with him. Here is a little helpful info on that:
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Oh UGH! I told my ped that *I* was concerned that my ds2 only gained 1lb between 6 and 18 months and that he would not eat anything but grain products and fruit. My ped said to me when I said he only gained a lb, "Wow! He must have been a fat little baby!" (He's a really funny guy and was just being funny. I wasn't offended.) He's our new ped, so we weren't seeing him when ds was a little baby. Then he told me it was perfectly normal, absolutely nothing to worry about as long as he was growing in height and head circumference, which he is. Ds went from completely off the chart in weight down to the 25%ile. His head circumference stayed in the 98th and his height has been slowly dropping from the 50th line. Dh and I are both short, so that's no surprise.

Then when I discussed his diet w/ the doc, he told me that ds was getting all the protein, fat (there's more fat in bm than cow's--and it's MUCH MUCH healthier fats!) and vitamins he needed from my milk and would most likely start eating more of a variety when my supply dropped b/c of my pregnancy. Lo and behold, my milk pretty much dried up a few weeks later and now he eats meat and will try a bite or 2 of vegetables. He's still my little fruit bat all day long, but he eats other things now at meals (or after. lol) Your ped sounds sadly uneducated in the benefits of breastfeeding past a year. I would try to educate him or find a new ped. JMO. Good luck!
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Wow. I don't have any information for you, but I will say that my daughter went from not on the charts for MONTHS, all the way up to the 50th percentile, but is now down in the 20th. Her doctor was concerned, but couldn't really say much since she was still on the charts. It wasn't that she was losing weight, just that she wasn't gaining as they wanted her to.
Is your child more active? This makes their weight gain slower, or sometimes they even lose a few ounces.
Good luck to you! I hope next weight check goes better!
Don't forget that although you often look to your dc's doctor for information and advice, you are still your child's parent and have to make the day-to-day decisions for your child. It sounds like ds is growing & developing normally.

Toddlers are not sedientary individuals and all that movement burns calories. Because drs. aren't w/ your child day-to-day, all they can rely on is charts sometimes and I think they don't know what else to do but worry needlessly when a child doesn't 'fit the mold' so to speak. It sounds like this doc is only looking at one piece of a very big puzzle.

And I agree that taking a toddler back in for a weight check in such a short period of time will not likely produce much of a gain. If you had a newborn, that would be different (although I still don't believe that all newborns are meant to gain the weight as quickly as the drs. tell you they should).

There are a lot of factors that go into how much weight a person will gain (and lets not forget they are people!). I would say rather than try to come up something you can show or give to your doc to prove anything, you simply take ds back in, if you decide to, and thank the doc for his/her concern and go on your merry way.

Good luck and follow your instincts, not your doctors.
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Thank you all so much for your support and information. I will check out the links when I have a little more time.

A couple things: I guess the part of me that wants to convince the ped. really wants to A) justify that everything is OK and that there's no need to do anything drastic to "fix" the "problem" and B) EDUCATE her so that she doesn't inadvertently discourage others from breastfeeding their toddlers and older babies. She does state that she encourages extended BF'ing, but, as several of you mentioned, she doesn't seem educated in the benefits and outcomes of it.

Just to clarify: the most recent visit was at 12 months, and the weight check will be at 13 months - I know my OP may have implied that the visits are 1.5 weeks apart. Still, I know my DS may not show much weight change in 1 month.

Once again, thanks very much. Without the support of MDC mamas, I may have been trying to wean at this point - before I became PG and started learning about these things, I had no idea that people extended BF'ed and how "normal" it is!
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is it because you want to educate an ignorant doc? if so, then i don't have links, but i know plenty of other mamas are probably posting those. if it's just b/c you disagree, STOP going. well baby checks are bogus. you know you are right and your babe is fine, so why go listen to someone who is obviously so grossly misled? you could write a "farewell" letter to the practice informing them of why you think it's a waste of your time to go somehwhere where the people who are supposed to be the "experts" know nothing accurate in this realm.
BTW, i have a dear friend whose first son ate NO soilds until 15 months, and then VERY little. he is now 3+ and very healthy, smart and a normal size (by the look of him compared to other kids
- she doesn't take him to a ped to have him compared to a FF chart!)
my own DS#2 was 10 pounds at birth and gained what averages less than 1 pound a month so far (he's 5 months) but he is FINE developmentally (rolls back to front, sits up, is very expressive, sleeps well, is HAPPY, is starting to rock on all fours) on exclusive BM. a ped would tell me his weight alone equals FTT by those charts.
that's why we don't go!!
what would mamas have donw before those stupid formula company (propaganda) charts came out? they would have trusted maternal instincts, that's what.

quit doubting yourself!
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It is normal for an active toddler to not gain as much weight around the 1 year mark. And really it takes I think 3 months of consistent drops (ie 25% to 6% to 1% to not on the chart) to start worrying about FTT. And even then activity and hitting milestones also need to be taken into account. Everyone grows differently.

Rather than suggesting weaning, your ped should making sure that your dc is nursing well as well as making sure that any additional calories he's getting from solids aren't empty. When we saw a nutritionist she set up a goal for calorie intake based on current weight and what we'd like it to be. We wanted a little padding for dd b/c she'd lose a lot of weight when she'd get sick and she is already small to begin with, 19.5lbs at 21 months and 31" in height. So the goal was set at 1000 calories to get her to 20 lbs, a weight that was good for her height. The nutritionist didn't count short nursing sessions for calorie intake b/c she saw them more as comfort and check-ins rather than a meal. Which I agree with. Any nursing session 5 min on one side or more or 10 min for each side was counted. DD at 18 months was still getting at least 1/3 of her calories from breastfeeding. We made an effort to add another good nursing session in as well as make sure the solids she gets are calorie and nutrient dense.

I guess what I'm saying is, rather than just give your ped all of this information that proves that it's ok for your ds' weight to fall off, you might also consider showing how bm can still be part of a good nutrition plan for your toddler. Sort of the more flies with honey kind of thing.

We actually just listened to our ped and tried not to say anything when she suggested trying chocolate milk b/c dd might drink more, came up with our own plan and then explained it to her when we went to the next visit and her weight was coming along nicely. Happily the nutritionist also agreed with us that setting up bad eating habits (chocolate milk) to get her to gain weight now wouldn't be a good idea for the long run.

And I should say the reason we worried about her weight anyway was b/c of her bout of pneumonia where she lost 5 lbs about 1/3 of her weight and was on the verge of going to the hospital due to having no weight stores and needing fluids. So that's why peds get worried about huge weight drops or at least mine. Now, if you could just get them to stop worrying about foods that often can't be exactly measured going in (ie bm) and concentrate on building weight in other ways without weaning, we'd all be a lot happier.
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Oh sheesh, you can't win!

I have no advice whatsoever, just wanted to share my OPPOSITE story--at our 10 month appt, my ped told me to (instantly!) nightwean my daughter (she has averaged 75%ile in height/weight over her whole life) implying continued night nursing would make her overweight! WHAT?!?!
(Oh and also to stop cosleeping and introduce CIO.)

Needless to say I am pediatrician shopping
NOBODY insults my breasts and says they are not smart enough to keep up with my baby!
See less See more here they also break bm nutrition down like a nutrition label on food products.

great bf site with lots of research result info. migth be a good site for ur ped to peruse.

i am surprised ur ped. didnt want to know how u and ur husband were when u were babies. my dd was born big and then levelled out. the ped. looking at me didnt say a word.
No links for you, but just some more support from a BTDT mama with a skinny mini. Watch the baby, not the scale. At 12 mos, you child is probably going through a period of increased activity too,which may account for a plateau in growth around this time.

Eliminating the one thing that your DC will reliably eat and that has superior nutrition is no guarantee that he will increase his solid intake. Why take the risk?

Weighing in with a diaper?! That's pretty bad. I mean, we all know how heavy a really wet diaper can be, right? Ditto PP - if weighing was done on different scales as well, that's not reliable at all.

Trust your instincts. You're doing great.

Originally Posted by Fiercemama

Eliminating the one thing that your DC will reliably eat and that has superior nutrition is no guarantee that he will increase his solid intake. Why take the risk?

You, my friend, are a frigging genius! Well, at least you agree with what I've been trying to tell dh for months! He worries constantly (and vocally) that letting ds nurse on demand is hindering his appetite for solids. He actually thinks that by denying the breast, ds will be forced to eat more "real food."

Our little Banana Baby (as Dr. Sears calls them) weighed in at 17 and a half pounds at one year, and we were promptly turned in to DHS for child abuse by our Formula-pusher neighbors. Long story. Anyhoo, I refused to suppliment with formula and continue to bf on demand, 24/7, as birthday number two approaches. He's still wafer thin, but he's healthy (two little colds in two years, period), energetic, strong, happy, smart, gorgeous,

I think the most harmful injustice the neighbors did us was to plant the seed of doubt in our parenting. Like new parents don't worry about every move they make already. Nothing like a full blown child abuse investigation based on your parenting practices to really get you good and insecure. Hence, joining MDC.
Thanks MDC mamas!
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I just wanted to also say BTDT, but I switched peds because of it. Some of these people are set in their professional opinons, and it's so relieving to have someone who is supportive 100%. In fact, it became a question I asked a ped - my kid is thin, what do you think of extended BF?

I was so insecure, I took her to someone for a second opinion, and to a naturopath for a third. Doctors seemed a little unsure at first, but then they met my (very thin) husband and realized that her weight/height charting was totally genetically correct, and that she was fine, and very normal. They suggested using a little butter when making her eggs in the morning - but that didn't change anything either. Basically, nothing I've done in her diet helped out, except for cutting back on cow's milk when she was an older toddler. When we did that, she seemed to ingest more calories from a variety of foods (not to gain weight, just to increase variety, all I was concerned about).

Today, she's a preschooler and eats A TON of food. It's hard to keep up with her sometimes. She must've been drinking so much milk when nursing.

And is still completely rail-thin. Ah, her lucky genes (I didn't give 'em to her, for sure - I look at a piece of chocolate and gain five lbs).
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While I've already replied, I had to reply again:

Please help me prove to my ped. that BM is the best thing for my slim 12 m/o
The best way to "proove" that, IMO, is to take DS in to his 2 year well-baby check having him be healthy and happy and "reveal" that he is still getting many of his calories from bmilk. There is nothing that talks like success.

My pediatrician has been fairly supportive, but more than supportive she truly does listen to me. When I disagreed with her comments about iron and the bfed baby, she read up on the matter, APPOLOGIZED and changed her recommendations. She has incorporated my needs and beliefs as a parent into her work/recommendations as a doctor. That said, her natural reaction when we went into DD's 2 year check up to the news that I was pregnant (even though she had *just* given me a piece of paper that said "Nursing continues to be benificial as long as mom (basically is willing to)" was "OH, now you've got to wean." I educated her and now not only does she have the info I passed on, but she has the picture of DD at DS's first well baby check (still nursing), at her 3.5 year appointment (still nursing) and now--- having nursed past 4. I *do* think that will influence the advice she gives/how she views other nursing moms in the future!
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