Still a skinny minny at six months!

[carlicost]

Hi, I have thread going on the health issues board and it was suggested that I post here as well to see what other advice I can get.....

The gist of the situation is that my DS is just over 6 months old and only weighs 11 lbs 3.5 oz.  He was 7 lb 12 oz. at birth, lost a bit and then has only gained slowly.  From his 4 month check up to his latest weigh in last week, he has only gained a half of an ounce.  His height and head circumference are both around the 20% percentile and he is an incredibly happy, well adjusted little guy.  He is meeting all of his milestones and shows no signs of any ill effects from his weight.  He has been exclusively breastfed, therefore I am not sure how much he has been taking in.  I don't believe there are any issues with my supply as he has been having the right number of poops and pees and he ends nursing when he appears to be full after about 10-15 minutes.  He has had a textbook latch since birth.

Upon my last check-up, the doctor informed me that I need to begin supplementing with formula to try to boost his caloric intake.  For the last two days I have been trying to see how much he is eating.  I have fed him formula at some feedings and expressed breast milk at the others (he will take roughly 6 ounces of each).  He also gets a few tablespoons of rice cereal twice a day.  We are aiming for getting up to 40 oz of fluids but I don't see how that will be possible as I simply don't think his little tummy will hold more than 6.5 at a time.

I'm reluctant to give up on bf entirely because I'm having a hard time believing that he is not getting enough and I was hoping to make it to at least 8-9 months.  A bottle just isn't the same as a booby!  I am pumping when I feed him formula to keep up my supply and offer it to him as well at a later feeding.  I have to go back in a week to see if he has gained any weight.

Just wondering if anyone has had to deal with this and if they found that the formula made a big difference in weight gain.  I don't know how to get more in him as I'm currently feeding him every 3.5-4 hours and once in the night.  I guess if this doesn't work, we'll start looking for other potential answers....I'm not sure what they could be,  perhaps he can't absorb the nutrients properly or something.  He had been spitting up alot which I'm sure led to some lack of weight gain, but he has been good for the past week (cross my fingers).

If anyone has any advice or info I would really appreciate it.  I trust my doctor's advice but looking for a "mom's" second opinion    I'm just so afraid of hearing the dreaded "failure to thrive". Not that I will believe it, but I've got to fatten this little guy up a bit.  His little butt can't hold up his pants! 

Thanks

[shivi]

Hi everyone,

If you want some more background, this is Carlicost's original post along with the advice given on the growth and development board:

http://babywhispererforums.com/index.php?topic=149451.0

Hugs

Siobhain x

[lilisuze]

Hi carlicost! HUGS. This time must be very hard for you.

Our lo had pretty much the same issue but at 4 months! He is now 7 mo and we have got his weight gain to improve. We too had a health visitor concerned about his weight gain (he also has a sick issue to compound the problem!) he was only gaining about 2oz every 2 weeks. We ended up weaning him early onto baby rice to see if that would help keep the milk down and then did a gradual wean from breast to bottle like this:

week 1 and 2: offering formula in bottle 1-2oz after each bf. sometimes he would eat none of it, others would wolf it down

Week 3: sub'd 1 bf (11am) for formula, 6oz.

Week 4, 5 and 6 : sub's 1 bf a week for a formula bottle.

This also avoided any engorgement issues, plus it took long enough so i was happy to keep bf'ing till i had planned.

His weight gain went right up when we started him on formula and proper meals (was down at 2nd percentile now back to 8th! Woop!)but after 2 months has slowed off again so i am not sure it is a long term fix. Plus we have battled with constipation etc since moving to formula.

I was feeling really rubbish in myself that i could not feed the baby properly, but once they mentioned failure to thrive, i thought, no, i have to do this for my little guy, its the best thing. We are still waiting for a pead appt to discuss possible MSPI and reflux. He is now on soy milk formula and i think this has helped the spitting up a bit (not so many clothes in the wash now!

I'll stick with you here on this thread, I'm no expert but have done exactly the same thing so may be some help!

Lili xx

[shivi]

this is the SNS I talked about earlier

http://www.medelabreastfeedingus.com/products/breastfeeding-devices/51/supplemental-nursing-system-sns

A b'feeding mod should be along later to give you some more advice....

Hugs to you too Lili!

Siobhain x

[deckchariot]

I'm wondering if he may have reflux?  the spitting up a lot makes me wonder.  I don't really know anything about that personally, but wondered if you've checked into it?  Now that he's 6 mos and you can start solids, can you start with some high fat foods rather than less bfs and switching to formula?  Avocados are high in fat (and calories) and most bubs really do like them.  I'm glad to hear you don't want to give up on bfing, and if he's happy and meeting developmental milestones, I don't see why you should need to.

[Erin (redstarfalling)]

I can't help but wonder about the reflux too...

It really seems like your supply is fine to me.  If you're able to pump 6 oz at a sitting, then that's great!  And breastmilk is designed to have enough calories for him already... Here's some info on weight:  http://babywhispererforums.com/index.php?topic=94121.0 If he's eating every 4 hrs during the day and once at night, that would be about 5 times a day?  Or is it 6?  If only 5, I'd suggest adding a dreamfeed, if you're not already.  If you are, then that should be enough.

Where in the world are you living?  Is there any chance you could get a second doctor or breastfeeding specialist's opinion?

[Canwi]

Having read your thread both here and on the Growth board I'm wondering if your LO is a "happy-spitter" and that he's just not keeping enough breastmilk in his stomach to be able to grow.
I'm always a bit irritated when Mothers are told to "feed formula" because that's the only way to get a child to gain weight.  But that's just my issue  .

I totally agree with Erin.  Sounds to me like your supply is fine.  If you read the thread that Erin supplied the link to, your LO seems to fit the description of a slow-growing baby.

Another point to consider is that your LO is at the age when babies start to develop, what my DS2's GI doc calls, their genetic potential.  That is to say that a LO may have been born at, for eg, the 25th percentile but was meant to be a 5th percentile baby.  So around 6mths-ish is when the weight gain slows down and baby reaches his genetic potential.  Some other posters on one of your threads mentioned familial tendencies.  If you and/or your DH are not big statured people, then I woudn't expect your LO to be a large baby.

Lilisuze brings up an important point to ponder when she talks about her LO's weight gain slowing up after being on solids & formula for a bit. 
Another point to consider is that formula and/or solids can cause constipation very badly.

I have a friend whose DS was always on the 2nd percentile.  She saw umpteen doctors, nutritionists etc etc in a desperate effort to get her child to gain weight.  She now has a child (he's 4.5yrs) who is still on the 2nd percentile for his weight and he also has significant issues with food as it was made to be such a big deal.

IMHO, leave what isn't broken and don't try to fix it.  As long as your LO meets the description of a slow-growing BF baby, then keep doing what you are doing. 

[carlicost]

Well we are on day 4 of "fattening him up" and so far so good.  He now is okay with taking the formula and eats roughly 6 oz, four times a day with one bf in the middle of the night.  I haven't been giving him a dreamfeed as when I tried it when he was younger it seemed to disrupt his sleep.  He also has been getting 4 oz. of milk in his cereal throughout the day.  I have been pumping to keep up my supply, but the doctor recommended that I just freeze this milk for now and have him strictly on formula.  I don't really believe in that but....

It may be the end of bf anyway.  I was so sad this morning as I went to bf him and he only ate a bit and then didn't want anymore.  He did however want the bottle that I had prepared in case. :-(  Maybe in a way it is best to let him decide, then I don't feel so bad about it all.  He will take the expressed breast milk in a bottle with no problem.  He even drank some from a sippy cup.  My little boy is getting too big already...

I may still go and talk to a dietician this week to see if she has any insight going forward with his solids and I guess start the weaning process that lilisuze mentioned above.  I'll just pump and feed him that rather than feed him directly from the breast.  We'll see what he weighs when we go in again on Thursday, but I think he has already gained as he appears to feel a bit heavier.

I guess I made it to six months so I should be pleased with that.  I was hoping for longer but as lilisuze mentioned, I have to do what is best for him, not what feels best for me.  I guess I just have to be happy that I will have a bit of freedom back now.

Thanks so much everyone for your support.  I will post back on Thursday and let you know how much weight he gained.

[carlicost]

Now I'm a bit more confused.  I went through the suggested links again and saw that perhaps he is refusing the breast now due to the slower flow than the bottle.  I'm really not sure how to proceed now knowing that he probably was fine with the breast but everything is now all screwed up!

I think he was probably getting enough before, he just was spitting up too much.  From everything that I have read, women rarely have an issue with milk quality, and judging from the amount that I can pump (between 4-5 oz) I think that quanitity is okay too as baby is more effective at getting milk than the pump?

I guess it would be different if he was 2 months old or something, but maybe I should just let go knowing that he would likely be weaned in another couple of months anyway.  I'm just worried about him getting constipated and perhaps not getting the added immunity benefits from my milk (perhaps that was just from the colostrum, but he hasn't been sick yet!).  I don't think I'd go to an SNS system at this point in time seeing as how he is already 6 1/2 months.

I know most women are pro-breast, as am I, but wondering realistically what everyone's thoughts are on this.  If I knew for sure that formula is best, I'd just bite the bullet and call it done.

[Canwi]

What age did you have in mind to wean your LO from BFing?  Or were you taking a "wait & see" approach?

[carlicost]

I was hoping to feed him for the full year unless it got difficult (painful) once he got teeth or something.

[mom of two]

I would definitly say stick with bfing!  It is the best nutrition for him.  And you could go back to only bfing and no bottles he will get used to it again since he had been doing it for so long.  Make sure you eat plenty of fat....butter, whole milk, whole yogurt, olive oil, coconut oil, avacado...that is how to get more fat into him.  If you want to be bfing him than totally stick with it.  Formula will not answer your problems.  Maybe even cut out the cereal.  He could have an allergy to it and cannot digest it...thus the spitting up and no weight gain...
My dd was it the 5th percentile from 4 months on and was always a very happy, healthy baby.  She has bumped up some on the scale but will probably just always be a little peanut

[Canwi]

TBH I would ditch the formula and bottles, and go back to exclusively BFing.  Go with  your 'gut feeling' ('scuse the pun ).
Increase the fats in your diet and see if that makes a difference.
I would ask the doc if you can try some Domperidone or another motility drug to help your LO's stomach process the food better/quicker.  See if him keeping more food down helps.
I would definitely go see the dietician and see if she has any helpful hints about how to help.

If the pic of your LO is recent, then IMHO I don't see a "failure to thrive" baby there.  He's just one of the lighter, small-framed people in the world.

[hemz80]

My ds has always had issues with weight and now at 2yrs 5mths only weighs 10kg!!  I did bf regardless of what i was told and when he did switch to formula full-time at 10mths... his weight gain was still the same.  Maybe continue with the formula for now and give it a period e.g 2weeks etc and see how his weight is.  The other thing i was told to do was offer formula after the breastfeed to check if it was my supply... Ethan never took any!  I agree with pp about eating properly, it does help for some reason.  Also do you and him take multi-vitamin drops/ tabs??  That can sometimes help as absorption can be a nutrient thing too. 

I feel better now that dd has some along and is growing lovely on bm... feel like she's redeemed me!!  Good luck x

[Mama2boys]

Ditoo what Hema said, could totally be a genetic thing as well.

DS is also 10kgs at 2 yrs and 3 months and skinny and tbh i think - longterms as long as yoru LO si healthy and feeling good doenst really matter what percentirle they fall into.

DS also did not show any change of weight gain when we moved from BF to formula but as PP said, I would ensure your diet was rich and healthy, so eat loads of avacados, nuts, full fat milk and so on.