Next steps with weaning - 13 month old

[K-JDA]

Hi all

I am hoping you can advise about my 13 month olds diet and next steps.

Basically his diet is as follows, based on his schedule at nursery (weekends similar so as to remain fairly consistent):

WU - 5oz milk
8am - breakfast - generally weetabix or porridge with milk and water
10am - snack (eg fruit, crackers, breadsticks) with milk at nursery (I tend to just offer water if at home)
12pm - lunch (generally hot meal of fish or meat/veggies and then pudding of either sponge/custard or yoghurt and fruit) with water
2pm - snack as above
4pm - dinner as per lunch
6pm - supper at home as dinner so early. Generally cereal or toast or yoghurt and fruit. Water.
Bedtime - 6 or 7oz milk (was 5 and then v small night feed but have cut the NF this week so added extra 2oz to bedtime bottle)

He has suffered with constipation from about 7 months and is currently on 1 sachet per day of paediatric movicol. He will probably stay on this for another month or 2 then will attempt to withdraw.

He is very poor at drinking water which I think is the main cause of the constipation but this is slowly improving. At home he has a sippy cup available all day aswell as at snacks/meals. At nursery they offer drinks just at snacks/meals. Am trying to get to the magic amount of 900ml total fluid per day (excluding fluid in food) as per guidance from our GP but not there yet.

My 1st instinct is that he is getting too much dairy (I know this can contribute to constipation) as there is plenty milk/cheese in his diet plus milk at nursery and morning/evening bottle - would you agree? I think he should be having equivalent to 1/2 pint now?

My concern about reducing the morning/evening feed and switching to a sippy cup etc relates to the fact that this would reduce his fluid intake further but conscious it could also be contributing to his constipation so am in a quandary about what to do next!

I have read from other posts that there is merit in reducing the evening feed as this will lead to earlier achievement of dry nights. Also given he wakes at 6 generally and then has breakfast at nursery at 8 I am keen to keep a decent sized morning feed for now so he can last til breakfast for food.

I would be really grateful for thoughts on his current diet and next steps.

Thanks in advance, Kate

[creations]

Hi there - sorry you didn't get any response sooner.

Looking at your DS's food intake the first thing that jumped out was quite a lot of dairy, which you also mentioned, so I'd agree with you it does look quite high in dairy, but what is he like with all his food groups?  It looks like a balanced and varied diet but is he eating all that is offered or does he have a tendency to skip some of the meat/fish/veggies in favour of the custard? (mine would!)  Is he hungry enough for his solid meals whilst having the amount of milk plus dairy that he's taking?
If the constipation/movicol issue wasn't there I'd say you would be fine to drop the BT bottle, there is more than enough dairy in the rest of his day (and if he really needed it he could increase his morning or snack time milk intake), but what you've said about fluid intake needs to be taken into account.  My understanding is that milk is classed as a 'food' rather than a 'drink' and would have thought he would become more thirsty for water if the milk was cut BUT I don't have any experience of movicol so really I am not a huge help.
I will see if I can get someone over to have a look for you.

[*Becky*]

I would cut back on the dairy in some way just to see if it helps the constipation so like pp suggests maybe try cutting either the am or pm bottle. You can still offer it in a sippy so it is available but 2 bottles is not necessary at this age. I would look at offering water in different cups - my DD loves to drink from an open cup far more than any kind of straw or sippy cup.

I would also be mindful of how much dairy he is getting in the day. Of course some is good at this age for most children but with constipation being an issue you certainly don't want to overload him. In my experience it will be hard to tell until you are off the movicol what really works best re diet as the movicol should be keeping him regular but you can def make a start at watching his dairy intake and a good place to start is with cutting a bottle.

[creations]

Thanks Becky 

[K-JDA]

Hi,

Thanks so much for your replies.

In response to some of you quesionts/comments:
- I agree it is high in dairy - I have asked at nursery today to ask them to confirm how much diary they plan for in the diet there since he east most of his meals there but am guessing it is going to be close to the maximum amount they need so the morning and evening bottles are the ones that need to be reduced
- he does have a balanced diet as the food aty nursery has been carefully designed to meet all requirements. He is pretty consistent at the moment in eating everything put on his plate be it main course or pudding.
- yes he is hungry enough for his solid meals - in the last couple of months he has consistently been eating everything put in front of him as since he got walking and started nursery his appetite has really increased.
- I've tried loads of different cups - he is back to favouring a sippy at the moment as they use these at nursery and his fluids are gradually increasing. I have also had to resort to giving extremely diluted no added sugar cordial as he will chugg this down even though it is so dilute that it tastes revolting compared to water. So long as we regularly clean teeth (which we do) then do you think this is OK for now? His water intake has previously been so low that I was desperate to try anything!

Based on what you have said I am tempted to cut the bedtime bottle first as I do think he needs the morning one given the time to breakfast at nursery. I have reduced to 5oz again now the NF is well and truly dropped and have also been giving this prior to going upstairs for bath/bedtime routine to ensure teeth are cleaned after milk.

So my plan (I think) is to make sure I offer lots of water when he gets home from nursery to make sure fluids are where they need to be and then to make his supper a bit later than currently so it is just before starting bedtime routine and increase its portion size a bit to compensate for less milk and to include a sippy of milk instead of a bottle after support. Does that sound right?

Just some other questions if you don't mind?

Do I give the full 5oz or give a smaller amount e.g. 2-3oz or gradually reduce?
I take it I go cold turkey on the bottle and swap to the sippy? What if he refuses?!
What are some good ideas for supper which don't include dairy? Currently I tend to give toast as he doesn't eat any other bread generally or dry cereal (e.g. cheerios) and maybe a bit of fruit.

He is going to be on the movicol for probably another couple of months to give time to sort out the diet and get it where we need it to be.

Thanks again for your input.

[creations]

Sounds like a great eater!

For weaning the BT bottle I would do it gradually, I am not one for cold turkey on anything.  You can read a description of what I did in this thread and also how another BW mummy successfully weaned that bottle tear-free and no upset to BT.
morning bottle still needed?
(the initial question was about morning bottle but it was the BT bottle that was weaned).
I think that will answer all your questions about reducing the BT bottle, it will be gone within a couple of weeks so I wouldn't worry about the sudden switch to the sippy, he can take or leave his evening milk.  Mine didn't take much of that sippy milk in the evening for ages then about a year of a 100ml or even more and then dropped it totally.

Supper can be anything really, crackers, toast, cereal, veggies, crumpet, pancakes, muffin (I bake sugar free), little pastries (puff pastry tarts - sugar free) as he has a very well balanced diet it doesn't matter all that much. I avoided fruit but only because I suspected it made him gassy after BT.

I have once of twice given mine a few drops (literally 2 drips) of lemon in a cup of water but I don't give juice or cordial at all, sorry can't really comment as we don't have any constipation issue here.  Teeth wise if you give juice try to make it at meal times so he doesn't get an extra attack on the teeth.

If you have any more questions do ask, and good luck with the wean, I'm sure it will be fine
Do

[K-JDA]

Fab thanks. He actually ended up having late evening meal and thus late supper today so I just gave him milk in a cup - he drank a bit and then we went upstairs and since I haven't been giving bottle directly before bed he went off to sleep fine! Eek! Will see how it goes but probably best not to go back now!!

[*Becky*]

bit different here as i do tend to do a lot of things cold turkey tbh but we got rid of the am bottle first before the BT. We just put the milk in a straw cup and went for it. DD did not want it so kept offering but was not too worried as she had enough calcium in her diet anyway. In the end we just stopped but her BT drink she happily took from a cup so she obviously just did not want the am milk. Good luck with it all x

[creations]

I just gave him milk in a cup - he drank a bit and then we went upstairs and since I haven't been giving bottle directly before bed he went off to sleep fine! Eek!

Just like that. Easy

[K-JDA]