Breastfeeding and slowing weight gain, tips?

[mia1181]

Hi Guys, some advice needed:

O had her 4 month check up today. She is almost 5 months old but we were out of town since before she hit 4 months. She saw the nurse practitioner today instead of her regular doctor. The NP was concerned that O is now only at the 50th percentile for weight but the 90th for height. Here are her percentiles since birth:
Height
Birth: 66th
2 wks: 65th
6 wks: 55th (doctor said this might not be super accurate because baby was squirmy)
9 wks: 66th
19 wks: 90th

Weight
Birth: 82nd
2 wks: 81st
6 wks: 90th
9 wks: 83rd
19 wks: 54th

NP recommended we come back in 3 weeks to recheck weight and start solids in the meantime. We started rice cereal today and it was a smashing success! O was grabbing the spoon and giggling before every bite!

I am just a little puzzled because O looks like a huge and chunky baby! She is a good eater and she definitely lets me know when she is hungry! She eats every 3 hours.

But now I'm concerned about my breastmilk supply. I have had an over supply since the beginning. But what makes me nervous that the problem is me is that I usually pump 6-10 ounces at a time. The last time I pumped was while we were on vacation and I barely got 3 ounces. I chalked it up to the heat and humidity and maybe I wasn't drinking enough. But she seemed fine all along.

So what do you guys think I should do about this. Just feed her the solids and wait the 3 weeks to see if it worked?
Go to a breastfeeding support group to weigh her after she eats? If the problem is my supply, shouldn't I be trying to feed her more? Wouldn't the cereal decrease my supply further? On the other hand shouldn't she be starting solids anyway? I'm confused!

 

[Rosebloom]

I'd call La Leche League's hotline and ask them. They have been so helpful to me in the past. Also, http://kellymom.com/ is a great reference. I'm not a health professional, so my advice is nothing but another breastfeeding mom. But I'd research your doctors recommendation some. I know some people really recommend waiting until 6 months to do solids for a variety of reasons. In the meantime, I've had great luck with "mothers milk" tea, extra rest and hydration, and extra pumping to beef up my supply. (Of course all of these things are hard to do with a little one to take care of!).

Your baby is as cute as can be!! In the adorable category, she's definitely 100th percentile!!!

 

[Dandi]

Gosh she is so, so beautiful!!

At this stage (or so I've been told), breastmilk is their primary source of nutrition, and any solids are supplement nutrition. I noticed my supply dropped a bit when Oscar started solids too because I was feeding him solids first, then breastmilk afterwards, so of course, he wasn't hungry for milk. Since I went back to 6 breastfeeds a day, and always breastmilk before solid meals, my supply increased again, I also pumped every evening to boost it back up again. I also found that if he got fewer than 5 breastfeeds a day he was hungry overnight and waking for feeds, having dropped his night feeds at 5 weeks of age. He was hungry during the night, irrespective of how much he had eaten in the way of solids, as he still needed the calories from my milk I guess.

I would continue on your regular breastfeeding regimen, and offer her solids an hour after a breastfeed. It was recommended to me to do that and it has worked well, as Oscar has been getting everything he needs from my milk, and then only eating whatever else he needs to in the way of solids for additional nutrition, as well as purely learning to eat. He is slowly losing interest in breastmilk - breasfeeds are getting shorter, if he is interested at all, which I guess is a natural progression towards weaning.

You're doing a brilliant job with your baby girl, she is the picture of health and happiness! You must be the proudest mummy!!

 

[Logan Sapphire]

My son was also EBF and was/is 95th percentile for height but fell to around the 10th for weight for many months. His height to weight ratio was under the 1st percentile and is now up to the 5th. The dr was a little concerned too, and told us to try to fatten him up some, but to be honest, we didn't make any extra effort b/c I was worried that we'd be "overriding" what probably was just his natural body type and have heard that fattening them up can lead to eating problems later. Sure enough, he slowly gained weight over the months and while he's still slim, it's apparently his body type is tall and lean.

 

[mia1181]

Rosebloom- Good idea on calling the hotline! My local hospital has an excellent one too! There are a few breastfeeding support groups around here so I am going to see if we can stop by to weigh her after a feeding and determine how much she is getting. I'm definitely not a fan of feeding babies early (mostly because I don't see the need to go through the trouble if their main nutrition is from milk anyway) but I have read a lot on the subject and I feel comfortable giving it a try with just cereal. If my supply is a low I will definitely try mother's milk tea! Thanks for the suggestion!

DandiAndi- Thanks for the compliments on our little girl! That picture is not the best but I chose it because it is very recent and shows her rolls! I couldn't believe when the NP took off her diaper and said "Oh good you do have some rolls under here!" I was like "Are we looking at the same baby?!" Either way I think she is perfect! Thank you so much for suggesting waiting an hour after feeding to offer solids! I was trying to figure it out because if I tried to give her only half a meal of breastmilk and then pulled her off for solids, she would flip out! Waiting an hour is the perfect way to make sure she gets what she needs but is a little hungry to try and eat some more. Come to think of it, O is waking a little more during the night to eat. Hopefully if I focus more on the feeding during the day she will sleep a little better at night. She actually sleeps fine but has been waking twice a night instead of once. I didn't really bother me because I am still awake for the first wake up.

Logan Sapphire- I was wondering the same thing! My husband is 6 feet tall and only like 165 lbs. He is tall and lean. I am only 5'4 with average weight and a small frame. I was shocked when we had a 9 pound baby! I even asked her regular doctor if she would always be in the 90th percentile and the doctor said a lot of babies thin out. So when they told me 50th percentile, I just thought she is naturally thinning. Everyone keeps saying she is a big baby too! I also worry about going crazy trying to fatten her up. Over the past month we were on vacation and I was nursing her to sleep a lot (something I don't normally do) out of ease. Both of the 6 hours flights, she nursed practically the entire way. Wouldn't that do more for my supply than the pump? The problem is she only comfort sucked because she wasn't hungry! Anyway my current plan is to check out a breastfeeding support group and weigh her. If it seems my supply is low I will work on that starting with least invasive strategies (drinking more water) but I want to hold off on creating more work for myself like pumping until I am sure there is a problem. If my supply seems okay I will continue with the cereal and see how the next weigh in goes. I really don't want to get crazy with this!

 

[monkeyprincess]

Mia, I just wanted to ditto what LoganSapphire said. My little guy started off nice-sized at 8 lbs, 5 oz and 21.5 inches. And while has always been pretty tall (around 90-95%), he dropped way down on the weight charts to about 5-15% from about 1-6 months. He is now creeping up again to around 35% at 9 months. I'm not breastfeeding my little guy, so I know that he has a healthy appetite and gets plenty of formula. Anyway, the doctor has never been concerned and told us that is probably just his body type. When I saw your post, it struck me that it looks like your little one has really shot up in height over that time. Maybe she has been doing a lot of growing "up," rather than growing "out." For what it's worth, she looks very healthy to me. And adorable!

 

[mia1181]

Thanks for also sharing Monkey! I can't help but think that my baby is just going to be long and lean like her dad. This whole situation is so strange because she seems so satisfied! It is strange that she shot up to the 90th percentile in height. Maybe she had a growth spurt and just needs a little time to bulk up a little.

 

[amc80]

Thanks for also sharing Monkey! I can't help but think that my baby is just going to be long and lean like her dad. This whole situation is so strange because she seems so satisfied! It is strange that she shot up to the 90th percentile in height. Maybe she had a growth spurt and just needs a little time to bulk up a little.

This. I've noticed that B will pudge out a bit and then shoot up and thin out. My husband is tall and skinny (6'7", 200lns) so it wouldn't be surprising if B ends up skinny. BTW, although he was 8lbs11.5oz when born, he lost over a pound and it took him a few months to get back up to the 50th percentile in weight (while never being below the 99th % in height). And it took until 7 months or so for his height/weight ratio to be at the 50% percentile.

 

[Octavia]

Mia, I'm not a mom quite yet so take this with a grain of salt, but do you know what chart they're using for your LO? It's my understanding that one of them (CDC, I think? It's one of the federal health agencies, anyway) was primarily based on formula-fed babies while the WHO chart is primarily based on breastfed babies. There tend to be some differences in growth patterns between the two feeding methods and if they're using the "American" chart rather than the WHO one, it might make it look like your baby is underweight where the other chart won't. I'd ask your ped which chart they're using and whether they're accounting for exclusive breast feeding before getting too worried (easier said than done, I'm sure).

 

[Rosebloom]

Mia, sounds like you have a wonderful sense of perspective. Trust your "mommy instinct." It is almost always right!

I forgot to mention one of the best things for my supply - taking a bath with the baby and letting them nurse. It is extremely effective for me (and my dear friend who gave me the tip)!

 

[Logan Sapphire]

Thanks for also sharing Monkey! I can't help but think that my baby is just going to be long and lean like her dad. This whole situation is so strange because she seems so satisfied! It is strange that she shot up to the 90th percentile in height. Maybe she had a growth spurt and just needs a little time to bulk up a little.

You sound like my husband and me! Mine is 6'1" and thin, while I'm 5'3" and on the thinner side of average, though I used to be really skinny (back in the day!). Mine was 8lbs 3oz and 21" at 39 weeks, so I do believe he could well have been over 9lbs if he'd gone the typical 42 weeks.

Keep in mind that if baby isn't perfect straight for the measurements, even a quarter of an inch can throw the percentiles off. Same with weight- mere oz can make a huge difference in percentiles- which really is a good poop, pee, or meal, right?

Btw, my older child has the exact opposite body type- 75th percentile for weight and 15th for height. I will admit to be more worried about her than him.

Good luck!

 

[mlk]

Hi Mia, I can't offer much advice as my little boy has been exclusively FF since 5.5 months and is sitting on the 3rd percentile but I second Dandi about feeding the solids one hour after a milk feed.

O is just lovely and certainly doesn't look underfed or underweight to me!

 

[FrekeChild]

Good grief Mia! She's ridiculously adorable!

There have been points in A's growth where she will be 25th for weight and 90th for height, and no issues or concern from our doc. I wouldn't stress out too much about it, and just keep doing what you're doing.

(One of these days we'll have to get A and O together and play some CAH again with Auntie E!)

 

[dtnyc]

Your milk is more calorically dense than any solids you can give your baby. Breast milk has far more calories in it per oz than any solids.
BF'ing for 6 months is the gold standard (and what is recc'd by the WHO, CPS, AAP, etc.) - I would not be concerned about 50th% for weight and 90th% for height- my dad (a physician) and my friend a pedi NP both agree that the height measurements can be notoriously inaccurate, as it is all about how stretched out the baby is, as a PP mentioned.
That said, even if the measurements are all accurate, if the baby's head and length are on a good curve and increasing then baby is getting enough to eat. If baby wasn't getting enough nourishment than the height/length would be the first thing to slow down in terms of growth.

In other words, you are doing an excellent job and I would follow your gut in moving forward with solids. If your LO is happy just nursing then keep it up. Remember that under one solids are just for fun.

 

[Demelza]

I will preface this by admitting my bias: I am passionate about breastfeeding and I get irate when I hear health professionals (unintentionally, I'm sure) undermining a mom's breastfeeding relationship by causing her to doubt her milk supply. Based on what you've told us, I would absolutely NOT be concerned about your baby one bit: you say she is happy and satisfied, bright and alert, and you have historically had a very good milk supply. And at the risk of overstepping my bounds here, I would go so far as to say that I would NOT follow her recommendation to start on rice cereal. If there is one thing that will harm your supply, it's supplementing with another food source. As far as I know, all the recent literature seems to support waiting on solids until 6 months, so I see no reason to start on cereal simply because she is in the 50th percentile. Does the NP think she should stay in the exact same percentile for the rest of her life? My oldest daughter dropped OFF the charts at a year. She went from being in the 25th percentile for her entire first year to not being on the chart at all. Everyone (including me!) panicked and she was followed closely by her pediatrician for a long time. She is now 6 and still tiny -- only 34 pounds or so -- but the doctors have determined that it's just the way she is. Her father is tall and very thin (6 ft and 155 pounds) and I am 5'2 and petite. I am not a doctor or a lactation consultant -- just another mom who has been through something similar. Trust your gut -- your baby looks as happy and adorable as can be! If she weren't getting enough food, I am quite sure it would show! And kudos to you for breastfeeding!!

 

[mia1181]

I don't have much time to respond but wanted to update you all and thank you all for your support!

I went to the breastfeeding support group (a day late and when the lady at the counter told me it was the day before I exclaimed "Oh is today Thursday really loudly, showing off my mommy brain!). The boutique that holds the meetings has a breastfeeding room and a scale that anyone can use anytime do I fed O as planned. It was an hour before she needed to eat so I don't know if that affected anything but she only gained 3 ounces from both breasts combined. Well I don't know if that is good or not especially since I know babies take in different amounts at different meals. So I left even more confused and defeated about this whole ordeal.

I called the babyline at our local hospital and talked to an LC. Her take on it was that my baby is just going to be long and lean. But then I explained all of the other factors in play (our traveling, that my period had returned last month and I am currently menstruating, baby isn't sleeping as well since returning (jetlag)) and her recommendation was to just try to boost my supply to put my mind at ease, but she still firmly believed that this has more to do with O's body type.

So I've kind of decided to not do anything special besides make sure I am eating/drinking enough and getting enough rest. I hate pumping but since we have started the cereal, I just make sure to pump before feeding her cereal. That way I have something to mix with the cereal and to minimize the effect the cereal might have on my supply. In a few days I will go back and weigh her again, hopefully to put my mind at ease.

Thank you all for the encouragement that I am doing the right thing. It's really helpful to hear from those of you who have formula-fed babies who also thinned out. I hate that this appointment was with the NP because I previously asked her ped if she would always be a big baby/kid and she told me that she will probably thin out. Luckily when I go back for the next appointment it will be with her!

Freke I can't wait for A and O to play! And for me to get to play CAH with some wine this time! Name the date/time and we are there!

 

[pancake]

A few thoughts.

1. ADORABLE baby.

2. You're at a stage where it is very common for oversupply to settle down and for your supply to much better reflect your baby's demand. Like you, I had ongoing issues with engorgement and oversupply until about 4 months, at which point things finally "settled". When that happened, I completely FREAKED OUT because I didn't have hard rocks strapped to my chest any more and I figured I must be losing my supply! It was not the case.

3. Length measurements of infants before they can stand are notoriously unreliable.

4. Birthweight is a reflection of genetics, maternal size, in utero nutrition. Over the first year of life, babies will declare themselves in terms of their likely growth pattern and genetics. If your husband is long and lean, it may well be that your bub will be the same. I'm looking at my own (17mo) daughter's growth chart right now. She was born on the 25th centile for weight, 75th for length; then transiently up to the 50th for weight at 2 months before settling (and staying) on the 50th. Length-wise, she was around the 50-75th, but since about 6 months has declared herself to be a giant and is sitting comfortably on or just above the 97th centile for length - in keeping with my tall husband, and the pattern on my husband's mother's side of having very very very loooooooooong children!

5. Solids are great (and I'm an advocate of starting between 4 and 6 months), but nutritionally they contribute very little at this stage as the gut does not absorb a significant amount of nutrients from solid intake at this age.

6. I don't think you have anything to worry about.

I'm commenting on this mostly as a mum, but I'm also a pediatric endocrinology doctor and growth is a large part of the work that I do. Just go on being sensible, and see how you go at the next appointment. But there is no cause for alarm at this point, so try not to torture yourself - I know that's easier said than done (self-torture seems to be a skill we abruptly gain the second we become mothers!) but do your best!

 

[mia1181]

Pancake, thanks so much for chiming in!

'

A few thoughts.

1. ADORABLE baby.
THANKS! We kinda love her!

2. You're at a stage where it is very common for oversupply to settle down and for your supply to much better reflect your baby's demand. Like you, I had ongoing issues with engorgement and oversupply until about 4 months, at which point things finally "settled". When that happened, I completely FREAKED OUT because I didn't have hard rocks strapped to my chest any more and I figured I must be losing my supply! It was not the case.
That is what the LC said. She said they get a lot of calls around this time because it is very common. It also might explain why O used to spit up a ton and now she doesn't spit up as often. It may be that she is getting just what she needs. I really hope so.

3. Length measurements of infants before they can stand are notoriously unreliable.
Yes her regular pediatrician says the same thing. At one point it appeared that O hadn't grown at all and the doc said they really don't stress about height for that reason. I just can't help but wonder what she would have said if she was the one we had the appointment with. I'm glad the follow-up will be with her.

4. Birthweight is a reflection of genetics, maternal size, in utero nutrition. Over the first year of life, babies will declare themselves in terms of their likely growth pattern and genetics. If your husband is long and lean, it may well be that your bub will be the same. I'm looking at my own (17mo) daughter's growth chart right now. She was born on the 25th centile for weight, 75th for length; then transiently up to the 50th for weight at 2 months before settling (and staying) on the 50th. Length-wise, she was around the 50-75th, but since about 6 months has declared herself to be a giant and is sitting comfortably on or just above the 97th centile for length - in keeping with my tall husband, and the pattern on my husband's mother's side of having very very very loooooooooong children!
I agree with this. My daughter was way bigger than anyone would have expected at birth. I knew she was going to thin out eventually because both my husband and I were small children. I understand that the NP probably just wants to make sure that this drop in percentiles isn't the beginning of failure to thrive or anything like that so I don't mind the extra monitoring, but I am uncomfortable with the notion of trying to fatten up my baby. I just want her to be whatever she is supposed to be unless there is real danger to her health.

5. Solids are great (and I'm an advocate of starting between 4 and 6 months), but nutritionally they contribute very little at this stage as the gut does not absorb a significant amount of nutrients from solid intake at this age.
Don't worry, I totally understand that solids are just practice at this age and more for teaching the baby the skill of eating. I think giving solids early just means more work overall so I was planning on holding off until at least 6 months. But since it was doctors orders and I have done my own research on the subject, I figured it wouldn't hurt. It's not replacing any meals and she is nursing just as long and frequently as before. She also seems to be ready since she enjoys it, giggling at each bite and even grabbing the spoon at times! I'm not going to introduce anything besides cereal until she is older though. Mostly because it's not worth the trouble at this point. But yes, I am skeptical that a little baby cereal is going to do anything to beef her up.

6. I don't think you have anything to worry about.
Thank you a million times for saying this!

I'm commenting on this mostly as a mum, but I'm also a pediatric endocrinology doctor and growth is a large part of the work that I do. Just go on being sensible, and see how you go at the next appointment. But there is no cause for alarm at this point, so try not to torture yourself - I know that's easier said than done (self-torture seems to be a skill we abruptly gain the second we become mothers!) but do your best!

Thanks for all your advice! I hope you can tell from my posts that I know rationally that this is not worth stressing over but of course as a mom it is hard to turn the worrying off. I just never want to think that I somehow neglected my daughter's health! The breastfeeding is so hard because you really have to trust that your body and the baby's body know what to do! I have several years of experience working with babies and children so that part comes very easy to me. But the breastfeeding is so new and foreign to me. I just have to be grateful that for the most part it has gone well.

Thanks again for your help!

 

[pancake]

Mia, I totally get that it's 100% different when YOU become the mother! I found the same thing. It sounds like you have a very sensible head on your shoulders and your little girl is a lively, happy, healthy bub!

One more thing, just because your comment on solids made me think of it - since you've decided to start solids now, it's probably worth making the most of the opportunity to expose bub to a wide range of allergens in the next couple of months. There is some evidence now - reflected in the position statements of most allergy associations - that exposure to a wide range of "highly allergenic" foods (ie. nuts, eggs, etc) between about 4 and 6 months may decrease the risk of severe food allergy.

 

[Logan Sapphire]

Mia, I totally get that it's 100% different when YOU become the mother! I found the same thing. It sounds like you have a very sensible head on your shoulders and your little girl is a lively, happy, healthy bub!

One more thing, just because your comment on solids made me think of it - since you've decided to start solids now, it's probably worth making the most of the opportunity to expose bub to a wide range of allergens in the next couple of months. There is some evidence now - reflected in the position statements of most allergy associations - that exposure to a wide range of "highly allergenic" foods (ie. nuts, eggs, etc) between about 4 and 6 months may decrease the risk of severe food allergy.

Off-topic, but do you know if this "exposure" is also through breastmilk or only through solid foods? I ask b/c my son wasn't on any solids until he turned 6 months...and naturally he has peanut allergies. I did eat peanuts throughout pregnancy and breastfeeding (well, I say BFing b/c it's easier than explaining that I EPd)- didn't pig out but didn't avoid them (I eat them on occasion). No history of food allergies on either side