What to do with the

[mawbroon]

DS is 21 weeks tomorrow and is exclusively bf (unless you count Lansinoh, Calpol and bathwater ). He was following the 25th centile beautifully but over the last six weeks has only gained 7oz and is almost at the 2nd centile. Now I know that the graphs are not the be all and end all and that exclusively bf babies can dramatically slow in weight gain around this time so I am not particularly worried as he is bright and happy, feeds well, sleeps well and has plenty wet/dirty nappies.
HV suggested baby rice. I want to wait until 26 weeks as there are countless allergies in the family, myself included. The HV said that although she agrees that ds seems perfectly fine, as a health visitor, she can't ignore the slow down in weight gain which is fair enough.
So, I spoke to my LLL breastfeeding counsellor who confirmed my suspicions that there are actually more calories in breastmilk than baby rice and there were plenty other things which could be done rather than just jumping into weaning.
She suggested various thing- some of which I am already doing - but one thing she suggested was to let some EBM settle and then spoon off the cream to feed to DS. Makes perfect sense, but what do I do with the "skimmed" EBM?? Doesn't make sense to feed it to him just now whilst there is an issue with weight gain, so my idea was to freeze it and then use it in veg purees etc in a couple of months time. Does this sound feasible? One thing for sure is that I'm not ditching it!!
Any (sensible) ideas appreciated and sorry for the long post.
MB

milk pudding for the family?

LOL. DH would have a hairy fit. But then, who's going to tell him what it's made of........??

I would just carry on with feeding, keep an eye on how often and long just in case a busy baby is getting distracted and not feeding long enough.
Also, if you can, just try and relax and take your time with the feeds.
Take a step back from the housework and see if this makes a difference.
I dont know if you have older children, but its easy to get busy and interrupt feeds at times.

As for your health visitor, remind her that the charts were designed for totally bottle fed babys and that if baby seems well and alert and is happy. Then (IMO )keep on doing what you are doing.
There is no mad rush for starting solids.
I can understand the allergy side of things, and ( lots of allergies in my family) I breast fed all of them, (4) and the last two didnt have solids until 6 months.

it might be worth asking how long the HV breastfed and when she started solids,as personal things do get in the way of decent medical advice, if you know what I mean.

My midwives I had over the years, only one was a mother ( of three) and she said she didnt 'take' to breastfeeding, so gave little comment to breastfeeding.
the other non mothers gave out the text book stuff, but it had little meaning to the reality.

I am of the opinon that all midwives must have stretch marks and have personl experience of intense , long lasting pain!!! LOL

my thought exactly, and it does taste good i am informed, not a hot milk fan myself so not for me, also milkshakes...yum...

My dd was very similar - almost at 25th centile at 20 weeks, dropping through to almost 2nd by 25th. Fully breastfed and kept so because of my allergies - she herself was already developing excema, not food-related, but I wasn't takiing any risks. Both the hvs I saw at the clinic were extremely relaxed about it - they said that unless she dropped through two whole lines they would worry about it, and that it was simply that dd was starting to be more active and thus using up calories more than storing them. I reintroduced a dreamfeed to keep her going, but as long as she seemed alert and well in herself, with plenty of wet and dirty nappies (no probs there ) it was nothing to worry about. I eventually started solids a couple of days short of 26 weeks; she took to it like a duck to water. She piled weight on for a fortnight and has settled happily on the 9th centile again, which is where she was when she was born.
You don't say how your ds is in himself - if you hadn't actually had him weighed, would you be able to tell any difference in him lately? Has he started to be lethargic, or wake up earlier, or be generally unhappy, or to cry for a feed before usual? Personally I would say that if he is happy, keeping up the wet nappies and not causing you any worries away from the scales, then the best option is probably to give him as much breastmilk as he wants and relax about it! To me, spoon feeding EBM cream sounds lie a lot of faff for probably not a lot of gain, but I'm a bit lazy like that . If you find it easy to express large quantities of milk, and your ds seems hungry but won't take extra milk 'direct from the source', then give it a try, but if it were me I'd smile, say "thank you very much for your advice" and avoid the clinic for a couple of weeks!

Sorry - unless she dropped through 2 lines the wouldN'T worry about it...
Lots of people have jumped in since I started writing (I'm 1-fingered typing whilst eating with the other hand ),so hopefully you'll get plenty of good advice.

williamsmummy: charts in the UK are not designed for totally bottle fed babies (check my name and archives for my explanation of this) but it is certainly true that by the time a baby is mawbroon's baby's age, they do not reflect the normal plateauing of weight of the fully breastfed baby....the health visitor is indeed off the mark in suggesting baby rice for what she (presumably) thinks is no more than a need for extra calories.

The rice is not an efficient way of getting calories in - quite the opposite in fact.

The ebm/skim off the cream caper is something often suggested in the US, maw, but I do wonder if it is worth the hassle, for a healthy, thriving baby.
It would be easier simply to fit in an extra feed - surely? One extra small breastfeed is going to have far more calories in than thd couple of teaspoons of baby rice usually suggested as a first taste (total calorie value of this is something like 8 calories, if I remember rightly...will check later).

Ooooh Williamsmummy, tiktok will give you a row! Apparently the charts are actually based on a wide cross section of babies whether breast or bottle fed and the "charts based on bottle fed babies" is a myth..... You are right though about letting the housework go - any excuse!! DS is my first so I can devote as much time as I like to him. We do also snuggle up in bed of an afternoon for a long feeding/snoozing session.

JennyWren - DS is absolutely fine. He is coming on great in every other way and I have no other concerns about him whatsoever. I had actually decided to stop stressing about his weight a few weeks ago, but then I went to baby massage for 6 weeks where they also weighed the babies seeing they were in the buff anyway. I think I would have seemed a bit odd if I hadn't got him weighed at the class, but I agree, there's no need to get them weighed every week by this stage. I think though that I have probably now been flagged up in the HVs mind and that she'll be on the phone if I don't go to the clinic.

Mawbroon - In case you don't know her, tiktok's our resident expert - fount of wisdom and definitely to be relied on!

x post tiktok......

I agree with you tiktok that it does seem a bit of a faff spooning off the cream. DS will probably swipe at the spoon and it will all end up on the floor!! I am feeding around every two hours through the day as well as our afternoons in bed (which I have done twice in the last 4 days). He is not a sicky baby at all, but is bringing up more than usual (but still only a tiny bit) which makes me wonder if his tummy is full to the brim and he can't take any more. He has NEVER refused the breast ever and if I let him, he would sook away all day, but it's more the light fluttering type of sucking rather than the big sucks where he is obviously getting milk. Does he get any milk whilst doing this light sucking?

Oh and I've tried compression but just can't get it to work at all. Perhaps I'm doing it wrong

\link{http://www.kellymom.com/nutrition/vitamins/babyfoodcalories.html\calories in baby rice} shows that there are 20 calories in 2 tablespoons mixed with 1 oz of water - 2 tablespoons are probably rather more than a baby would eat at first.

It's hard to estimate what a small breastfeed would be, but lets say 50 cals which would be between two and two and a half ounces.

The HV might like to say which is most likely to help the baby gain weight.....

oh, don't you make baby rice up with ebm? I haven't even looked at it yet.....

DS has just filled his nappy so there's obviously more than enough going in!!

You can make it up with ebm.....but what is the point? he can have the ebm at source :) Of course adding ebm will boost the calorie content.

mawbroon - my DS did the same weight trick !

He put on masses of weight in first 5.5 months, then slowed down. Like you I was never worried because he is the cheekiest looking happy, healthy monkey around.

I have refused to visit HV or GP since his 6 week check - waste of time.

I bought a baby scale and have been weighing him at home. He is 21 months now (still bf), only 10.5 kilos. I say ONLY because some of the boys I see his age are tall and heavy looking. I have seen quite a few bf toddlers my DS's age, and even they are taller than DS, but then I am only 5.2" and DH 5.7" so not expecting DS to become a basketball player

DS stopped putting on much weight at around 5.5 months. But then he has always been on the same centile for height, so he is very well proportioned, short and slim though by no means skinny due to round face and big round cheeks

Totally agree with not bothering with rice. Empty calories and very very bland. Never even bothered with it at 6 months, went straight to fruit and veg, quickly followed by pureed meat, much more vits. and iron than rice.

I can't believe people still recommend solids this early as a way to increase weight. I was worried about allergies just like you and just would not risk allergies by weaning before 6 months.

I would just bf more often if you can.

Best of luck

tiktok - I love your no faffing approach re getting ebm at source!! Right up my street I was going to skip baby rice actually and go straight on to purees as koolkat mentioned because making up a spoonful or two just for it to get smeared over his bib seems like a bit of a waste of time!

Skip the purees, too, mawbroon - not worth the bother. In fact, skip spoonfeeding, apart from the stuff that is naturally sloppy like yogs unless you want a big mess.

I think I might be tempted to do spoonfeeding with a baby whose weight was really causing concern, just to make sure the stuff got in, but otherwise, finger foods are the way to go :)

Don't want to have a row with tiktok but depends on how ready your 6 month old is for swallowing.

My DS found it quite difficult to swallow big chunks at first so did purees to make sure he didn't choke. Depends on the baby. Some are better with swallowing than others. But yes, did give him finger foods as soon as I was happy he could eat them without choking.

OK. I'll bear that in mind both. What would you suggest for first foods then if I didn't bother with purees? I am thinking carrots or turnips or the like cut into sticks and boiled until they are very soft but still holding their shape?

mawbroon - yes the ones you suggest are excellent.

Also try cubes or small slices of:

apple
pear
mango
banana
papaya
melon
peach /nectarine

potato
sweet potato
butternut squash /pumpkin
courgette
broccoli (loads of iron)

I steamed the harder fruit like apples and pears for a few mins., as the ones that were a bit hard were difficult to bite on (he had no teeth until 9 months old !)

Also if you steam everything rather than boil in water you will keep all the vits. in them.

There are some really good websites that recommend what are good first foods.

i weaned dd at about 3 month but this was because she hated milk and never drank much and her weight was suffering, tried baby rice and she hated that too. then went on to purree, she hated that so tried lumpy soups and she thought they were great, by about 5 month she was fingerfeeding with the same stuff we ate. she got teeth through before she was 6 month because she was chewing so muchand it all helped.

i know this is all a bit off subject but would agree with going straight to finger food, as long as you'r with them (like youd wander off!) and that you let them deal with their own gagging or they will choke (if dd gagged i didnt even get up till the 3rd time! oops bad mummy!)

good luck!

Thanks for all your advice ladies. I can see how, as a first time mum, it would be easy to feel pressured by the HV. I feel I can argue my corner about holding off on weaning because of all the fab stuff that I have read on MN over the months. NOT that I should have to "argue" over following the current guidelines, but that's another thread!

Just watch for a thread in a couple of months saying "My ds is huge - he climbed all the way from the 2nd to the 90th centile when I put him on solids" Only kidding

I had exactly the same problem with DS. And despite upping the feeds ('oh, he's a snacker then?' commented the HV, ), I couldn't get him to gain faster than 1/2 - 1 oz per week. But he was happy, alert, bright, & didn't look undernourished, although he's not as plump as his little mates. So... I stopped having him weighed. I was anxious because I thought the HV might chase after me, but she didn't. One sensible suggestion another HV made at his 8 month check was that he might be cold at night and using up cals that way. We increased the background temp in his room and he does seem to be filling out a bit.