6 month old dropping right off the centiles, I’m confused about weight gain – help!

[FirstAtForty]

My DD is 28 weeks, started off on 25th centile (2 wks overdue), gained well until 13 weeks when her weight gain suddenly flattened for about 9 weeks. Since then she has gained only very slowly, is now right at the bottom of 2nd centile and has only just hit 13lbs.

She seems healthy and alert, looks fine to me but maybe I?m just used to looking at a skinny baby?! (DP and I are average height / chunky in build). Her height has followed the 25th centile fairly consistently since birth. She isn?t sleeping well, wakes every 3-4 hours for bf, seeming hungry.

She is exclusively bf and started solids at 25wks, she?s on a couple of smallish meals a day of fruit and veg with baby rice or Ready Brek.

I?m confused about the bf / solids balance, and what food is best to give for weight gain? HV has said to give three good meals a day (in addition to usual bf?s), and introduce cereals, dairy and meat in order to get her to fill up, put on weight and sleep better.

I?m worried that too much food will cause her to take less milk ? is milk still the best thing to get her to put on weight at this age? I don?t want my supply to decrease since formula may not be an option (it makes her ill). HV said not to worry about this as it will adjust to what she needs, and to try and supplement her diet with dairy to see how she reacts. Whenever I have given her formula (about 4 times total) she has been very sick (vomiting) for hours afterwards. So she hasn?t had dairy (formula or otherwise) since 15 wks. I?m nervous about even trying dairy in weaning foods in case it will worsen any sensitivity.

So I guess the question is ? should I be trying to fill her up with food and risk her taking less milk, or keep meals small to avoid interfering with bf? And should I risk trying dairy?

[Twinklemegan]

Pavlov - Happy 7 month b'day to your DD! My DS has his tea at around 5 or 5.30 ish when I get home from work. His routine goes something like this (for all the times read "ish"). Although the aim was to give his milk first followed by solids, in fact they're more like separate feeds now which seems to work for us.

7.30am milk
9am breakfast
11/11.30am milk
12pm lunch
3/3.30pm milk
5/5.30pm tea
7pm bedtime milk
and then he still wants some milk when we go to bed

I just realised today that we have in fact finally achieved a "routine" and I'm very proud of the fact

[Pavlovthecat]

I agree there. My LO is eating well on solids at 7 months (today, happy birthday!), which is I beleive 30 weeks (I lost count!). but I usually giver her milk first. To be honest, she is usually too crabby if I dont and wont eat anyway!

I give her baby muesli and fruit for brekky, or baby some banana and baby rice that kind of thing, vegetable of some kind at lunch time, although now I am introducing chicken and fish (she loves chicken, not so sure about the fish. And for tea, either vegetables if she has had meat or fish at lunch, or fruit of some kind and baby rice for tea.
I have also started to give her rice cakes to snack on (more to practice, dont think she actually eats any of it!), makes her feel part of the family when we eat.

I don't make her eat all that I put in front of her, she eats as much or as little as she wants, its more, I feel at this stage, getting them interested and learning about tastes and textures than substinence. And right now she is not eating much, or taking a bottle as she has a cold and only BF will do!

Need some advice about one thing tho...what time should I do evening tea? just before bed with her milk or her 4:30 feed?

[Twinklemegan]

Hi FirstAtForty. DS is 27 weeks and has been on small amounts of solid food for 7 weeks or so. I've been increasing DS's solids very slowly since I started weaning him and consequently he hasn't noticeably cut his milk intake.

I'd definitely avoid increasing the solids too quickly. The approach I took, and am still taking for the time being, was to make sure he takes his full milk feed first before any solids. I've just introduced a small breakfast of oat cereal and fruit, in addition to a veg lunch and a tea of fruit and baby rice.

DS hasn't had any adverse reactions to formula but I'm still not planning to introduce a dairy for at least another couple of weeks. I would certainly leave off the dairy for a fair while if I were you. I haven't introduced any meat yet either - that'll be in a week or two. HTH!

[eviletc]

really try not to worry firstatforty. between 11 and 25 weeks dd only put on a pound. i was also cautious about food/milk balance as i was worried about her not wanting milk.
she is now nearly 9 months and weighs 16lbs. she eats 3 excellently sized meals a day plus snacks and just looks "petite." she has 2/3 fair sized bfs a day too and usually one in the night.
maybe try offering more food? as well as normal bfs? i am no expert, but dd seemed to figure out a healthy food/milk balance all by herself and while her lack of weight gain did worry me initially, the amount of food/milk she takes more than reassures me.
if she is a healthy happy baby in evey other respect then you are doing a fantastic job

[Pavlovthecat]

Sorry pinkdolly typo with your name!

[Pavlovthecat]

exactly pinkmolly. If it all matches, it is alright. My LO is a long thin babe. She is up to second quartile from the bottom on length, and now halfway between first and second in weight and head. and sooooooo sooooo active (pace upped in last three days too). Cant use bouncy chair any more, as she can stand up in it and climb out. She is into everything. I love the fact that she is a bit small, as it shocks people to see her so alert and crawling!!!

[pinkdolly]

Firstatforty,

Did I mention, Jazz is only 12.7lbs at 28 weeks. I think you can tell if your baby is healthy by looking at them.

I did get a bit wound up on monday when hv's weighed Jazz, but she is totally in proportion. Just a neat little bundle.

[FirstAtForty]

Thanks Pavlov and Adath ? that?s reassuring. I really do think (deep down) that she?s fine, but those charts do look quite depressing so you always worry don?t you. I?m sure all three of our (very) lo?s will grow up to be perfectly lovely! (And god knows where mine gets being petite from, it?s certainly not me lol)!

[adath]

Have to agree with pavlov here and also say you summed it up yourself in a lter post.
You would not have been concerned had it not been for this weighing.
Some babies do drop down the centiles and steady on a low one it does not mean there is anything wrong your baby may just have found here centile and she is going to be a small one so what.
If you were not concerned then you are probably right.
Ds is 9 month now and he has a good mix of BF and solids, he has settled into the kind of routine b himself that you are in on nursery days. Also at 6 months DS never slept more than 2-3 hours through now he can go for 12 hours at the very least wakes up once.

[Pavlovthecat]

I understand your concerns and fears here. I too have had problems with my dd's weight gain. She was a bit different to you, born on time but weighing only 5lb. She gained good weight for a bit then slowed down, I was breastfeeding and 'encouraged', rather forcefully to top up with formular at first, then I stopped gradually with good weight gain. When it slowed we started giving a top-up, as our HV made us seem like such bad parents for her low growth, mentioning horrible words such as 'failure to thrive'.
However, her behaviour was, and is normal, she is active, develping well, in fact crawls already at 29 weeks, is happy, content, smiles and laughs all the time, does not look ill and is a joy. She weighs, as of last week 13lb 3oz.
She has 3 meals a day, as much as she wants to each, and breastfeed with a little top up as we did before (she used to refuse a bottle, now takes about 3oz twice a day plus usual breastmilk) We are no longer concerned, her weight is now steady although not very large and we have come to accept that she is a small, petite girl, although we do keep an eye on it of course. Up until the last two weeks, she was skinny, quite muscley and did not have much 'baby fat', now though, she has chubby thighs and a double chin, yey!

It was a specific health visitor who put our minds at rest when our own one was away. She told us this.
Do not expect your baby to put on half pound in a week, she will not. Bigger babies need more calories, smaller babies need less. If your baby's behaviour changes, if she becomes listless and uninterested in the world then come back and see me. If not, then just accept that you will have a smaller child.
I think health visitors can (some are great, some are not) put unnecessary pressure on parents. Sounds like you are doing a great job as you are, and well done for the exclusive breastfeeding!

[TrinityRhino]

sorry to interrupt but TIKTOK
I think you are needed here

[FirstAtForty]

Thanks, I think that?s probably the only thing I can do, just gradually adjust to avoid any sudden drops in supply, and try and fit in extra feeds where I can. I have always really enjoyed bf so that?s not a problem, it?s just scary when it doesn?t seem to be enough and there's nothing to fall back on, and having to go back to work cranks up the pressure no end.

I think the govt are extending statuatory maternity leave to 9 months soon, hopefully that will help working mums, shame they didn?t do it earlier!

[tiktok]

I can see all this is quite demanding, First....any extra bfs are probably most easily done on the days you are with her, maybe fitting in one more bf on the days she is at nursery, though even that might be hard, I accept.

I don't think there is an easy answer here! You don't want to give her more solids because you recognise that they may take the place of breastmilk, and impact on your supply (which is the case, though with 7-8 bf in 24 hours you are probably ok unless you start giving a lot less too quickly). Yet you do want to reach a stage where most of her requirements come from solids, and not breastmilk.

There isn't a way to square that circle, sorry!

I don't understand about giving cereal to stop her waking - there is no evidence it works like that, and if it did, it might decrease her overall intake, because she would have less milk (and there are not that many calories in cereal, really. Most of the calories in cereal come from the milk it is mixed with!) If there is a question mark about her weight, we don't want her missing feeds, do we?

Perhaps continue what you are doing, gradually increasing the solids, while keeping an eye on her weight. is gonna be the way forward.

[FirstAtForty]

Thanks for replying Tiktok. I must admit if it wasn?t for that chart I wouldn?t really be too worried about weight, although I don?t want to just assume everything is okay if it isn?t. HV isn?t really panicking about the chart to be fair, she just said it would be good if she could at least follow the 2nd percentile line without dropping down further (as it looks like she might on the current projection). She seems more concerned about me as I?m quite stressed about work (returned 3 weeks ago), lack of sleep and also about having enough EBM for nursery (currently 2 days a week, going up to 3 in Feb).

Re more bf?s ? not sure but I think possibly the reasons she didn?t suggest this is because of DD having just gone into nursery, so in practical terms feeding more often isn?t so easy. Also with the waking during the night she said that solids might help as breastmilk is more quickly digested than eg cereals.

On nursery days I bf at 7am, 8.30am (just before dropping her off), come back about 12.30pm to feed her, she has a 4-5oz bottle of EBM at 4pm, then I feed her again about 6.30, then on demand through evening and night. She has solids at about 11.30am and 4.30pm, and sometimes about 7pm (after bf). On an average day she has 7 or 8 breastfeeds over 24 hours. Hard to know how much she?s taking, but 4-5oz bottles seem to be about right for her as she sometimes doesn?t quite finish them.

I usually only express on my days off, as I can?t get it to work unless DD is on the other breast. I struggle to express 3 oz a day (takes a couple of gos) and also worry that the milk I?m expressing is milk she?s not getting that day. I don't think I could feed and express more often than I already am, especially on nursery days. To be honest it would be a relief if most of her food requirements could come from solids rather than from me. I just don?t want to risk my milk dropping right off in case she?s then reliant on formula which might make her ill.

Sorry this is so lengthy!

[tiktok]

Hi - what about simply giving her more breastfeeds?
If the HV thinks your baby needs calories (and there's not enough info for an outsider to say whether she's right or not - nothing in your baby's behaviour indicates this, as the waking pattern and the growth you describe is within normal), anyway, if she thinks your baby needs more calories, why can't they come from breastmilk? You have the breastmilk, and it would be a simple matter just to give her more feeds - rushing with solids has all the drawbacks you decribe as well as being a hassle!

She can continue with solids, gradually increasing the amount and the type as she gets older, alongside more breastfeeds which are an easy and effective way at getting 'more' into a baby, without running the risk of promoting an unphysiological weight gain.

I wonder why your HV did not suggest this herself? Maybe you could ask her what she thinks! Her answer will help you work out how far to accept her advice.