HV says I am bf 11mo too much - no weight gain

[Jellybabie3]

I am just abit confused so asking for some advice. My DS has not gained any weight for about 6 weeks. He weighs 8kg, 9th percentile

When asked about his diet I explained he has 3x meals a day but sometimes hes just not that bothered i.e he will throw most on the floor. He also will not eat any kind of bread (bagels, wraps etc) which is a bit of pain. On average I would guess he bf 4x a day (6.30am 11am 4pm 7pm ish) then wakes 3x a night and wants a feed. I know this is probably habit but I dont feel compelled, as much as I would love the sleep, to push him by sleep training.

Straight away my HV said that it's the night feeds which are the reason hes not eating enough food and I need to stop it as bf does not have the calories he needs anymore.

1 measley attempt of shortening a night feed (i pulled him off sooner to try to eventually make it not worth it for him to wake) meant he woke 4x instead of 3!!

I then asked if i should give food instead of or before a bf and she said yes although then went on to say he should have an early morn bf before a late breakfast but for the remainder of the day give food first. This is despite me saying he wont drink from a cup. Water, milk, nothing (I am worried about dehydration here).

Should I really be doing this?? I am so confused as this doesn't really go with what I thought which was that bf comes first til 1 year old

OP Have you tried feeding him water from a baby's milk bottle?

BM changes as your child's needs change.

This was one that Mumsnet challenged because it was yet more confusion but might be worth reading www.theguardian.com/lifeandstyle/2011/jan/14/six-months-breastfeeding-babies-scientists

And @Ditching - there's always mixed advice, including yours. If I drank a pint of milk before supper I wouldn't want anything to eat. You could. Would you be imposing your own choice on your baby? Probably not, but I do disagree with your "our children are smarter than all of us " - at what point is their lead ignored so the DPs get some sleep esp when the BF DM is going back to work? Some of us don't have a year's grace - I'd think it was the majority nowadays - so need to reduce BF - and nor should that cohort be made to feel bad.

Thanks all for your advice. I am going with DS lead right now although I did offer porridge before BF this morn and he ate it all. But. At lunch he ate nothing but a breadstick. I offered creamy tuna pasta with carrots peas sweetcorn, yoghurt, breadsticks, even thise carrot puffs and all he had was about 3inches of breadstick. So so far today its been.

Bf 5.30am
Breakfast of porridge and 6 raspberries 7.30am
Bf 10.30am
Bf 3.30pm

I am at a loss tbh

It might be a backward step but maybe they prefer the texture of a purée? That's why the porridge was the biggest success?

And also, eating all their porridge and 6 raspberries is excellent!

@DitchingTheDye thank you.

It doesn’t sound like he breastfeeds very often tbh BUT they are all different, some are very efficient feeders and will take what they need in a few feeds a day. However, most babies tend to spread their milk intake over 24 hours so feeding infrequently during the day could be partly why he feeds a lot through the night.

Honestly, he will start to eat more at some point, some don’t get the hang of food until 18 months or so and even than have good and bad days.

In terms of solids v breastmilk it sounds like you’ve got the proportions spot on. He’s doing exactly what he should be doing.

Offering breastmilk before solids is recommended at that age too.

It sounds like the GP has concerns over his weight and usually the best thing to do is to get as many calories into him as possible and the easiest way at this point is by more breastfeeding! In 6 months time he’ll probably be totally different and eating loads (although I appreciate it’s so hard to see it when you’re in the middle of it) so just do whatever makes your life easier for now to help him gain/maintain weight. There is no point in worrying yourself silly over tuna pasta when you’re in a fantastic position to have breastmilk available for him on tap

OP Have you tried feeding him water from a baby's milk bottle?
In terms of a baby that has weight gain concerns, I’m not sure water from a bottle is beneficial. I would say offering breastmilk is far better than water in terms of calories and nutrition.

BM changes as your child's needs change.
Yes, as the child gets older breastmilk becomes more nutrient rich and contains more antibodies.

@DitchingTheDye thats a good point RE: puree. Maybe i could try that

I do think I have no choice but to follow his lead tbh as like you say i cant force him to do anything. Its just the unfortunate pressure from the doc and HV! He will be at the childminders in a few weeks so may be his preferences will change then

If he does prefer puree you can do calorie dense ones rather than just veg, so avocado, carrot and full fat creme fraiche, cheesy mash (dd adores this, even when she's fussy) sweet potato and cream cheese etc.

I honestly wouldn't worry, I know thats hard! Babies don't purposefully starve themselves. Breastmilk is incredibly nutrient and calorie dense so don't ever worry about him still having a bf. A carrot puree isn't going to offer the same nutrition. Keep offering a wide variety of food throughout the day and I do think one day it will just click and you'll breathe the biggest sigh of relief!

You've been given absolutely bullshit advice there.

A child of that age doesn't associate food with satiating hunger and is not eating enough, effectively enough for it to do so either.

Your milk does not lose calories or become insufficient.

If you're only crossing the 2nd centile line since birth now, and it hasn't been rapid, what the hell is the problem.

Oh and DS didn't put anything on between 11 and 13 months btw. Hes dropped from 98 to just above 91 and no one batted an eyelid.

Oh, and BM does a fine job of hydrating children.

Long and short of it: keep boobing and don't worry about food. Offer it frequently, but keep boobing

Try not to worry, my DD was BF on demand and really didn’t eat three proper meals until she was about 13 months. She barely ate any ‘real’ food but was on the 98th centile and stayed there, so breastmilk not being calorie dense enough is bollocks in my experience! Many HCPs have little experience of BF beyond six months.

If anything I’d continue to offer food as you are, but actually offer MORE breastfeeds afterwards if you are worried about weight. And on demand at night.

Food is for fun until one (even a bit longer!) If you treat BF as the main food source and mealtimes as an opportunity for baby to try lots of tastes and textures (encouraging as much eating as he’ll cooperate with, but not worrying about it) you might find it less stressful.

I think you are spot on following his lead but I completely understand the pressure from HV/GP and how it can make you doubt yourself. That’s why it’s so important to do your own reading and research.

Are you on any breastfeeding FB groups? They can be great to reassure you of what’s ‘normal’ in terms of food at that age.

DS was like this no interest in food and still breastfeed 4 times a day if Id refused during the day he just wouldn't eat/ drink and feed more at night. He's only just starting to drink milk (cows) from a bottle at nearly 3.

He didn't really starting eating 3 meals till about 19 months and always maintained his weight even when fully on solid food

@piglet81 yes, the breast milk its self would not have reduced in calories but the baby is getting bigger and so needs more calories than breastfeeding can offer.

I would ordinarily agree with much of what's been said about following his lead etc, except two health care professionals (who have actually seen your baby)have raised concerns about his weight and suggested reducing bf to encourage solids. I don't think you need to do anything drastic, but I'm not sure I would be dismissing what the hcp have said. Could you offer a snack at 10 ish before his second feed? The I think the amount of food babies (well, young dc in general)need is over estimated so for instance porridge and fruit sounds absolutely fine.

Are you going back to work ft op? You might want to persevere with the different types of cup for when he's at his cm - you might find that he has more food when he's there anyway.

Thanks all. Its a toughy as he is being checked again in a couple of weeks and I feel a little if I get it wrong, aka he continues to lose or not gain weight and I havent taken medical advice I will feel terrible and have some explaining to do. That said imo he seems fine. Hes bright eyed and loving life so I feel inclined to follow his lead. I will try offering more snacks though. Its such a pain he avoids all bread stuff...like toast etc that I could easily prepare in a multitide of ways but maybe peanut butter on apple wedges or something will help. It also makes me feel a little chained to be home for meals etc as hes so easily distracted in public he eats even less (he waves and offers his food to everyone!)

Thanks again

@arbrighton RE: your comment about not crossing a line rapidly I agree with. The last time he crossed it was back in March I believe (red book downstairs) which was when my GP warned me I may need to cut dairy out of my diet. I didnt and 2 weeks later his weight had shot back up and no more was said...

That said now hes been following a period of plateau weight and then a drop 2 weeks ago (he actually lost 150g across 2 weeks) and then an increase of only 13g. I can see their concern maybe but hes also just started moving and the world has become so interesting he wont stop

I would not use the Kellymom's website for advice on solids - it contains inaccurate information and completely ignores the WHO recommendations on iron and zinc intake from complimentary food. Here is a pretty good summary of why "the food before one..." mantra is so unhelpful and misleading:

breastfeedingwithoutbs.blogspot.com/2012/09/bullshitometer-food-before-one-is-just.html

I would not worry too much about the slow weight gain but I would definitely try and offer food before milk. I would also try and reduce (and eventually drop) drop the late morning milk feed to get the baby hungry for lunch.

Have you seen a dietian that specialises in breastfeeding? Reflux can be a symptom of food intolerance which can lead to malabsorption and slow growth. If you could see a supportive dietian they might be able to help. If you can’t find one an NCT counsellor might be able to point you to one.

And as for less breastfeeding... it’s the most easily absorbed, high nutrition, calories dense food with hormones for growing baby humans. If you have an underweight infant more breastfeeding rather than less is better.

If you have the time/energy you could express some milk and use that on porridge or to make an egg rich custard.

I’m bemused by the suggestions to reduce BM ( High in calories ) and to give him water, bread and apple purée instead .

And water ??? Seriously ? Have any of you ever tasted BM? it’s sweet and yummy , why would you trade it in for water . Your baby isn’t stupid you know !

None of my children would have eaten a meal of tuna pasta with veg , breadsticks and yoghurt at 11 months. They would have thrown the pasta on the floor and made patterns in the yoghurt on the high chair tray before rubbing it through their hair.

If I were you I’d BF him MORE times in the day ( and night too if you feel like it ) and offercnich more simple foods that he can eat himself eg cubes of cheese if he likes solid things

Don’t make such fancy meals and get all stressed because he doesn’t eat it .

You have he has relflux - does he vomit ? I’m wondering if he’s throwing up a lot of the food and milk that he is taking.

Or maybe he’s avoiding food because it makes him feel unwell.

Do you think he has some food intolerance ? If so shouldn’t you be avoiding foods like peanut butter and bread products ?

Why did your GP suggest that you cut out dairy ? Does DS have signs of CMP or lactose intorlerance ? Do you have a family history of aetopic disease or coeliac disease ?

I'd breastfeed as much as he wants. I breastfed my son on demand and would have done so until he wanted to stop.

I'd keep an eye on coeliac disease. I'd avoid much veg if I was worried about weight and just try just offering higher calorie food.

Do you think he has some food intolerance ? If so shouldn’t you be avoiding foods like peanut butter and bread products ?

No, not unless it is done under a dietician. But I agre, I wonder if the bad reflux is linked to the lack of weight gain. What do they think caused the reflux? Do they think it's related to an allergy or intolerance?

I would keep BFing on demand, keep offering calorie dense foods and keep a food and symptoms diary to see if you spot a link to the reflux.

But, also, what percentile is he and what are you and DH? I had big babies and all dropped percentiles. But DH and I are titchy so they were just settling into their natural size. DD1 at 10 is the smallest girl in her class, she's skinny with no fat on her (aka a healthy weight). No-one worries that we feed her too little these days.