Breastfeeding underweight 18m/old - too much milk not enough solids?

[Firepile]

Need some evidence-based info here - have been given advice and think it may be based on misunderstanding of breastmilk - on othre hand, it might be correct, in which case I'd have to Take Some Action...

DS is now 18 months old. He has been off the bottom of the chart since he was about 8 months old, and under paed supervision. Paed of view that he is probably just small, but is keeping an eye. At his last checkup he had fallen even further behind his peers.

Paed thinks I am bfeeding too much, he is filling up on bm rather than eating solids and is not getting the calories he needs. I have heard that this happens with some children who are ffed, and soemetimes with other liquids too, but is bm the same? My understanding is that bm is dynamic - ie, if he feeds a lot, the milk will become more calorie and nutrient dense in response. I think the advice may be based on the misapprehension that bm is not a food... He is feeding a lot, though.

He does eat solids, but patchily. He has eaten a wide range of foods and we are trying to give him high calorie solids when he takes them.

I am still feeding him on demand, co sleeping and hoping for him to self wean.

He is pretty thin, but active, bright eyed and developmentally fine. Does the evidence suppport me taking the advice and consciously reduce the bfeeding, or is the advice well meant, but poorly supported?

[casbie]

from one years old though baby should be having three small meals a day plus breastmilk.

try porridge (with breast or cowes milk) with banana, drinking water from a cup with meals, or lunches can be eggy soldiers and dinner can be unsalted food that your eating, spag bol etc.

great deserts can be baby yoghurt, mango, or dried fruit, all build fat/sugars.






breastmilk is excellent, but can't sustain a toddler on that alone (emergencies the exception).

[tiktok]

Firepile, breastmilk for older babies does change and become more calorie dense, but no one would argue that it can be the sole or almost-sole source of calories for an 18-month-old.

These situations are so very individual, and you're right to wonder if the paed may not really understand about extended bf. The risk is that if you reduce the bf, you end up with your child taking in fewer calories, because all that happens is he has less breastmilk...he doesn't actually have more other foods instead.

This seems to me to be a behaviour issue rather than a nutritional one, given that he is healthy and developmentally normal.

The high calorie solids are obv a good idea, and casbie has some great suggestions. It'll help to make mealtimes sociable and interesting, and to give him autonomy to self-feed and explore new tastes and textures. Can you ask the paed to refer you to a dietitian with an interest and expertise in encouraging reluctant eaters? Try to get an expert view on whether reducing bf would really increase his calorie intake or not.

[Firepile]

Thanks very much for the information - there's so much rubbish advice about (and I have already been advised to try topping up, early weaning ...and Mars Bars, by the same team) so am pretty cynical about the quality of the advice...

He'll somtimes eat omelette, loves cheeses on toat (or more accurate the cheese) and dried fruit, custard and chocolate are all winners. He'd eat his own body weight in fruit but we've been advised to avoid giving it to him because it's so low in calories... I wish I could unpack what's going on because he isn't even that picky an eater - if he is in the mood he will eat almost anything, but if he's not, he just refuses even the "banker" foods.

We will find out soon enough about what heppens when he can't feed on demand, though - he will be a childldminder 3 days a week, so it will be interesting to see how he responds to that.

[Feenie]

Will be interested to see how he goes at the childminder - my 21 month old ds copes perfectly well in the week with my childminder then totally makes up for it at weekends and in holidays! (I'm a teacher).
He is on the 9th centile now, but was 9lb 2 when he was born, so I've had my fair share of hv pressure too. But although small he is round, plump and healthy, and eats well like your ds, so I've never shared their concern.

[Philomytha]

Bm does become more calorie dense, but I think there are many foods that are denser. If I were you I wouldn't cut down on breastfeeding but I'd time it so that I didn't offer milk right before mealtimes, and offer snacks of solids as well as milk during the day. Like tiktok says, if you cut down on bf before he takes to solids more, you risk him simply eating even less, and with his weight difficulties I guess what you'd like ideally would be for him to continue having the same amount of breastmilk but also a lot more solids.

[3madboys]

sounds like my ds2 an ds3, they both preferred breastmilk to solid food till they were nearly two, they would eat solids but were bfeeding monsters ds2 is now 5, he weaned at three and a half, and he eats a good varied diet but is still a skinny thing, takes after my dad i think

ds3 is two and a half and still bfeeds loads, "milties" he says when he wants a feed if i am not there, he will be fine but as soon as he sees me he asks for a feed, he is tall and skinny but eats like a horse, it took him a while to get into food but now he loves it and will eat anything at all, but still bfeeds frequently

whatever keeps him happy i think, also i think that as these are my second and third babies have been a bit lax on the weighing, infact i dont know what ds3 weighs, i checked he was the right wieght for his car seat, but i am sure he is only about ten kilos? he is happy, healthy and thriving tho, so i am not worried

i would go with your instinct, carry on offering a wide range of foods etc, if you can, tho you may already, sit down to eat together as that will encourage him to eat, but i wouldnt reduce the bfeeding, well unless you are unhappy with it?

i co sleep and feed during the night too, the bmilk at night is more fatty which is good

[Lua]

Firepile- I would listen to tiktok, she knows her stuff!
But if I can add my two pence worth....
My DD is sound similar to your DS, and health visitir so insisted that she was not eating because I was still bfing that I finally quitted. Want to know what happened? She got smaller!!! An it has remained at the 2 to 9% forever!

I would say the issue is whether you can give more calorie rich food. If he stops drinking milk but doesn't eat instead (which is what my DD did) it won't solve the problem!

Perhaps you can try restricting bfing to special times, away from food?

[Firepile]

Thanks very much all! Latest chat with paed this pm (getting blood test results, all fine) had him suggesting a phased withdrawal of bf, as the amount that he is feeding is impeding his physical wellbeing - this is more important than his emotional welfare he thinks (at least he acknowledges the the emotional side of things).

It is very difficult - sometimes I look at him and think that he is so thin I could cry - but I really don't want to wean him. It's not as though I am chasing him round the house trying to force my breast into his mouth after all...

I really hope that the childminder means that he does reduce his bf, so that I won't come under any more pressure to give up completely.