Skinny 5mnth old - reassurance needed

[peneloperabbit]

Hi there,
I have been exclusively breast feeding my ds for 5 months now. Things were a little slow to start with as he was very sleepy for the first few days. However, he woke up and started feeding more regularly and I never really had any problems with latch etc. For the first few months it was sometimes difficult to keep him awake whilst feeding - he never just came off once full - always nodded off. As the months have gone on he has nodded off less and less and although he appears to feed for shorter lengths of time, he appears to be more efficient - clearing one breast and often having at least a little of the second (though he often just looks at me and grins with nipple in mouth when I offer him the second. The only problem I'm having now is that he is just too interested in what is going on around him so I often have to find a darkened room to feed him.

Until last week I had been avoiding weigh-ins as I didn't want to become obsessive about him following the line. He has always been very smiley, bright and alert and rarely cries. He is sociable and interested in the world and so I assumed this was the best indicator of his wellbeing.

However, last week I was passing the health centre and thought I would just pop in and see what he weighed now- just out of interest. At birth he followed the 75thcentile line. He is now on the 25th! eEK! The hv asked me all sorts of questions like - are you eating properly, does he urinate (he pees for england and I eat better than anyone I know- protein, good fats, 10 portions of fruit/veg a day)etc and seemed concerned - suggesting I come back in two weeks. She didn't ask any questions about his temperament, crying etc. I did mention that he still doesn't sleep through and she looked at me in a sort of sad and patronising way and said "well he's hungry isn't he." (I do feed my baby when he wakes up)She then went on to suggest I give him formula. I was surrounded by bottle feeding mothers being congratulated by hv as their babies were following the 50th line. I felt patronised by this woman - she made me feel like I wasn't doing a good job at all and failing cos I had a skinny baby. Although he is skinny he is long and continues to follow the 75th centile for length- so he is growing.

I do not want to top up because I feel like it is being suggested so that my baby neatly follows a prescribed line. Also he has just developed eczema and I worry that introducing dairy at this point may exacerbate this.

I feel confused because on the one hand he appears extremely alert happy and content, but on the other hand he is a skinny thing - and the slightly irrational part of my brain is whispering that I am somehow failing to feed my baby properly. DP is not helping - he is a Doctor and thinks that ds is absolutely fine and that I am mad - but he doesn't have to face the dreaded baby clinic!

Has anyone else experienced this?

You're not obliged to go to the Baby Clinic either. 50th centile is meaningless it isnlt a target, simply means 49/100 are either larger or smaller than that line. A lot of babies tail off the charts as they become mobile especially b'fed ones who have more efficient metabolisms. Go with your and dp 's instincts.

I'm not going to go. I hope they don't send someone round. I feel like I'm bunking off school! I know these charts are just a guide and I know they are based on ff babies. I guess the reaction I received made me question my instincts.

isnt it around this age that breatfed babies begin to dip on the charts compared to bottlefed babies? Has your lo's weight been compared with the breatfeeding charts rather than on the standard one that includes both bottle and breastfed babies?

Kellymom has a link to the breastfed growth charts: Growth charts for breastfed babies

This is an extract from one of the pages:

Healthy breastfed infants tend to grow more rapidly than formula-fed infants in the first 2-3 months of life and less rapidly from 3 to 12 months. All growth charts available at this time include data from infants who were not exclusively breastfed for the first 6 months (includes formula-fed infants and those starting solids before the recommended 6 months). Because many doctors are not aware of this, they see the baby dropping in percentiles on the growth chart and often come to the faulty conclusion that the baby is not growing adequately. At this point they often recommend that the mother (unnecessarily) supplement with formula or solids, and sometimes recommend that they stop breastfeeding altogether. Even if mom realizes that her baby is perfectly healthy and doesn't follow these unnecessary recommendations, she ends up worrying for no reason (and moms don't need anything extra to worry about!).

penelope - your story is one of poor health visiting care.

Your HV sounds very dozy indeed. For a start, using a chart on a 5 mth old health bf baby as a means of assessment is inappropriate. By now, there is a gap between the UK standard charts (which are a rough and ready tool for the first months, when used properly) and the WHO reference charts (which are again a rough and ready tool, but which are at least a more accurate assessment of growth beyond the newborn stage). If it's the point on the chart that's bothering you, plot it on the chart linked to from
here and you will see your baby is probably higher on it.

The HV should know that your diet will have very little impact on the growth of your baby. Waking up is normal at this age. If there is any doubt about his calorie intake, then the easiest way to fix that is to bf more often - why should formula be an option if you want t avoid it?

Your dh sounds very sensible!! But you are right - the baby clinic is powerful emotionally. You can fight this power, though

Thanks very much for that link - it is very reassuring.

Tiktok - I was under the impression that my diet wouldn't affect his weight gain after reading about successful breast feeding amongst women during famine. However, two health visitors have made reference to my diet. Now I am feeling cross that I allowed myself to get worked up! I'm usually pretty calm and rational, however, when faced with chart wielding health visitors something peculiar happens.

penelope - this link between diet quality/quantity and breastmilk sufficiency is a Big Myth.

It is normal, for the human race, to have times of plenty (for which read 'basic sufficiency') and for those to be interspersed with times of barely enough . The human capacity to make breastmilk copes with this perfectly well, as is seen in numerous studies. In times of true starvation, women don't get pregnant.

The idea that an averagely nourished western woman would not have enough breastmilk for her baby or could somehow make more by eating more, is preposterous.

Having said that, some foods have a reputation for boosting milk supply, but there is no real evidence for this at all, beyond the anecdotal. What drives the milk supply is frequent, effective removal of milk from the breasts - not nutrition. I'd far rather women be informed about this, than told to eat any amount of whatever (though they can eat the whatever - it won't harm them!)

In any case your baby is gaining just fine. So you don't need to worry about what you are eating!

have another word with your dh

DS was a skinny baby - he never ever had 'chubby legs', and was always on the lowest centiles - lower for weight than height, I think. That just means he's one of those people who is slight and skinny - not that he isn't healthy or growing.

I stopped going to the baby clinic, too.

Penelope I could have written your OP 3 years ago. sadly, I didn't have the benefit of Mumsnet then and was pressured into giving up BF in favour of formula by my HV. DS was STILL skinny and is skinny to this day. I firmly believe, now, that he's just built that way, he's average height but skinny - he's as strong as an ox and never tires and I just don't worry any more. He actually eats as much as his 8 year old sister and doesn't put weight on.

You've had excellent advice on this thread, just wanted to give you my experience. Well done for BF for 5 months, don't give it up until YOU are ready.

I've not been worried about my eating affecting my milk supply -just interesting that hv continue to refer to it. one told me to eat cke and drink full fat milk! I followed her cake advice every day i must say. Nonsense of course but i do love cake. For one thing we surely get fat during pregnancy so we have adequate energy stores for milk production. Maybe I'll take them some books and journal articles to read- they seem a bit clueless round here. Imagine how that would go down - sure i would be very popular! I do wish new mothers were encouraged to go with their instincts more.

Thanks blu and mamagotadyson. He probably is just a long thin worm. His Daddy is long and thin after all.