10 month old being referred to dietitian

[TheSeaTheLand]

Hello! I’ve just been to my son’s health visitor for his 9-12 month developmental review and been told he has dropped from the 2nd centile to the 0.4th centile since I was last there (when he was probably around 3/4 months). He’s perfect in every other way developmentally, hitting all his milestones and is very physical during the day so I assume burns a lot of calories. But the weight seems to be a concern.

I was told I am feeding too much breastmilk and not enough food. That my breastmilk is not giving him what he needs nutritionally so I need to stop the night feeds so that he eats more food in the day. However, we were slightly delayed with our weaning journey as he just wasn’t interested and has only started being interested in the last couple of months. He is eating food during the day but he’s still getting used to different tastes and textures and apart from natural yogurt and fruit everything else is a bit hit and miss at the moment. I don’t feel like it’s an appetite issue I think it’s more that he is quite early on in the weaning journey and still getting used to different tastes.

Me and his dad are both quite short and were small babies so not expecting him to be huge but I guess it’s more that he’s dropped centiles/slow to gain.

I just want to know if anyone has been through something similar and what I can expect from the dietitian as I’m feeling a bit anxious now!

thanks in advance!

Don’t drop the breast milk if that works for you! That’s such bad advice from the HV. Not every child ticks the boxes. He can definitely get what he needs from it and will pick up food to supplement as and when he needs / wants it.

I thought there were more calories in breastmilk than many foods, so I wouldn't be trying to stop that, especially if it means it eats even less overall. I might try offering food first and then milk during the daytime (but you likely do this already).

Do you know his height? Is it roughly in line with weight? It will be good to speak with the dietician but try not to worry in the meantime.

What centile was he born on? Did he drop previously to get to second? My ds was on the 2nd percentile from around 1 month to 4 years when he dropped to 0.4th as the dataset shifts then and they all drop a centile. He’s then tracked the 0.4th perfectly and is now age 11. No HV or GP has ever batted an eyelid because I am also small, and his dad has a very slim build too. It’s just his genes and the way he’s built (he’s built like a bird and is about 2 inches wide 😆). Someone has to be at the bottom of the chart!

If your ds has always been on 2nd then a drop of one centile isn’t particularly significant. They wouldn’t usually care until they’ve dropped two centiles. But if he’s steadily been dropping that’s a different matter.

I’d accept the referral for reassurance, but I would wait to speak to the dietician before reducing breastmilk, as it’s typically more calorific than weaning foods so that sounds like bad advice to me.

Thanks for your messages. His height and weight have both dropped to 0.4 so they’re in proportion, which I would assume is a good thing? If his height had continued at the 2nd centile and weight had dropped then I could understand, but his height and weight have always been in proportion and with the drop it’s still in proportion. I do offer food first and milk afterwards and he does have a good appetite for things he likes, Like the yogurt and fruits and eats loads when I give him that. we are continuing to offer him a variety of other things but he’s just not as keen on anything else yet! So I don’t think it’s necessarily an appetite issue. I don’t want to deny him milk in the night as when I try not to feed him he could be awake for up to an hour and then just wakes up again 20 mins later. Whereas when I feed him he will do another 3 or so hour stretch. The health visitor said I’m putting him in a vicious cycle

I focus on giving my dd higher calorie foods, so lots of avocado, cheese, full fat dairy, peanut butter. She's so active so these foods seem to keep her gaining weight steadily.

So he was born on the 50th centile a dropped quite quickly to the 2nd but he did have a tongue tie. Once the tongue tie was sorted out and our feeding journey improved significantly I expected him to go back up but he stayed at the 2nd centile then but the health visitor at that time said she didn’t need to see us anymore as although it’s a big drop, he stayed at the 2nd for a while. This was probably when he was about 4 months old that we stopped going. So now at 10 months he’s gone to the 0.4th centile. However, he is very active and like you said in your circumstances, me and his dad are both small people and most of our wider family is also quite small

Why on earth has the HV suggested dropping night feeds! It’s not recommended to stop night feeds before one if they still wake for them. Surely if there is concern about weight it’s also good to keep them.

I follow a few lactation consultants on instagram and they all advise not to cut back on milk to increase solid food intake as it often doesn’t get them to eat more and removes a good source of nutrition.

Personally if it was me I’d carry on as you are awaiting the dietician appointment

That's very inappropriate and dangerous advice to stop night feeds, please don't do that. Cutting back on breastfeeds does not force a baby to eat more, they'll just take on even less calories. My 12 month old has only really started eating recently, it can take longer for some babies to learn about eating food. As PP said, focus on high calorie foods like avocado, add olive oil to pasta, cheddar cheese, full fat yoghurt. just wait to speak to the dietician, but I really wouldn't worry given he sounds like he's doing well.

Thanks everyone. I really appreciate the advice and I feel better already. I left the HV feeling really deflated and battered but I feel so reassured now. So glad I posted. I won’t cut back the night feeds. Hopefully seeing the dietician will be a more positive experience

He sounds a lot like my son! He was born 25th I think but dropped straight away to 2nd, also with a tongue tie. But as I said has always tracked his centile from there. And never stops moving. I think around the age of 4 or 5 when he dropped to the 0.4th and nearly fell off the chart I did take him to the GP and they did take it seriously (brought him in to be seen in person mid covid) but said in view of my and his dad’s build they weren’t concerned. Depending on when you see the dietician maybe keen an eye on his weight yourself, you can plot it yourself in the red book, so you’ve got a bit more data. You might find he goes up again anyway - when they are that small a small gain or drop makes a big difference!

As has been said, do not limit breastfeeding in any way! Especially not cutting night feeds, what silly dangerous advice. If they were drinking massive bottles of formula 20 minutes before a meal then maybe, but not in this case. I think you’re right, it’s early in the journey, they’re accepting and experimenting with food. Just keep offering healthy appropriate food at each meal time alongside you as you eat, ideally the same as you and it’ll all work out. Take the dietician appointment obviously and double check, but I wouldn’t be panicking currently. Sorry you got bad advice - it’s a running theme with many HV visits!

Dietician referral sounds like the best idea that HV had. Theyre the specialists and are generally good at the difference between small and not getting nutrition that they need.

There is probably an angle that says at this point breast milk is unlikely to be covering all their nutritional needs. And liquids can be filling capacity wise. But equally, theres also an angle of anything is better than nothing and where there are concerns on growth cutting anything needs to be done really carefully.

While you wait, one of my main takeaways from the good advice had was to keep an eye on calorie density. A lot of baby food suggestions are things like veg purée. Stuff that an adult trying to lose weight would eat. And can find getting filled up with that. So avocado, cheese, full fat yoghurt, meat, hummus etc are much better options than veg purée, rice cakes etc.

Just to reassure you, DD really didn't want to wean, and was only drinking milk by 12 months, by which point she'd reached the 91st centile for weight (she wan't mobile, so wasn't using as many calories as a crawling/walking baby) - if anything she was overweight, though our HV didn't express any concerns. She was on formula by then, but milk contains plenty of calories.

Many years later, DD is as healthy weight and height. Food remains a challenge, but not because she wasn't getting enough energy from milk.

Sad it's the same as 10 years ago. I stopped going when this big fat HV told me breastmilk was not a meal and she should be eating 3 full meals a day of babyfood slop from 6 months. Never saw them again. Absolute nonsense.

The centiles are based on formula fed babies aren't they? It doesn't really apply to BF babies. It's a completely different substance that does completely different things to the body.

My daughter dropped a percentile between 7 and 12 months. She was slow to wean too and needed 3 meals a day and 4-5 breastfeeds later bottles to gain weight. She was 20 months before she ate enough to be able to stop the formula.

She was under paeds and dietician and as long as she wasn't losing weight they were happy. Between 1 and 2 she dropped from the 25th to 1st for length /height. She had to have some extra checks to see if she had dropped and was now steady on the 1st or actively dropping. You might find yourself in the same situation are they following the 0.4th or are they still dropping.

I would only make inclusion based changes to their diet before speaking to the dietician and not removed any thing. Our dietician told us to make sure she only had milk outside of meal times so she would have breakfast and then a milk feed mid morning. She had lunch then a milk feed mid afternoon. She had dinner and then a larger milk feed before bed and 1-3 smaller feeds overnight

I also think it’s a terrible idea to drop the night feeds. Nobody with an ounce of knowledge of BFing or baby nutrition would suggest dropping night feeds before 12 months.

I agree too with trying to get as many calories into his meals as you can, so oily fish 2 or 3 times a week, adding mascarpone or olive oil to foods. Plenty of cheese, eggs and meat.

So something like this:

BF at 7am

Breakfast of porridge made with full fat milk with a bit of cream stirred in avd chopped banana added, you could add a little cinnamon for flavour.

Lunch omelette fingers, cheese on toast or salmon pasta

Tea Cottage Pie, Fish pie or Chicken Korma with white rice or chapati.

I also agree that a fair bit of food aimed at babies would be part of a calorie restricted diet for an adult so its probably best dodging things like rice cakes and puffs.

Wholemeal foods aren’t advised for under 2s either.

Obviously with all of the above you should BF often. I think at this stage I’d be aiming at every 2 hours in the day, you can look at spacing out the feeds when he’s gained a little weight and height.

Do you think it’s worth getting his TT reassessed too? They can sometimes reattach.

Using Breast Compressions might help too.

Thank you! I am trying with naturally fatty foods for mealtimes but it can be very hit and miss. The only thing he will definitely eat loads of without fuss is full fat yogurt. A lot of other things just get sucked on and spat out or thrown at the dog, but he definitely is enjoying meal times more and more willing to try things in the last couple of months so hopefully we will continue to make progress with that. I never thought about getting the tongue tie reassessed as feeding has gone so well since, but maybe that’s actually a good idea!!

One more thing to try is asking the GP to check for anaemia as this can affect appetite and growth.

Is he getting enough calcium too?

DS1 is 12. Advice was good is for fun until 1. We were told to offer food from 6months but that almost all of their dietary requirements should be from milk (breast or formula).

thats what I’ve always thought was the advice. Food is for fun and is about exploring textures and tastes before 1. But I guess if he weighed more she may have had different advice for me! Just hope the dietician is more helpful (and more kind 😅)

That’s terrible advice from the HV, don’t drop the breastmilk if he needs to gain weight!
Continue to offer all kinds of food too, try and offer food before milk to encourage him to eat a bit more too.
I’d wait until you see the dietitian before making any drastic changes, hopefully they will have more sense

If he’s dropped from 50th to 0.4 centile that’s extremely problematic, and I’m not surprised your HV is worried. If you still want to breastfeed can you pump the feeds so you know how much he’s getting? Are you supplementing properly? From 6 months babies need vitamin d, which is added to formula, but breastfed babies should take drops.

Just remember that the health visitor is NOT a dietitian. The DT may have completely different advise.

Because only around one in 200 British babies are still receiving breast milk at 12 months old, HVs are simply woefully under-informed, if not ignorant, of how breastfeeding works. At our 10 month check we got told to stop feeding to sleep along with other nonsense!

You are doing a great job, @TheSeaTheLand. If height and weight are proportionate then that is less of a concern than if there is a significant mismatch. And if you and DP are short/petite too then that can also account for it.

Just make sure you are supplementing with the NHS A, C and D drops. They’re very cheap around £1.70 and you can buy them from the clinic. Same stuff as in Boots but a fraction of the price.