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!

How much you can express is absolutely no indication of how much milk baby is getting. LO will be much more efficient than a pump.

I had all this 20 years ago with my eldest! He was just short. Perfectly happy and healthy as a child, just a head shorter than his peers. Now a fairly short (5ft 5/6 ish) 20y old at uni. I am also short at 4ft 11! I am convinced the HV charts dont work for breastfeeding fed shorties. If he's bright and active and trying foods I wouldn't worry i.e it's not developmental delay. I remember when mine dropped to the 0.4 percentile there was all kinds of drama and worry about that and they tried ro make me switch to formula but is was all fine. Met all milestones, became a sporty kid and now runs marathons. Just slightly short adult man.

Why would you say this ? Breast milk does not contain iron or b vitamins, it won't have sufficient vitamin D if the mother is deficient ( v. common). Your child needs some iron containing foods or supplementation. Why do you think the weaning journey has been difficult ?

I do try to give as much iron containing foods as possible. Not sure why weaning hasn’t gone as smoothly as it does for other people, my mum has said that I was also quite slow to be interested in food as a baby. I can’t force feed him so other than continue to offer different healthy food not sure what else I can do about it. We still have two months to go till he’s 1 so hoping things improve

Thank you. I am only 5ft 2 and so is my mum, her mum is 4 ft 11. His dad is only 5ft 6 and the rest of the men in his family are also around the same height as him. His mum has said he was a small baby. So genetically he’s destined to be below average in height! This didn’t satisfy the health visitor though 😅. I am worried they will try to make me switch to formula as I really don’t want to do that. The start of our breastfeeding journey was so difficult as he had a tongue tie that I’m really proud of how far we’ve come and I don’t want to end it here!

Thank you! I have been giving vitamin d drops but not A & C so will start that

DD was the same, started on the 50th centile then dropped to the just above the 0.4th.
She was breastfed for 4 months exclusively until the HV said she should be on formula. could have ignored her really but being a young ftm I stopped breastfeeding apart from the odd feed on her advice.
Thing is she stayed small, as an adult she's only 4'11 so breastfeeding wasn't the issue!

BM does contain iron though? Admittedly it’s in small amounts but the absorption and utilisation of the iron from BM is far higher than the iron from other food sources.

Have a read of this on iron from the LLL.

The original drop from the 50th to the 2nd centile at 8 weeks was accounted for by the tongue tie. Which the HV refused to refer me for, as even though he had dropped centiles he hadn’t LOST any weight so she said if he has a tongue tie he’ll grow out of it and also grow out of the reflux issues the tongue tie was causing. I had to go private in the end to get it cut and feeding improved dramatically and the reflux symptoms disappeared, but he still stayed steadily at the 2nd centile for months so she said she wasn’t worried, that maybe he had plateaued and found his place. That was months ago and I hadn’t been back since but had no concerns as he is very active, hitting all his milestones and isn’t delayed in any way. The only struggle has been he hasn’t been interested in food, but like I said that has started to slowly change. I was suprised to find he had dropped again to 0.4 but his height is also 0.4 so hoping the dietician isn’t as concerned as the HV

Iron deficiency aneamia is very common with delayed weaning.

In BF babies? Can you give me some links please?

And further down the thread I did suggest she gets LO checked for anaemia so I’m not ruling it out, was just replying to a poster who was claiming there was no iron in BM

My firstborn was slow to wean too. He dropped from 98th centile to 75th between 3 & 9 months, and no one batted an eye. He's remained there ever since. It sounds like it's only of concern because you're at the bottom end of the scale?

For us, we saw more success with weaning around the 12 month mark when I stopped feeding 2 hours before a meal. He loved milk and needed hunger as a motivator to love food too.

Also focused on making the foods he did eat nutritionally dense. Mixing ground seeds & nuts in to yoghurt, trying spoons of nut butter, Cheerios for snacks (fortified with iron and kids love them). Let him feed himself and tried not to shudder when it went all over his head!

Food before 1 is just for fun is something you will only ever read on Mumsnet and is completely false.

Adding ground seed and nuts to yogurt is a great idea as he loves natural yogurt so this will be easy for me! Thank you!

I expect the concern is that he has dropped to the 0.4th centile as that is below the normal range and so it is used as a threshold - doesn’t mean it’s actually always an indicator of a problem, there just needs to be threshold.

My son was on the 2nd centile when born and dropped to the 0.4th quite quickly. He had issues feeding due to a digestive issue and so we were referred to a dietician at an early stage. For now I’d say keep doing what you’re doing and wait the dietitician referral. A paediatric dietician will be MUCH more knowledgable on all of this than the HV. We also had help from SALT and OT when it came to weaning. However my son did have some developmental delay - sounds like your DS is making good progress on all front including weaning which is the most important thing. The referrral probably isn’t necessary based on what you have said - but the dietician will give you some really good advice on weaning with a reluctant eater so you’ll probably find it helpful.

I can see where the old “food is for fun” thing started. Where I grew up weaning before 4 months was a regular occurrence, the earliest I’ve heard of is 6 weeks. So perhaps it was used to take the pressure off to wean early and to get Mums to focus a bit more on the baby having more milk.

Some people took the whole thing too far the other way though. Babies do need to eat solids alongside milk.

If this baby were formula fed the advice would be to drop to 450 ml/13.5 Floz a day by 10 months, so that usually equates to a Cup of formula with breakfast, a bottle before his afternoon nap and a bottle before bed.

Sorry I haven’t read the thread.

• Don’t drop the breast milks
• Make sure he gets sources of iron as he won’t have realky any iron stores left
• Make he has finger food as it’s important to develop the his facial muscles for eating and talking.
• Make sure he is on appropriate vitamins

My friend was v upset post HV visit at 9 months 15yrs ago as baby led weaning and twin babies only eating 2 meals a day, not consuming a huge amount, still primarily breastfed and HV had a right go. They were exploring tastes and textures, took a while to ramp up to the "3 full meals" HV was insisting they should be on (on what planet would they actually go from nothing to 3 full meals overnight??) Her twins were 50th and 75th and hadn't even dropped. They are 16 now, 5'5" & 5'4" (both girls and Mum only 5'3") and good healthy weights. HV often spout total bollocks and are mean and intimidating and unhelpful. In my humble opinion.

Maybe state your qualifications if you’re going to contradict medical advice?

OP, go along to the dietician and see what they say. If you’re unhappy go back to the GP.

Breast milk does contain iron and B vitamins… highly bioavailable iron and B vitamins. It’s just not sufficient amounts after baby is > 6mo. But to say it doesn’t contain them is inaccurate.

https://www.sciencedirect.com/science/article/pii/S1875957214000710

https://www.cdc.gov/breastfeeding-special-circumstances/hcp/diet-micronutrients/iron.html

Couple of links. Sorry shoukd have said breast milk does not contain sufficient iron

Honestly I’d go to the appointment but ignore what they say, you know your baby best!

My son now aged 8 got flagged by the school nurse for being underweight, he just isn’t interested in food, there suggestions were to add dips to make chips more interesting ( because he told them he didn’t like chips) and add more food to his plate 🙄 he can eat what he wants I don’t restrict him at all. There’s suggestions were ludicrous no way would he eat a dip or a chip and I knew over facing him with a huge plate of food would put him off. just nod along and play the game.

Such awful and ignorant advice from the HV. I am glad you are seeing a dietitian - who is qualified to give you proper advice about your baby. I would advise dropping the HV - she is not helping you.

My son didn’t regularly eat solids until he was TWO. If there’s enough calories in breast milk for a hyperactive two year old, it’s will be fine to sustain your son!

Hopefully the dietician will be an infant feeding specialist and will put your mind at rest.

Yes I agree that it doesn’t contain enough and that’s why I suggested getting her LO checked but the iron it does contain is highly bioavailable, much more than the iron in other milks.

Agree that baby should be eating solids after 6 months. Also, and I know the OP hadn’t got a Time Machine, but not cutting the cord until after it has stopped pulsating can help with iron reserves. Maybe something to bear in mind if you have anymore DC OP

Have a look at this guide from the Caroline Walker Trust too @TheSeaTheLand. 10 months starts at page 77 I think .