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!

Holland and Barrett sell jars of almond butter, cashew butter and a peanut butter that are just nuts with no added salt or flavourings etc. My little one looooves it when we mix some in to yoghurt or into his breakfast porridge etc. Just make sure you really mix it in well as if it’s in just one lump it’s a choking risk.

A spoonful of this mixed in also goes down well, they are finely milled. Think we got ours from Sainsbury’s!

I’d stop seeing the HV tbh, you don’t have to see her. Go to the dietitian and see what they say, but I would carry on as you are and offer lots of calorie rich foods like avocado and nut butters, and give some vitamin drops so you know he’s getting enough iron and vitamin D

My ds dropped from 91st centile at birth to 1st centile by 1. He was breastfed, ate three full meals a day and was very active. HV was not concerned as he was generally well, but referred us to dietician as that was policy. He was assessed for all manner of health issues but ultimately they said he had a very fast digestive system and it was going through him so quickly he wasn't absorbing enough nutrients and calories. He was put on a low fibre, high fat diet to slow his digestion. He grew out of it, though was always skinny but tall and is now a 6ft adult....

Wait and see what the dietician says - don't make any changes until then, other than perhaps figuring out which foods are high fat eg avocado, peanut butter, cheese etc and adding butter to everything! Most HV do not have training on anything outside "normal".

Lidl does a fancy peanut butter Thats doesn’t have any additives, and it’s really nice

So what’s the plan then @TheSeaTheLand?

Get the Tongue Tie checked again?

Look for high calorie, iron rich foods?

Use Breast Compressions for the daytime feeds?

And carry on with the night feeds till they are 12 months?

Can’t advise on the breastfeeding but my baby also loved yoghurt and didn’t seem keen on other foods at first! you can sneak blended banana or avocado into full fat yog (as well as the seeds etc others suggested). and double cream! it has so many cals. Mine also liked really creamy cheesy sauces which I added tiny pasta to, and then built up exposures to new foods that way. he was never interested in finger foods in the slightest (until he discovered ketchup ha)

Ask for a genetic blood test for coeliac disease for him. Also he could have a milk protein allergy - which would also apply to your breastmilk

There’s some terrible advice on this thread. There’s a weaning window and if you miss the window it can be very difficult to introduce lumpy foods and finger foods. The HV is worried because your baby is on the 0.4th centile, has dropped centiles and is only tolerating yoghurt at 10 months old. I know mumsnet hates HVs but they are trained health care professionals. I think the HV has recommended reducing the breast feeds as baby will be very happy to breast feed and not take solids and if this continues baby could miss a crucial step in weaning.

I am a huge breast feeding supporter by the way.

Would I have seen some other symptoms pop up by now if he had an allergy? I’ve tested all the allergens and he’s had no reactions. I have been exclusively breastfeeding him for 10 months and he shows no signs of allergies from what I can tell. I also eat a lot of dairy myself (no idea if that means anything)

He is not ONLY tolerating yogurt. I just said that’s the food he loves and will eat loads of. He also eats fruits. He likes chewing and sucking on meats (but isn’t swallowing much yet) he likes scrambled eggs, he likes toast, as well as cheese. I did start weaning him at 6 months but I said he’s only just started showing an interest in the last couple of months. So even though he likes certain foods I am still experimenting with varieties of textures and flavours with him and for that reason I can’t say he is getting 3 meals a day. I said it was hit and miss apart from natural yogurts and most fruits.

Thank you! Double cream and creamy/cheesy sauces is something I haven’t tried yet so I will definitely add that to the list!

He does have peanut butter on toast but I am going to try it mixed into some yoghurt seeing as that’s a flavour he already likes.

the plan moving forward is contacting the tongue tie specialist again, adding ground nuts, seeds, nut butters into yogurts. Concentrating on high fat, iron rich foods and although offering food first, continuing to breastfeed on demand (especially at night).

Thank you, you’ve been really helpful!

I mean this gently, you’re only listening to the posters who agree with you. No one is saying anything you’ve done is incorrect. No one is saying there is anything wrong with your baby. Being able to manage lumpy foods and fingers food is a skill a baby has to develop. HVs are there to offer support before something becomes an issue. I won’t comment again as I’ve upset you and that was not my intention. I’m sorry to have caused upset.

You haven’t upset me, I am just correcting you because you said he will only tolerate yogurt and that’s not true. But it is his favourite food at the moment. I’m not only listening to posters who agree with me because there is nothing to agree or disagree on? My post was simply asking if anyone had been through something similar and had any experience with dieticians as I’m nervous about it. I am now getting tips and advice on what I can do to fatten him up and I am grateful for it and have thanked everyone and agreed there are small changes I can make, eg. Adding nut butters, seeds etc into his diet, that will hopefully help. It looks like you’re trying to start an argument when there isn’t one

Butter and double cream are great for kids you’re trying to feed up a bit.

In scrambled eggs. On veg. In mash. Porridge. Cereal etc.

Readybrek is well fortified, and can splash cream in.

(just don’t do what I did and start snarling it for yourself too).

Mash is good for gradually adjusting textures too.

You were eating Ready Brek with double cream? Well I suppose it would provide you with some calories and hopefully cut down on snacking?

I do agree though that Ready Brek is great because it’s fortified and obviously adding cream and or seeds and nut butters would add much needed calories.

OP, please ignore this rubbish. There's no such thing as a 'weaning window'. My 12 month old barely ate anything til the last few weeks, and now she'll happily eat any texture or lump.

I was doing the classic finishing off what child didn’t eat, or making one thing for us both to share. Focussing on what she needed and not really thinking about me. What I definitely didn’t need in my life was more calories.

(Readybrek made with milk, with a dollop of peanut butter, and splash of cream. Actually pretty nice breakfast. Just not for an adult who should be eating less not more).

Mine wouldn't wean. Various reasons. I just had to keep breast feeding exclusively. She started eating in her own time, thankfully before I went back to work

She's healthy now although can be a picky eater. She's tiny, but some people are. I'm only 5 feet and was slim as a child (sadly no longer;)

Ready break with cream sounds divine 🤤

Kids who like yoghurt tend to like coconut cream too. High cal & a new flavour!

The cognikids dip spoons are good for nut butter on a spoon when they're teething - they're a nice texture on gums. Little bit of maple syrup mixed in to the nut butters tempts me my kids!

Second the lots of butter too, or olive oil, mixed in foods for healthy fats and cals.

The yummy toddler foods chocolate protein muffin recipe is really good for picky eaters too. Tastes divine and lots of hidden veggies.

If they like toast, they'll probably like potato farls toasted, or dare I suggest waffles. 🙈

Just to add, my second 1 year old was a dream eater at the start. Now just threw their dinner on the floor for the 5th day in a row to demand yoghurt and fruit. 🫠

The only thing I’d see as a weaning window would be at the point the extrusion reflex starts to reduce and gut maturity is improving. Physical improvement to muscles of mastication and speech is helped by exercise of facial muscles during eating of course.
There is actually a ‘flavour window’ based on dietetic research about introducing as many different tastes in order to widen the child’s palate and hopefully avoid or at least reduce fussy eating traits. This flavour window is believed to be between 6 months and 18 months but some dieticians believe it can be addressed up to 2 years of age.
Discouraging breastfeeding is something I would never do but at this age I would promote food offering as appropriate. Foods high in vitamins, calcium and iron are good and complex carbohydrates for increasing energy needs.
All children are now believed to need supplemental Vitamin A, C and D until age 5 yrs if not taking more than 18ozs of formula milk (it is added to that)
A drop from a pre-existing 2nd centile to 0.4th centile with smaller stature parents is unconcerning in the absence of any other worrying factors but I’d suggest a weight review in 2-3 months just because it is the bottom centile and you don’t want it dropping lower than that. However, there is no evidence I can see that would indicate it would. It would just be for reassurance and further discussion.
Was it a Health Visitor you have seen before? If not, you may not have seen an actual Health Visitor, skill mix carry out that review in this area. I would ring the service to ask to speak to team leader to discuss the advice given. Not a full blown complaint, just a discussion - otherwise training needs are not highlighted.

I always eaten full fat everything, it keeps you fuller for longer and usually the ingredients are a little less like UPF. Ready Brek with milk, peanut butter and cream sounds fine to me!

Thank you for this, that’s really helpful. It was a health visitor I have seen previously quite a few times, so I assume she is the resident health visitor at that centre. I am going to start adding vitamins A & C as I've only been giving vitamin D, also start adding ground nuts and seeds and nut butters into his yoghurts and concentrate on high fat, nutritious foods whilst awaiting the referral and hope for the best. I had already started offering food before milk and giving him a chance to eat 3 meals a day, even if it ends up on the floor, so will persevere with that. I am holding onto the fact that his height and weight have both dropped to the 0.4th centile and not just his weight and the fact that he has a short family