9 Month Old Weight Gain Slow & Offering More Solids

[@llli*juliasmomma]

We had DD's 9 month check up today and her pedi was a little concerned about her weight gain. To start off, here is her weight history:
Born 7/2/11 (9 days early) - 6lb 14oz, 19.5in
Left hospital 7/4/11 at 6lb 7oz
1 week (7/6/11) - 6lb 11oz, 19.5in
2 Weeks (7/14/11) - 7lb 11oz, 21in (I think the height may have been measured wrong here, don't think she grew 1.5in in a week)
4 Weeks - 9lb 6oz
2 Months - 12lb 2oz, 24in
4 Months - 14lb 3oz, 25.5in
6 Months - 15lb 15oz, 26.5in
9 Months - 17lb 6oz, 28in

Basically, she gained really quickly at the beginning but it has slowed quite a bit over the last few months. She is very active, not crawling or standing yet but she bounces, wiggles, rolls all over So I know she's burning more calories than she was in the early days. She nurses 6-7X per day, sometimes just one side (usually before/after naps), sometimes both (first thing in the morning, before bed at night, and any other time she wants - I always offer the second side if she's awake ). I am confident that my supply is fine, she always seems content after nursing and I am able to pump enough for her bottles at daycare (she takes (3) 4-4.5oz bottles over 9 hours). Right now she gets solids 2X per day, oatmeal w/EBM & mashed banana in the morning and usually applesauce or pureed fruit & a mashed veggie in the afternoon. We offer finger foods too, here and there but not very consistently.

She has also been having "diarrhea" for the last month or so (I thought from teething). Her pedi thinks it may be because she isn't eating enough solids. She said to offer solids 3X per day and more finger foods - crackers, etc. She said we can start meats too. DD had a dairy intolerance, I think she may have outgrown it but was hesitant to test anything b/c her tummy was already upset. But the doctor said it was ok to try some so I ate a string cheese earlier - waiting to see what happens! If she doesn't react I may try something else before I give it to her straight but I'm really hoping she doesn't so I can try giving her some yogurt or cottage cheese.

I'm feeling sad that my BM is not enough for her anymore Any thoughts on her weight gain? Her doc was also a bit concerned about some of her gross motor stuff (she's not crawling or pulling up yet, not really waving, etc. but she talks a ton and is a very happy, smiley, interactive baby). So that's another thing...I really think she's fine, just moving at her own pace. Well see.

Also looking for ideas on what else we could offer for solids (non-dairy). She's had apples, pears, banana, avocado, sweet potato, squash, carrots, peaches, graham crackers and cereal puffs. Also rice & oatmeal (whole grain, organic) baby cereal which she loves. I have peas that I'm going to try and I thought of hummus and whole wheat pita or crackers too...she's my first so I really just don't know where to start with solids...how do you balance nursing 6-7X in a day with 3meals of solids? It seems like a lot...she'll be eating all the time! Which I guess is the point...

Sorry for another long, rambling post...just needed to get this out. Thanks in advance for the suggestions!

[@llli*mommy2lilah]

I think the weight gain looks great. I don't understand why your pediatrician is concerned. It's really normal for a baby to gain weight fast at the beginning and then level out when they start moving.

[@llli*auderey]

Make sure you chart her weight on the WHO breastfed baby chart, not the CDC one which even the CDC doesn't recommend but most pedis still use. See if that looks more like a normal curve, and ask your pedi why they're concerned.

[@llli*lllmeg]

I would suggest a second opinion or further clarification from your doctor, and to have baby's growth carefully plotted on a WHO chart. I think you may be being unduly alarmed. It is normal for weight gain to slow quite a bit after the very early months, if a baby gained at a newborn rate for an entire year it would be one giant toddler. It is also normal for some babies to be below "average" just as some will be "above", not all babies can be in the 50th %, kwim? It does not work that way. Healthy humans come in a variety of sizes and that incluudes babies.

I am not aware of any evidence that breastmilk causes diarrhea in a baby or "not enough solids" causes diarrhea at this age. Certainly more solids and less breastmilk would cause more solid, adult-looking poops, (and sometimes constipation as well) but is that the goal? So I am curious what you are seeing that appears to be diarrhea.

Experts agree that babies should (and certainly can) get most of their nutrition from breastmilk for at least the first year. And since breastmilk is chock full of calories and healthy fats, the only way it would not be enough for baby is if baby was not getting enough milk total. Since your baby nurses pretty frequently and you are sure of your supply, that seems to not be the issue. If your baby enjoys solids, that is great, but most common baby/toddler foods have less calories than breastmilk.

[@llli*juliasmomma]

Thank you for the reassurance! I haven't heard of the WHO chart, what is that? And where do I find it? She is in the 65% for height and the 23rd for weight (according to whatever chart they used). She doesn't look too skinny at all, she feels very solid & has some little rolls but overall she is not a chunky baby. DH and I are both thin though (I don't think I weighed 17lbs til I was over a year old), and average height, so I would be surprised if she stayed in the high %'s. I think the main reason that her doc was concerned was b/c she is pooping so much and her weight gain has dropped off, despite eating more.

I posted a description of her poops here. (Sorry for the double posting, I know it's annoying, I was just really caught off guard and kind of freaking out yesterday...). Today though, she pooped several times at daycare, a couple blowouts and went through all of her spare clothes. But tonight right before her bath she had a poop that was the most solid thing I've seen come out of her in over a month. After just one day of 3X with solids. So maybe that did help? I don't know what to think now...she nursed just as much it seemed.

I am pretty confident about my supply, but it can be so hard to tell sometimes. She is spending less time nursing I think, but she's eating more frequently & I know shorter sessions are normal for older babies. She always gets multiple let-downs, whether she eats from one side or both. I'm super paranoid about her not getting enough so I'm always offering when I'm with her, especially if she seems to be eating less than she should. Wet diapers are fine though. And I've been pumping 12+oz at work over 2 pumping sessions this week so it seems like my supply is good. She always seems satisfied after nursing too & would probably go 3hrs+ between feedings sometimes if I let her. I thought BM was higher in calories than the basic solids, but I know she does need to have the chance to try solids. I really thought (and still sort of do) that the runny poops were from teething & swallowing a lot of saliva. Her top teeth are taking FOREVER to come through and she's been a drool machine lately. But IDK if that would last this long...

Thank you all so much for helping me troubleshoot this! I really appreciate the encouragement...it's hard to hear that your baby isn't doing as well as she could/should be. I just want to do whatever I need to for her to thrive

[@llli*lllmeg]

The WHO (World Health Organization) charts are charts published in 2006 (I think) that are based on the weight gain reported for breastfed babies and also data was very systematically collected from different parts of the world. Earlier charts are based primarily on formula fed babies and often only charted a very small geographic sample. WHO charts are also gender specific.

Personally I find the WHO charts difficult to read, (I'd love help with this if anyone has a suggestion) but it is my understanding your doctor (and probably anyone) can go to the WHO website and download software with which she can plot your baby's growth.

Many babies are in different percentiles for height and weight. Did baby recently drop several percentiles in weight? THAT might be a sign of an issue. But if baby has been on a similar percentile for a while that shows baby is gaining, as your weight gain numbers also suggest. A baby being in the 23% does not mean baby is not gaining fast enough anymore than a baby being in the 87th percentile suggests that baby is gaining too fast. It's when a baby drops way off their own growth trajectory that indicates the possibility of an issue.

If you can pump 12 oz in two pump sessions that is quite a lot. Do you have oversupply, maybe also forceful letdown? That may cause green, frothy poops that are sometimes mistaken for diarrhea.
I'll take a look at the other thread too.

[@llli*auderey]

WHO charts are here: http://www.cdc.gov/growthcharts/. This is a good page to show your pedi because it's on the CDC site and it very clearly states NOT to use the CDCs own charts til 24mths.

Edited to add:the only thing I find hard to read about the WHO charts is converting to kg and cm ... But the internets do that part for me!

[@llli*juliasmomma]

Thank you for the info! I will definitely check out those charts when I have a chance!

Re: her %'s - she has dropped in percentile for both height & weight (she was 42nd for weight & 71st for height at her 6mo appt). If I remember right, I think she dropped %'s between her 4 and 6mo check ups also, but I don't recall the percentiles from her 4 month - I think it was something like 70th for weight and 85th for height.

Re: My supply - I do have a forceful let-down and am pretty sure that I had a bit of OS at the beginning, which is likely the reason that she gained so quickly at first. I leaked all the time until she was at least 2mos old. Don't leak anymore really, but I always feel my let-downs. It is faster on the right, which is typically the side that I pump a little more from. When she nurses that side, she gulps at the first letdown. I have recently dropped from 3 pump sessions during my work day to 2, so that could be the reason for the high output. Also, I pumped for 35-40min each session. I got about 7-7.5 at the first and 4.5-5 at the second - but I had to work hard for it And I have plenty for DD when I get home. I also pump at night before bed to keep my supply good, since she now sleeps 9-10hrs and does not nurse during the night. I have tried dropping this session but she gets very frustrated at her last feeding before bedtime - she has to work hard for a let-down and has trouble getting enough, it seems. So for now I think I'm stuck with it

Re: foremilk/hindmilk - Meg, you mentioned this in the other thread. How would I know if this is a problem? She almost always gets multiple let-downs when she nurses, so I assumed she was getting plenty of hindmilk. Also there is usually a pretty good creamy layer on the top of my EBM bottles once they settle. Her poos at the beginning (until she developed the dairy intolerance) were always yellow & seedy so I assumed this wasn't an issue. Is it possible to develop an imbalance later on?

I'm so confused...just want my baby to be ok & growing as well as she should be! REALLY appreciate all the help!