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Is My Baby Eating Enough?

Jun21

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Dear Amy,

Advice Smackdown ArchivesMy beautiful, almost too perfect baby boy has always been long and thin. The problem is that at his nine month check-up we found out that his weight has dropped off, and he has only gained a pound and a half within three months (going from the 25% to 5% for his age group). There hasn’t been a difference in eating or general behavior in him, aside from his last feeding of the day where he is distracted (wants to switch positions, constantly stops nursing to look around, etc) and eats for less time than normal. He is exclusively breastfed (four times a day), and is perfectly happy about solid foods, eating about an ounce or two of fruits/veggies/cereal with some table food at mealtimes. The pediatrician suggested giving my baby 4 oz. of juice every day, and he said that it would fix the weight issues. I think this is too much juice for him. Whenever he has juice (watered down or pure) he is noticeably “wired” and I just don’t feel comfortable with his advice.

Already, I’m going to switch pediatricians because of this and other issues that I have with his philosophies. But aside from this, I’m not sure what to do to determine 1) why baby’s weight dropped off in the first place? and 2) how to bring it up to where it needs to be? Since his main source of nutrition is my breastmilk, could it be a breastfeeding issue? Should we see a lactation consult to ensure that he is eating enough (or will she just think I’m crazy because OMG he is nine months and I should have all of this figured out already!)? Or is this just a matter of stuffing as many calories as possible into my little munchkin I’m still relatively new at this, and I just want to make sure that my little guy grows up as healthy as possible.

Thanks!

A.K.

Step One: Find a new pediatrician.

Step Two: Take your son and his growth chart to new pediatrician.

I am SO not qualified to answer this question, because a baby can drop off the weight percentiles for a wide variety of reasons. Some are perfectly innocent: increased physical activity (like learning to crawl or walk) or growth spurts. Some are…not so much, but only a doctor can make a real educated guess or decision about the cause.

That said, I completely agree with your assessment of your doctor’s recommendation of juice. That’s a really weird suggestion, because juice is more or less empty calories with a lot of sugar. Adding few ounces of formula would make more sense to me, for a goal of weight gain. So yeah. Time for a new doctor and a second opinion.

In the meantime, let’s examine your baby’s diet. There really really really isn’t a set “standard” for the “how much solid food should my baby eat?” at every age. You want your baby to eat how much his body tells him he needs to eat. You DON’T want to push “just one more bite” on him, ever. Some babies will eat multiple jars of food at one meal while other babies can barely seem to finish one or two ice-cube-sized portions. Always let your baby set the pace.

But if you’re worried about whether he’s getting enough nutrition, I’d say look at his solid-food intake before the breastmilk portion. Especially since he’s going through that pesky “super distracted” phase of nursing. A LOT of babies go through this, and many of them outgrow it. For others [like my Ezra] it CAN be a precursor to self-weaning [sob]. I’m sure your milk is just fine. The distraction — and this includes not wanting to take breaks from exploring to sit in a high chair — is a normal developmental stage where he’s figuring out that there are things in the world even more interesting than boobs.

(Oh! And that’s another thing. So your baby is low on the weight percentiles. Is he more or less meeting most of his developmental milestones? As in, can you look at a milestone chart for a 9-month-old and not be gripped with bone-shaking panic because he’s not doing any of that stuff? Did his height and head size remain more or less where they’ve always been? If so, I’d say he’s probably just fine. He’s just skinny.)

You didn’t give a ton of specifics about his solid food diet, other than “about an ounce or two of fruits/veggies/cereal with some table food at mealtimes.” While there is no “right” or “set” amount a nine-month-old should eat, I will admit that’s a bit on the low end. Have you thickened the consistency of his foods yet? Tried some basic baby soups or stews with a little protein in them? Offered any meats yet? Will he eat yogurt? If not, you can definitely start expanding his food horizons at nine months beyond pureed peas, pears and oatmeal. Here’s a sample menu for 8-12 month old babies (scroll to the bottom) that I used for my boys (who were both skinny babies). Noah rarely finished everything I offered; Ezra usually would, but the quantity really isn’t the point. The variety is.

At this point, aim for three “meals” a day and one or two small snacks (after naptimes). Nurse him first, then offer a grain, a fruit/vegetable and either a dairy or meat/meat-alternative protein. If your baby will only sit in the high chair for a limited amount of time, mix as many of these elements together as possible. Yogurt mixed with cereal, tofu and avocado, etc. Noah loved chicken pureed with pears; Ezra adored lamb stew with mashed lentils. Pasta pulsed once or twice in the blender with veggies is AWESOME. That way you’re packing maximum punch into each spoonful. And don’t forget the finger food! It sounds like your son is still mostly spoon-feeding (I think?), which is fine, but always offer some self-feeding options. They might not serve the weight-gain purpose right now (and might all end up on his lap or the floor), but they are so very important down the road when he might not be so willing to let you feed him. Diced veggies, bites of cheese, teensy bits of chicken, different pasta shapes — give him a wide variety of textures to touch and taste. Again: don’t force or cajole him to eat after he’s indicated he’s done.

Babies won’t let themselves starve. They won’t go hungry without letting you know about it. Provided there isn’t an underlying medical reason why your son’s weight has dropped (and again, if height/head circumference are fine, as are most of his developmental milestones, there probably isn’t), he’s FINE. He’s probably just going through that active, distracted phase that will last from now until college.

(And if it makes you feel any better — Noah, the child who ate nothing and still eats nothing, has skewed anywhere from 30th to 50th percentiles for weight. Ezra the Life Is One Big All You Can Eat Vegas Buffet child, fell into the SEVENTH PERCENTILE at his 18-month visit.)

About the author

Amalah

http://www.amalah.com
Amalah is a pseudonym of Amy Corbett Storch. She is the author of the Advice Smackdown and Bounce Back. You can follow Amy's daily mothering adventures at Amalah. Also, it's pronounced AIM-ah-lah.

If there is a question you would like answered on the Advice Smackdown, please submit it to amyadvice@gmail.com.

Amy also documented her second pregnancy (with Ezra) in our wildly popular Weekly Pregnancy Calendar, Zero to Forty.

Amy is mother to rising first-grader Noah, preschooler Ezra, and toddler Ike.


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25 Responses to “Is My Baby Eating Enough?”

  1. HereWeGoAJen Jun 21 at 2:27 pm Reply Reply

    This is not related to the main point, but if you do decide to go to a lactation consultant, I took my fifteen month old. The lactation consultant was actively excited to finally get to see a not a newborn. And they could certainly help a little with the distraction issues.

  2. HereWeGoAJen Jun 21 at 2:33 pm Reply Reply

    Oh, and between the nine month and the one year check-up, my baby didn’t gain any weight at all. She got taller, but it was just the time she chose to thin out.

  3. Jenn Jun 21 at 2:33 pm Reply Reply

    This topic made me laugh because it’s the same issue we had at my daughter’s nine month checkup. She was in the 95th percentile for weight at 2 months. At 9 months? 17th percentile. She is a great eater, she’s just gotten more active and is now a petite little thing. My second son did the same thing ten pounds at birth, 18 pounds at age one. My nephew was a really skinny baby and his pediatrician recommended ice cream before bed time. ICE CREAM. That’s some empty calories! Amalah’s advice is great- and good luck finding a new pediatrician!

  4. Jen Jun 21 at 2:45 pm Reply Reply

    It is totally normal for a BF baby to drop on the “weight charts” as they get older and more active. There is probably nothing wrong with your baby- the charts used are based only on formula-fed babies, who tend to be much heavier. Visit kellymom.com and find the WHO charts, based on BF babies and you will see that your baby is more normal than you think. As babies get more active, they do thin out- for a kid with a fast metabolism, it is hard for them to get enough calories (in any form) to keep up with their activity level. And solids won’t help your baby gain- they have fewer calories per ounce than breastmilk and are less efficiently digested. If you are really worried, try to add in a nursing session- that is what I did with my daughter who wasn’t even on the charts from 6 months until about 15 months. I would not push too many solids, since that will encourage your baby to wean. Babies do not need 3 solid meals or more at that age- the main source of nutrition should still be breastmilk and/or formula. Someone has to be at each point on the charts- it is okay to be the skinnier baby as long as they keep growing and meeting milestones.

  5. JCF Jun 21 at 2:46 pm Reply Reply

    Also, when you consider percentile keep in mind that in order for one kid to be in the 95th percentile, another kid has to be in the 5th. A friend of mine was told by her son’s pediatrician “we like all of our patients to be above the 50th percentile.” Excuse me? That’s not normal or right or possible.

    I would agree with your juice feelings–juice is NOT going to fix his weight “problem” if he does indeed have one. Formula, yogurt, beans, avocado, etc. are all high-calorie and nutritious foods. Juice is not.

  6. AJU5's Mom Jun 21 at 2:47 pm Reply Reply

    My daughter went from just under 50th percentile at 6 months to 15th percentile at 9 months – gaining less than a pound. Our pediatrician said genetics were probably the reason, as they start to play a role between 6 and 9 months. She didn’t recommend we do anything differently, and our daughter is perfectly healthy and happy. She has maintained at the 15th percentile (roughly) since then. Our son was both at about the 15th percentile, so I bet he will just stay there.

  7. Jaymee Jun 21 at 2:49 pm Reply Reply

    Everything Amy said is great! I wouldn’t stress too much about it. I have a 9 month old and he eats non stop. He has never refused food, and I usually have to cut him off at meal time after he’s consumed 12 ounces of whatever puree he happens to be eating that day(chicken/pork/beef/veggies/fruit). He has 3 meals a day(equaling 36 ounces of solids) plus he is breastfed and drinks water and juice mixed(I can’t get him to drink water unless it’s flavored with juice). After all of that, he still doesn’t even make the height and weight % chart. He is perfectly happy and healthy and meets all of his developmental stages. Just like adults, babies have different metabolisms. Some are just smaller than others. As long as he is happy and meets his developmental stages, I’m sure he is fine.

  8. Stephanie Jun 21 at 2:50 pm Reply Reply

    I wouldn’t worry. My baby was 9 1/2 pounds at birth and just turned one last week. A dime under 20 pounds. She went from 90th percentile to 37th. I think the issue is that as long as he’s gained some weight, he’s probably fine. In fact, my doctor said that my baby will probably go even further down the growth chart when she starts walking. But I agree with Amalah. I think you need to probably see how much solid foods your son will eat. I actually recommend doing solid feeding before nursing to see how much he’s eating when he’s hungry. Avocado is a great way to add some (good) fat into the diet. Still my daughter’s favorite food.

  9. Ms. K Jun 21 at 3:20 pm Reply Reply

    @Jen etc.

    Yeah, breastmilk/formula are by far the densest foods, calorie-wise. You totally shouldn’t worry about how much “solid-food” your kid is eating at this age – it’s primarily recreational for a lot of kids before they turn one year old. Some kids don’t eat any solid food at all before one year, and they do absolutely fine. And it’s also true breast-fed babies have a somewhat different growth curve than formula fed babies.

    I totally concur with Amalah’s recommendation to find a new ped.

  10. Lisa M Jun 21 at 4:28 pm Reply Reply

    Breastfed babies also take a lot less time to eat at this age as they are “experts” on getting the milk out quickly by this point. But if you’re worried, go ahead and add a session since he’s not eating many solids. Especially during the summer months when he’ll need more liquid intake if you are out and about in the heat.

  11. Delora Jun 21 at 5:06 pm Reply Reply

    Exactly what Jen said – consult the WHO breastfeeding weight charts (a quick search on the WHO.org site will bring them up), and compare your son’s charted measurements to those.

    Also consider if he’d eaten before your appt. or if he had on a clean diaper. If he’s eating 6oz of milk at a time, if you hadn’t nursed before the appt. and put him in a dry diaper, that could be a half a pound of weight right there.

  12. Susan Jun 21 at 5:54 pm Reply Reply

    @Jaymee “(I can’t get him to drink water unless it’s flavored with juice). ” – if he won’t drink water without juice, he’s not thirsty, end of story. Just like a baby won’t let himself starve, he won’t let himself be thirsty, either. My pediatrician (whom I adore) said that when a baby is thirsty, he’ll drink whatever you offer him (even plain water). When a baby is not thirsty, he’ll drink something sweet just because it’s sweet, and not because he needs the fluids.

    One thing that helped my son when he got distracted was for me to wear Mardi Gras beads. He could wrap the beads around his fingers and tug on them while nursing, which kept his attention longer. I also bought a “nursing necklace” off of Etsy – just a big wooden ring on a leather strap.

  13. tracy Jun 21 at 6:09 pm Reply Reply

    I’m confused… he’s “exclusively breastfed” and yet is eating solid foods? I thought exclusively meant… well… exclusively. As in, his only nutrition comes from breastmilk. Am I wrong about that? Does it only refer to breastmilk vs formula?

  14. KAren Jun 21 at 6:58 pm Reply Reply

    Tracy – I would assume an “exclusively breastfed” baby is taking in only breastmilk but in this context I think the writer is trying to say the baby doesn’t get formula.

    To the OP – my gal dropped to the 10th or so percentile at the 9 month appt. She was a very distracted nurser but eats food like it’s the end of days. She is COMPLETELY healthy. I wouldn’t worry about this weight drop. Like someone else said, the charts are really just a gauge and shouldn’t be used in isolation from other metrics. I think it’s kind of sad that numerical standards are so pervasive that we’ve neglected actually thinking about whether a kid is happy and healthy and instead turn straight to a chart of numbers to figure that out instead.

    I’d also suggest that you find the local La Leche League group near you and attend a meeting. I love my group and found the members and leaders to be especially helpful with my feeding questions during this transition from babyhood to toddlerhood.

  15. Lise Jun 21 at 7:37 pm Reply Reply

    My babies were all about 16 pounds at a year old. They were very healthy but thin toddlers who have grown into very healthy but thin young adults. But at nine months they were still nursing on demand and had far more than four nursing sessions per day. No matter how much I fed them, they gained slowly. Their dad and I were both thin, and they were meant to be thin people.

    If you’d like to add calories to your son’s diet, making sure he nurses long enough to get the high-fat hindmilk is a good idea. He might be less distractible during feedings when nursing in a dark, quiet room. Adding a feeding would be great. If you don’t want to do that, making sure that the solids he eats are high-calorie would help. Avocados are higher in calories, as are most meats.

    Congratulations on having a beautiful, healthy baby.

  16. Renee Jun 21 at 7:53 pm Reply Reply

    I agree wholeheartedly with Amy’s suggestions.  But as a dietician, I’d also suggest requesting a referral to a Registered Dietician.  (I’m not sure of the process in the US, in Canada your Dr can refer to a pediatric RD.)  
    This may turn out to be normal growth for your child, but if it is failure to thrive, it is far better to be aware sooner rather than later.  If you are concerned enough to be asking Amy this question and are questioning your doctor’s advice, seek out another professional opinion.  No need to panic, but seek out professional opinions until you feel confident with the result.
    Best of luck!

  17. Rayne of Terror Jun 21 at 11:03 pm Reply Reply

    I freaked out a little reading the question. That seems like SO little intake to me for a nine month old. I think seeing a dietician sounds like a good idea. My boys have never fallen below 75% for weight as babies, so I’m sure my experience is skewed the other way. My 10 month old weighed 27 lbs at his 9 month appointment and is so far off the charts for height it’s incredible. My 10 month old can REACH the KITCHEN COUNTERS. Fer real.

  18. Brooke Jun 22 at 12:04 am Reply Reply

    If your new doctor does worry about your son’s weight and decides to run tests/look for a cause, make sure she considers constitutional growth delay. It’s a variation of normal growth in which kids fall off the growth charts at around nine months and come back on around three years (among other things). My daughter almost certainly has this, but it was missed and we had a lot of blood drawn and a very unsatisfying visit with a nutritionist along with several long months trying to make sure we crammed calories into her. An X-ray of the hand will diagnose it apparently.

  19. Emily Jun 22 at 12:08 am Reply Reply

    My daughter had slow weight gain from 4-6 months (we’re talking less than a pound)…then had a growth spurt a little late and gained 3 pounds in 2 months! Sometimes, kids don’t have those growth spurts when the charts say they should. My pediatrician was pretty conservative with her advice, and just wanted us to keep track of how much she breastfed, etc, and said we could try some more fattening solids. She had a hunch my daughter just hadn’t had her growth spurt yet, esp. since all her other measuremtns were fine, and her milestones were ahead of time. And she was right!
    Avocados are high fat, but they were the only food my daughter wouldn’t eat! I found out bananas, and peaches are also high in calories, and also make great finger foods. I agree on the advice to offer more solids. My daughter also bf’s 4 times a day, but eats 2-3 good solids food meals also. (And I don’t give her any juice). Try the fruit/whole grain combinations from Earth’s Best. Super calorie packed, and lots of different flavors to introduce!

  20. Monica Jun 22 at 9:25 am Reply Reply

    I am in a similar situation, with an older baby. My 16mo old has fallen way off the charts for weight, even though he doesn’t look ‘skinny.’ He’s also short and I figured he was petite like I am, but the pediatrician showed me where he would be on the chart if he was in my range, which makes sense as I am certainly not in the “less than 5th percentile” for weight.

    She stressed the importance of fat in the diet for brain development and immune system health, so your pediatricians recommendation of juice doesn’t sound right to me either. She also encouraged lots of mashed potatoes with butter to get some extra calories in him. Unfortunately, he doesn’t eat this and doesn’t seem to eat much at all, so I understand that frustration. Since I’m no longer nursing, she has also recommended I put him on formula.

    It is difficult being a new mom, especially having issues that no one else seems to have. It seems everyone else has babies and toddlers in the 95th percentile!

    So yes, new pediatrician that you trust and that explains more to you, not just a vague oh give him more juice. And if you have access to a lactation consultant/nutritionist use it!

    Good luck fattening your little guy up!

  21. Monica Jun 22 at 9:26 am Reply Reply

    I am in a similar situation, with an older baby. My 16mo old has fallen way off the charts for weight, even though he doesn’t look ‘skinny.’ He’s also short and I figured he was petite like I am, but the pediatrician showed me where he would be on the chart if he was in my range, which makes sense as I am certainly not in the “less than 5th percentile” for weight.

    She stressed the importance of fat in the diet for brain development and immune system health, so your pediatricians recommendation of juice doesn’t sound right to me either. She also encouraged lots of mashed potatoes with butter to get some extra calories in him. Unfortunately, he doesn’t eat this and doesn’t seem to eat much at all, so I understand that frustration. Since I’m no longer nursing, she has also recommended I put him on formula.

    It is difficult being a new mom, especially having issues that no one else seems to have. It seems everyone else has babies and toddlers in the 95th percentile!

    So yes, new pediatrician that you trust and that explains more to you, not just a vague oh give him more juice. And if you have access to a lactation consultant/nutritionist use it!

    Good luck fattening your little guy up!

  22. wallydraigle Jun 22 at 9:37 am Reply Reply

    My daughter’s weight dropped off dramatically after 6 months. She was around the 90th percentile and suddenly dropped to the 50th. I was concerned, to say the least, but the pediatrician reassured me that this is very normal for breastfed babies, and that there was nothing wrong with her. She said that if she’s alert, happy, sleeping well, developing at a normal rate–in other words, obviously healthy judging by every other standard there is–, the weight should not be worrisome all by itself. It’s a place to START, but it’s not THE indicator of a baby’s health. Around a year, when she started eating solid foods with real zeal, her weight percentile popped back up to the 75h percentile.

    A lot of this has to do with the growth charts they use. Most pediatricians use growth charts that include formula fed and breastfed babies’ growth, and formula fed babies gain weight much more quickly starting around 6 months. So definitely look into it with a different pediatrician, but don’t get too worried just yet.

  23. Olivia Jun 22 at 9:38 am Reply Reply

    I’m with Jen all the way. The growth charts you are seeing are based on formula feeding and don’t reflect breastfed babies accurately. The amount of solid food a baby eats varies widely and there is no amount they “should” be eating. My daughter has been slow to the solid food bandwagon. At 9 months she might eat 2 oz of baby food in a day, and wasn’t really interested in anything she had to chew. At 14 months and 20 lbs she still gets most of her nutrition from breastfeeding (we breastfeed on demand when I’m at home so I really don’t know how many times she nurses). You might get some helpful advice from a La Leche League meeting in addition to switching pediatricians.

  24. MissBlissMom Jun 23 at 10:43 am Reply Reply

    My daughter (just turned one) has always been under the 50th percentile for weight, and I’ve worried lately about enough food. At her 9 month well-baby, her growth curve had dropped and our doc printed out the chart people have mentioned here that is based only on BF-babies and her curve didn’t drop off. From her 9-month to 12-month appt her curve did drop, but our doc still wasn’t overly worried (even though I was). She said exactly what people have said here: mashed beans, avocado, cheese, yogurt.

    She has also always told us (since we started solids) to keep offering her food as long as she’ll keep eating it – rather than making what we think is the right amount and stopping when its gone. So, sometimes she eats 2 and half bowls of yogurt… and sometimes she doesn’t get through the first helping. My husband likes to point out that I eat the same way :)

  25. Megan Jun 23 at 12:51 pm Reply Reply

    I’ll echo what Amy and others have said about not worrying TOO much at this point and looking at the BF-baby curves, but as a pediatrician who works in our hospital’s nutrition evaluation clinic, I do want to especially emphasize that the juice advice is just weird.

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