Saturday, March 29, 2008

How to Deal with an "Underweight" Baby

Mollybird was named before she was even born for her in-utero hummingbird flutters, but it is appropriate enough now to describe her weight and eating habits. She's looking forward to her second birthday this spring and has hovered at a pixie-ish twenty pounds for nearly six months. During our daily breakfast ordeal, I wrote this post in my head. Knowing my experience is not that uncommon, I wanted to share my thoughts.

Breastfeed, Breastfeed, Breastfeed

Do not (and this is as preachy as I'll ever get, pinky swear) let anyone tell you that breast milk is not the ideal food for your itty baby. If your supply is a little low, the best known way to remedy that is to nurse like crazy. Chances are, though, your supply is fine. If you're concerned, there are lots of articles at Kellymom that will ease your mind. Breast milk is much, much richer in nutrients and the fats are better absorbed than with artificial feeding.

Infants need only breast milk until around six months. Doctors or grandmas who encourage cereals or other foods before baby is ready may be politely ignored:) Six months is an estimate- here is a good guide (and as a bonus, recipes!) to when your child is ready for this milestone. After baby starts sampling foods, continue to offer the breast first until she eats pretty regularly. If that's still not happening at a year- that's fine. Some parents don't even offer solids until nearly a year.

Continue to breastfeed as much as you can stand as long as you and your child want to. If your baby is on the skinny side or is a really picky eater, I really encourage you to nurse her as long and as often as she wishes. The all-night, all-you-can-eat dairy buffet can be trying, but it helps me to remember that at night milk is higher in fat and denser in calories. While it's definitely appropriate to set limits on nursing after good eating habits are established, for the smaller toddler the nutritional excellence of breast milk is really important. And because it's so easily digested, you needn't worry that you'll spoil his appetite for solid food if you leave a little time between nursing and a meal.

Medical Stuff

There is a gaping hole in medical school where there should be training about lactation. Unless your pediatrician is very familiar with breastfeeding (we actually see a nurse practitioner who is also an IBLC certified lactation consultant) you may well know more than he does about nursing. Find a lactation consultant (LC) for feeding questions. WIC offices and La Leche League (LLL) groups are great starting points.

Self-education is important for parents, especially for breastfeeding moms. It's beneficial to find a balance between trusting the training and skill of your health care providers and owning your own power to make decisions. You have the right to refuse or modify treatments that don't make sense to you. We were sent for blood work on Molly to rule out any metabolic disorders. We weighed the fact that she has no symptoms besides being small against our own worries and the relative simplicity of a blood test. We decided to have the test and it showed that she was fine. The nurse suggested we come in for weight check every few weeks after that and we declined. We'll take her for her check up when she turns two.


Our relationship with toddler foods teeters between totally laid back and riddled with frustration. On the laid back end of the spectrum, we decided without discussion or thought, that we never met a calorie we didn't like. When Molly was an infant, I was the nutrition police, shooing away candy bearing grandparents and religiously watching for allergens. After we introduced a variety of foods that were well tolerated, we stopped worrying about it. As long as there's no choking hazard, we let Molly eat pretty much whatever she wants to. (I still try to keep dyes out of her diet, but am not a stickler.) So my child eats sausage, and her vegetarian mama shrugs. Protein? Good. Fat? Good.

On the subject of fats: calorically, all fats are equal. Olive oil = chicken fat = almonds = steak. Plant fats are much higher in the brain boosting Omega-3's, (pretty much the whole reason that we are all so keen on getting fats into these skinny kids) so if you can get your child to eat a higher percentage of these fats than animal fats, good on you. It is not true that animal fats will bulk her up better/faster than plant fats. Molly hates nuts and avocados, so that's a struggle for us- bringing me back to the "whatever..." approach to toddler feeding.

Go with the Flow

The thing about toddlers is um, they have their own will. However much I'd prefer a child who sleeps through the night after a sumptuous vegan dinner, it's not happening. Surrender is a beautiful lesson to learn. Watch your baby's eating patterns and offer food when he seems to eat best. Molly will not eat breakfast, beyond a few Cheerios. She will, however, eat all evening if we offer one food at a time. So I've given up on the early bedtime and hearty early breakfast.

Try to stay positive if new foods are refused, and try them again frequently. The "experts" literature says it can take 12 exposures to a new food before a baby will eat it. Be creative and don't stress it. Just offer new flavors and see what happens.

The toddler experience is an initiation into a whole new realm of mothering for me. Every little developmental step brings a new challenge and obstacles, and the answer always seems to be to open a little more. The lessons I learned from pregnancy and birth are coming into play, too, though. The idea of trusting my body to labor as it would flows into my trusting that Molly is the size and shape her body is supposed to me. Seeing her eyes sparkle and watching her mad fairy energy tell me more than the lab reports did. At the same time, I know the test eased my mind, so I'm confident about that decision, too. I'm happy I'm striking a balance between intuition and information, between concern and trust.

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