QUESTION: My daughter is gaining weight poorly, at 2 weeks she was 9lbs 6oz, at 2 months 11lbs 3oz, at 4 months 13lbs. 2oz, at 6 months 15lbs 8oz, at 9 months 17lbs 8oz and at 12 months she weighed 18 pounds, and recently she was sick and she weighed in at 18.5lbs. She is 28 inches in length now. She nurses almost exclusively in that she wont eat solid foods in an real quantity.

I'm extremely worried, and the doctor has said that he will run tests on her if she drops down to the 5 percentile (she's in the 8 percentile now). She is very active and seems healthy to me, but I have to admit that I am worried about her weight. I have an older son and he was always VERY big for his age in both weight and height. Devyn has never nursed for any real length of time, and I always felt that I had a very strong let-down (she often choked in the beginning), I am wondering if maybe she's not latching on properly? How can I get her to eat/nurse more?

I also thought that I should let you know that since she was 9 months old I have been taking 20 mg of Paxil, and I also started smoking again (outside the house) when she was 10 1/2 months old. Family members are pressuring me to wean her, but I don't feel comfortable weaning her when she weighs so little and breastmilk is almost the only thing she's eating.
 

Dear Serenity,

For many years, pediatricians have used growth charts based on information compiled from predominantly formula-fed babies. Recently these charts have been revised. I plotted your baby's weights on the new chart and guess what? She's actually at 16%! This chart is being distributed by a company called Med Tech Source Inc. There is a toll-free number: 1-800-542-7322 (call this number to find a distributor near you). It says on the chart that "Breast feeding infant weight gain percentages were compiled from An Evaulation of Infant Growth, WHO 1994, Charles Cadwell, PhD. Data from the National Center for Health Statistics." The chart shows both the Standard Growth Chart and Breastfed Growth Chart on the same sheet--and yes, I can see that on the old Standard Growth Chart your baby would be at 8%. That is exactly why someone finally decided to recompile statistics based on breastfed babies!

It has been suggested that one of the reasons we have such high rates of obesity in the U.S. is because of many years of formula-feeding. Hopefully your child will never have a problem with this! Genetics most likely plays the biggest role in determining your baby's weight. At 13 months, you cannot really force her to eat, nor would that be a good idea.

Since she is getting mostly breastmilk, you can be sure that she is getting superior nutrition. Just keep encouraging solids. She'll eat them when she gets ready. It is not unusual at her age for her to be mostly nursing. My own daughter, who also gained very poorly, didn't really eat much in the way of solids until she was about 18 months--even then it didn't seem like she ate much. Now she is 16 years old and still quite thin. Her older sister, who was formula-fed after 3 weeks, has not been so lucky. She has always had to watch what she ate or she would gain weight--I have the same problem, but I was formula-fed after the first 6 weeks.

According to the information I have concerning Paxil, "No reports of untoward effects have been found in breastfeeding women." Smoking, however, can decrease milk supply. I was glad to hear that you are smoking outside the house, since being "smoked over" presents the biggest hazard to children. Since you didn't even start smoking again until 2 1/2 months ago, it is unlikely that this is a factor in your baby's slow weight gain. She is certainly old enough to let you know when she is hungry! I really think the only problem you have is an outdated growth chart! If you have any problems getting a copy, I will be glad to make a copy of mine for you to take to your doctor. Hopefully, he will order some and cause a lot less worry for parents!!

Cher Sealy RN, BSN, IBCLC, LLLL

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