Anh - thank you for posting in such a clear, objective way about your
daughter who is gaining so little weight. This must be very worrying for you.
I work with a lot of FTT babies, but usually not as old as your little one.
I have to convert weights to metric because I can't "think" in imperial
measurements, but I find it helpful to track the rate of gain to obtain a
picture of what has been happening. The weights you gave showed that your
baby gained about half of what would have been expected up to 2 months of
age (14g per day, we like 30g/day) and then things improved and she gained
18g/day until 4 months, and 21g/day up to 6 months. You don't give a weight
for 5 months, but it is likely that she could have doubled her birth weight
by 5 months even though she had gained less than what would have been
expected, and we need to remember that she was tiny to start with - so this
would bring her within normal range.
However, it looks as if things started to go wrong after 6 months, since she
has only gained 10 oz (about 300g) in the last 7 months. You don't mention
why she only started weaning foods at 9 months - perhaps because she didn't
seem interested in anything other than breastmilk up to this time? This
would clearly point, as you guessed, to food sensitivities.
If you were my client I would cast serious doubts on the theory that the
breast is only being used as a pacifier, and suggest that you breastfeed
*more*, not less, perhaps using breast compression (support breast
throughout whole feed to make intake easier for baby, giving gentle
squeeze/lift when baby starts to flutter-suck) and "switch-nursing" (swap
breasts often, when you are aware that your little one is no longer
swallowing in spite of breast compression). I think Denise is also on the
right track, and would suggest manually expressing or pumping the milk that
the baby leaves *after* breastfeeding, perhaps about 5 times per day. This
milk could be fed another way, or mixed in with her solid foods. Maximizing
breast drainage would increase your milk production over time too. I would
also suggest increasing the calorie content of her solids - mixing in a
teaspoon of oil here and there, and adding extra sugar to fruits, cereals
etc. And increase meals from 2 to 5 per day - this could be 3 "meals" and
two between-meal snacks - eg a piece of fruit, a little finger-food - just
*something*, and you could be as inventive as you like about what she might
enjoy, sometimes toddlers like to eat off *your* plate, rather than their own.
Lastly, you mention that your older child was diagnosed with cow's milk
intolerance as a toddler, you yourself are lactose intolerant, and the baby
has atopic dermatitis on cheeks and earlobes. I would suspect a bovine
sensitivity and suggest that you avoid the Pediasure like the plague (isn't
this made from cow's milk?) and eliminate from your own and the baby's diet
*all* sources of bovine proteins - ie all dairy and beef products and all
foods containing even traces of them. A zinc supplement for the baby would
also be good to stimulate appetite.
These things might be worth a try as a first line of defence. As I say, I
don't work with many older babies who don't gain well, but I do distinctly
remember 3 of them - all were girls and all had tiny moms, like you, all
were healthy and thriving, and very active and alert - they just didn't
weight too well!
Pamela Morrison IBCLC, Zimbabwe
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