Dear all:

There have been many studies that have shown that babies who are given solids to bump up the weight gain actually gain at a SLOWER weight than if you didn't offer the solids.  This is because (apart from drastically changing the fat ratio of the diet into abnormally high fat intakes which is really uncalled for and may be one of many reasons why you see a U-shaped curve in poor growth early on followed by increased risk of obesity later on) almost no solid has the same nutrient and caloric density of breast milk.  Pushing too many servings of solids too soon displaces the more nutritious breast milk. Pushing fat over protein or over really balancing the solids that are offered doesn't make sense to me either.  The first nutrients babies are iron and zinc -- first and foremost, but they also need protein.  Carbs alone are not sufficient.  Carbs + fat is also not sufficient.

I believe it was Juan Rivera who elegantly showed that the NUMBER of services of solids per day was the determining factor, not whether or not the breast was offered first or second.

The first thing I look at when babies are gaining slowly or failing to thrive after the fourth month is the number of feedings and how long that baby is sleeping. Longer than the normal 6-7 hours sleep stretches and a low frequency of feedings are almost always the culprit.  

Every now and again it is something else, most commonly undetected tongue tie, regurgitation, teething, etc.  Once or twice, it has been due to a metabolic disorder.

Best,

Susan Burger, MHS, PhD, IBCLC, RLC

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