Too fat? Too thin? Nursing and toddler weight gain.

Remember that this is unedited text -- like "letters to the editor." Identifying information, such as names, has been removed; but otherwise it is posted here pretty much as it came in. So read it as personal opinion shared with warm intentions but without authority of any kind.

     My son has always been small and thin (except for a brief bout with chubbiness at four months). I offered him solids at six months and he was not interested (next baby, I'll wait 'til s/he asks)! At his nine month check-up, our new pediatrician (we'd just moved) expressed concern about his slow weight gain and suggested I start him on a follow-up formula (!) and start "buttering his broccoli." I said that he wouldn't eat anything buttered or not and he suggested I start skipping a nursing here and there. Well, if you're nursing on demand then there's no way to "skip a nursing" because they just happen, you know? Anyway, as a first time mama, I was terrified that my poor son was somehow losing out nutritionally by not getting food. I ran to my computer, read up, and realized he just wasn't ready. BTW, he was also walking at nine months which I am sure also contributed to his weight gain slowing down.

     At nearly two, my son still eats very little and still nurses a lot. I know that there are misguided folks who think he needs to eat more food and less "nu-nu" but he is following his formula-fed, forced-solids father's growth curve exactly (heredity wins out!) and I find comfort in this when people tsk-tsk my skinny boy. I know that he will not let himself starve and that any food that he substitues for breastmilk (which is usually his favorite crackers) is not going to be as nutritionally complete. I am sure that if he was nursing less that his thinness would be less of an issue for well-meaning but misguided friends (relatives are all supportive). We put so much emphasis on weight gain that it seems like we lose sight of how our children gain that weight. Really, buttering his broccoli?!

     The hard thing for me in nursing so much (about 12 or more times a day and who knows how often at night) is the usual -- exhaustion and keeping my own diet healthy. I do sometimes feel put upon but that's motherhood, isn't it? If he wasn't wanting to nurse, he'd want to be in my lap anyway. I mean, children are needy and that's what we're there for. I cope with it by reminding myself that childhood is short and that nursling-hood is even shorter. I do deep breathing exercises when I'm frustrated and try to let prolactin do its work.

     I had more, but with a nursing toddler in my lap and switching positions, we're both having a hard time with my typing!

     My (not-so-little) nursling is 13 months old and is for the most part exclusively breastfed. When I say "for the most part" I mean that he will occasionally eat some oatmeal (a few bites in a sitting), share some applesauce with me, or sort of mutilate a banana. But other than the occasional nibble, he receives all of his nourishment from the breast. As a matter of fact, until he was 11 months old I couldn't coax him into eating anything -- he just was not interested.

     At his 12-month check-up he weighed in at 24 pounds and was almost 31" long. His hematocrit was "the low side of normal" according to the Dr. but normal nonetheless. In spite of all this, the Dr. was appalled (to say the least) that he is not eating solids. (Note: This is my first child. If not for wonderfully supportive LLL Leaders and my own strong convictions that his body knows what it is doing, I might have caved to the proposed medical tests to find out why he is not "normally developed" in this area.)

     I have read everything I could get my hands on about older exclusively breastfed babies, but the information is scarce. Even though I truly believe in child-led development, it becomes very difficult not to get paranoid that something is wrong with your child when they stray so far from the "normal" time tables. We do have a long line of allergy sufferers in the family, and he has shown sensitivities from birth to certain foods in my milk (I have not been able to eat rice -- of all things -- since I finally pinned down that sensitivity) so there is that possibility.

     O. is also very much the in-arms baby (high-need), and I still, at 13 months, have to put him in a pack to get any housework done. This, combined with the fact that I am his only source of nourishment, make for 24-hour a day non-stop child care (he nurses anywhere from 4 to as much as 12 times a night). I have literally had nightmares about getting pregnant again (though I'm still experiencing amenorrhea) with such a needful child. It is hard not to despair at times that he will never eat real food. I have, finally, after so long, decided to just sit back and see where he takes me. I have to say that it is not easy, especially when family and strangers alike offer him food all the time and I have to figure out how to discourage it without appearing a freak (and boy do people think a 13-month-old exclusively breastfed toddler freaky!). Some people actually like to blame breastfeeding itself, saying that if he didn't like nursing so much he would eat solids. :]

     I don't think I will ever know why he has nursed so long exclusively. It is probably a combination of all the things I have mentioned. I guess I just have to trust that his body knows what he needs and that he is just marching to his own drum. I have to say that I am secretly proud of the fact that we have such a big, strong, healthy, beautiful and, above all, happy son, and I have nourished him completely with my own body. And when he has approached me to nurse for 20 more seconds for the 15th time that hour I will try to remember this (smile).

     Now if I could just get some sleep... :]

My three year old daughter is 27 pounds, and tall for her age. (She still nurses two to three time a day, once before naps and bedtime and first thing upon waking up in the morning.) My husband seems to feel that this is a result of breastfeeding, but he wanted me to stop breastfeeding for a while. She was always in the habit of reaching for me before food. I had to constantly offer her food "and than you can nurse". I think she is the kind of child that really loves breastfeeding, one of the reasons weaning her is going so slowly.

I am the mother of an active 15 month old boy. He weighs 19 lbs. 5 oz and is 29 3/4 inch tall. The doctor is concerned about him and will be running blood tests to rule out health problems. My gut feeling is that he is healthy and growing on his own terms. I believe that breastfeeding factors into this but would like more information.

A large comparison between children in Europe fed early solids (before 3 months) and those fed according to World Health Organization (WHO) guidelines (6 months exclusive breastfeeding, followed by breastfeeding and solids, breastfeeding continuing at least through the second year): "Our study confirmed that infants who are fed according to WHO recommendations have higher weight and length during the first 2 to 3 months of age than infants fed by other modes. Thereafter, they tend to be shorter and lighter, but the differences between feeding groups were small and probably not of clinical relevance. At an age of 2 years, differences up to 0.3 z-scores correspond to differences of aproximately 9 mm in length and 400 g in weight. These differences are not much more than the usual measurement errors in length and weight." At 30 and 36 months of age, the difference in height between the WHO group and the controls was small but statistically significant. The authors suggest more research to see whether or not these differences have any relevance in childhood or later in life. (Msc, M.A. v.'tH., The influence of breastfeeding and complementary foods on growth until three years of age in the Euro-Growth Study. Pediatrics (Online) 106:5 (Nov 2000), 1281A-1281)

In places where food supplies are inadequate, weaning foods are less than ideal, and sanitation is poor, breastfeeding in the second year makes a measurable difference in growth. Toddlers who are still nursing grow taller than those who are not. A study of toddlers in western Kenya, reported in Lancet concludes: "Our results suggest that breastfeeding in the second year is a strong positive contributor to linear growth and that when early weaning is unavoidable, interventions to improve household sanitation could limit its potential negative impact on child growth. Our findings on interactions reflect, on a much smaller scale, the worldwide variations in the association between long-term breastfeeding and child nutrition reported by Caulfield and coleagues [Caulfield LE, Bentley ME, Ahmed S. Int J Epidemiol 1996, 25: 693-703] which may be linked to differences in sanitation and water consmption. Thus, our results are consistent with the evolving evidence that the nutritional benefits of long-term breastfeeding are more evident in deprived than in better-off environments." (Onyango AW, Esrey SA, Kramer MS, Continued breastfeeding and child growth in the second year of life: a prospective cohort study in western Kenya. Lancet 354(9195) 1999 Dec 11: 2041-5)

Researchers have been puzzled by the high numbers of nursing toddlers in such places as western Kenya who are short enough to be regarded as "stunted." A recent journal article suggests that these chidlren's growth has been slowed down, not by breastfeeding as some have suggested, by introduction of poor weaning foods before 6 months, often before 3 months of age. Breastfeeding in the second year contributed to measurably better growth. Other important factors in child growth were sanitation and household water usage--perhaps an indicator of cleanliness or increased food preparation. (Onyango AW. Breastfeeding and growth in rural Kenyan toddlers. Advances in experimental medicine and biology 478 (2000), 151-62)

A study of white American toddlers between 12 and 18 months of age found that they eat and gain more if their parents do not try to keep control over their food intake. The researchers also noted that moms who breastfed at least 12 months were more likely "acknowledge "the child's role in the regulation of food intake." (Fisher JO, Birch LL, Smiciklas-Wright H, Picciano MF, Breast-feeding through the first year predicts maternal control in feeding and subsequent toddler energy intakes, Journal of the American Dietetic Association 100(6) June 2000, 641-6)