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Question: What can I do about my 7 month old who isn’t gaining weight well?

My son is seven months old and I breastfeed him. I have also started solid foods. He isn’t gaining much weight and his doctor has said that she is getting concerned. He only gained five ounces in a month. She is worried that he is not getting enough.  He usually nurses four to six times a day and he eats cereal and a fruit or veggie twice a day. The doctor is concerned that I don't have enough milk.

When he nurses he seems content and goes for a couple of hours before he wants to eat again. How can I tell if he is getting enough from me? What should I do? I would like to continue to breastfeed him if possible. Should I supplement him with formula? Should I give him more solids? I am so confused and getting worried.

Answer:
First of all, I would be interested in knowing your baby's birth weight and pattern of weight gain over the past seven months. If he has gained weight appropriately and has had good urine and stool output up to this point, then chances are that he is following a pattern that is normal for him and there is probably no reason for concern. If you had a supply problem, it probably would have shown up way before now.

Most babies lose some weight as they excrete the extra fluids they are born with in the first few days after birth - seven or eight ounces for the average baby.

Average weight gain for the first three months is four to eight ounces per week. During the second six months, it averages three to five ounces per week, and from six to twelve months it drops to one and a half to three ounces per week. Most babies will double their birth weight by five to six months, and increase it by two and a half to three times by one year.

All this applies to the "average" baby, who doesn't really exist in real life. There will always be perfectly normal babies who are at the 10th percentile or at the 90th.

Weight gain is only one measurement of growth, but sometimes doctors tend to focus on the weight charts alone (and by the way, these charts are based on formula fed babies and are in the process of being revised, because there are differences in growth patterns between breastfed and formula fed babies, especially after the first three months: From the fourth to the twelfth month, nursing babies gain more slowly (even after solids) and are leaner at one year. Breastfed babies consume 20% less milk than their formula-fed counterparts during this time, and their growth is perfectly normal.

What is equally important is the baby's growth in length and head circumference. During the first six months, his length will increase by about one inch per month. From six to twelve months, he will grow about a half inch per month.  Head circumference increases by one half inch per month first during the first six months, and a quarter inch per month during months six through twelve.

Family history is also a factor to consider when evaluating growth.  A child that comes from a family of very short people is, in all likelihood, going to also going to be on the short side. A child that comes from a family of tall, thin people will tend to be tall and thin.

Overall development should also be evaluated. Is the baby happy and developmentally on target?

All of these factors need to be considered when evaluating the baby's growth, not just how many ounces he gained in a given month. I have had two babies out of six who didn't gain weight the way all the charts said that they should. They both started out at the 95th percentile and ended up at the 10th. I tried everything to get them to eat, and they still stayed on the low, low end of the charts. They are both fine now, but are extremely thin and can eat anything without gaining weight. I think they were just genetically "programmed" to be skinny, although I didn't figure that out until they were older. When they were babies I worried myself sick about their weight gain and tried my best to force feed them.

In my experience, a healthy baby who is offered breastmilk on demand, as well as a variety of nutritious foods is going to be just fine. He may not follow the pattern of the "average" baby exactly, but you have to remember that the average baby simply doesn't exist in real life.

Of course there are situations where slow or low weight gain is a genuine concern. The baby who stops gaining weight completely or loses weight, the baby who is always fussy or lethargic, the baby who is lagging behind in mental or motor development, or the baby whose head circumference is not increasing is a baby who may have medical problems that need to be investigated and treated appropriately. This is very different from the much more common scenario of a happy, healthy baby who is contented and is gaining weight on a slow curve.

There are lots of things you can try to increase your supply (see article on my website: "Increasing Your Milk Supply"). If you do need to supplement, I would suggest giving more milk rather than solids. The best supplement would be your pumped breastmilk, and the second choice would be formula. Breastmilk and formula contain about twenty calories per ounce, and cereal contains about fifteen. What actually happens is that an ounce of cereal with less caloric density than milk is taking up space in the baby's stomach that would best be taken up by milk or formula. Since human milk is the most nutrient dense food you can give your baby, solids should be started slowly and not over-emphasized in the first year when the baby is still growing so quickly. Cereal doesn't contain the fat, protein, and calories that babies need during this critical period. That doesn't mean that it is bad for him, but he shouldn't fill up on it (it doesn't sound like that is happening in your particular situation, but I still wanted to mention it just FYI).

Breastmilk is a very complete food for at least the first six months of life. From six to twelve  months, an "educational diet" is recommended. This means that others foods gradually begin to provide for nutritional needs that milk alone can no longer provide, and your baby gets used to different tastes and textures as well.

Breastmilk or formula should be the main source of calories up till the end of the first year, and should still constitute about 75% of his diet at twelve months (25% solids).

You need to be aware of the possibility that even if you offer him supplemental feedings, he still may not gain weight like the "average" baby. I never found that I could get my slow weight- gaining babies to eat more no matter what I tried to feed them. I made sure that what I offered them was nutritious (not empty fillers), and they found their own niche on the weight charts and stayed there. It may be a good idea to try offering him supplemental feedings just to see if he will take them, but don't be surprised if he isn't too enthusiastic about them. On the other hand, he may gobble them up and then everyone will be happy, including his doctor.

I hope that this has given you some information that will be helpful. You most definitely need to continue nursing, because even if you do end up supplementing, any amount of breastmilk that he receives is valuable - and of course, the closeness that you share with him is priceless.

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