@amandak695 Firstly- just want to chime in as an ER physician who did a peds fellowship— who also has a pet research interest in how we talk about weight and BMI and what kind of biases that creates in medicine. In general, this is MOST relevant for adults (particularly women, and also particularly people of color)— but we’re seeing it a lot now with babies and kids.
Growth charts are good for ONE thing— recognizing an unhealthy pattern. By this I mean- a baby was 80th percentile, and 4 weeks later he’s 10th percentile. It is ONE single measurement that can alert when there’s something going on, but on its own is absolutely and completely useless.
It is also important to note that, like BMI for adults, the growth curves for babies do not take into account really important factors such as where a baby is in their development, what their ethnic background is and their parent’s body types. As a standalone number it is kind of silly. It is based on AVERAGES- and I would also like to point out that these growth curves are not accurate for babies who come from backgrounds that were not traditionally represented in high numbers in the US.
Some babies learn to crawl at 6 months, some learn to walk at 9 months, some are 13 months. No, the numbers do not adequately take this into account at all.
I will freely admit I am not an LC- but I’m a mom and I’ve seen a MILLION kids (I also spent years overseas doing global health work in pediatrics)— mot everywhere else in the world, this kind of thing isn’t an issue UNLESS it is an issue. If your baby is eating and happy and nursing and meeting milestones, great. I wouldn’t give AF if baby is at 50th percentile or at 99th or 5th. As a mom, you know when your baby is doing great. You do NOT need to stop feeding your baby when your baby wants to eat unless it is for you- unless it becomes a situation of it not being sustainable for YOUR health and well-being (which is totally valid).
There are situations where babies will prefer breastmilk over solids, and if the baby becomes seriously underweight, or drops significantly in percentile (I’m talking like 50th percentile to 3rd percentile in a month or two), I think there’s something to be said for just keeping an eye out. But I wouldn’t personally make any changes without being seen by a pediatric dietician that works with breastfeeding moms.
During my peds fellowship, I was really lucky to work in a hospital where we had dieticians and lactation consultants as a regular part of our team- we rounded with them, we brought them in for consults, and in this kind of situation, that is who I would go to first. I have all the respect in the world for nurses, but this is out of their scope, frankly.
It sounds like the problem isn’t necessarily that your baby is nursing at night— but that your baby is having trouble with solids and that is valid. It can take some babies more time. There are some babies that might struggle with sensory issues or structural issues, and this is especially true for babies who were in the NICU or went through anything difficult when they were little. What you don’t want to do is miss a medical issue— a digestive problem, a swallowing issue, a metabolic disorder. Sometimes these can be harder to see until a baby is eating solids. This is where it becomes really important to see the right people- to make sure that your baby is otherwise healthy, and has just moved onto a different growth curve, which is completely valid. The numbers are taken into account because no one wants to miss a kid who has short gut syndrome or severe reflux, or has a vitamin deficiency due to a genetic disorder (there are the rare outliers).
I would seriously advise you to ask for a consult with a pediatric dietician who can help you work with where you are and maximize what your baby is eating during the day and maybe help you offer the right combination of foods. Its not just fats- which are GREAT- and you want a good proportion of them- but you also want proteins and iron-rich food sources, and fiber and vitamin-c— if you go too heavy on fats, it might fill them up before they get some of the other foods they need (like protein-dense foods and iron or vitamin C-rich foods which are also really important). Or it could just be that your baby is settling into a slower growth curve and there is NOTHING wrong at all.
Never feel pressured to wean, particularly before a year. Seek out other opinons and seek out experts in feeding. Sometimes that involves a team with a speech language pathologist (SLP) because they can be experts with feeding as well, but also a registered dietician who specializes in babies. It is game changing.
I’m so sorry for all of the stress you’re going through- just know that you are NOT doing anything wrong, listen to your instincts, but also be open to experts who might be able to help you find the best way to get your baby ideal nutrition while you continue to breastfeed. You’re doing great- trust your instincts— but don’t close the door on your medical team. That said- one person’s opinion ins NOT always the answer, especially when it is beyond their scope of practice.
My kid went on to use nursing as main source of nutrition into his second year and pediatrician said that’s fine as long as he was willingly exploring texture be flavor (in our case he was just struggling with teething a ton).