How Come Doctor Says Baby Gaining Ok but He's Going Lower Percentile

My baby isn't gaining weight as fast as he was. Should I be worried?

Probably not, but it's a good idea to keep an eye on your baby's growth chart. Remember that while your baby should gain weight steadily – with the exception of her first few days, when she may even lose a bit before quickly catching up – it won't always be a perfectly smooth climb.

Your baby's growth rate will speed up and slow down. It may even stop temporarily – when she's ill, for example. But overall you should see the ounces and pounds piling on.

If you're at all concerned that your baby isn't gaining enough weight, talk with her doctor right away.

What will the doctor do?

The doctor will give your baby a physical exam and ask you a number of questions to help determine whether there's a problem, and, if so, what the underlying cause might be. She'll look at many factors in addition to your baby's growth rate to assess how he's doing.

If your baby is hitting his developmental milestones pretty much on time, relating well to you, and looking otherwise happy and healthy, he's most likely doing fine.

If the doctor finds that your baby isn't growing at a healthy rate, however, she may diagnose him with "failure to gain weight" or "failure to thrive." The criteria she'll use to make this diagnosis may include:

• falling below the third percentile for weight on his growth chart
• weighing 20 percent below the ideal weight for his height
• a decrease of two or more major percentile lines on his growth chart since his last checkup

By the way, while failure to gain weight can happen to any baby, premature babies are at a higher risk than full-term babies.

If your baby has failure to gain weight, it's very important to find out why. Proper nutrition – especially during the first three years – is crucial for a child's mental and physical development.

Your baby's doctor may order blood, urine, or other tests and monitor your baby's caloric intake for a period of time. She may also watch you nurse or bottle-feed to see whether your baby's jaw is working correctly or whether he's having trouble sucking. Sometimes the answer is very simple, and sometimes it's quite complicated.

The doctor may refer your baby to a pediatric gastroenterologist, a dietitian, or a feeding specialist for evaluation and treatment.

This can be a worrisome and frustrating time. It can be difficult to hear that your baby isn't thriving, but it's important that you don't blame yourself or feel like you're not a good or nurturing parent.

What could be causing my baby's failure to gain weight?

There are so many potential causes that a doctor could spend months performing tests and studying a baby's diet, health history, activity level, and possible causes of stress before discovering the source of the problem.

In general, if your baby isn't growing steadily, it means that she's either not eating well or not absorbing or using nutrients properly. Here are some reasons this might happen:

Feeding problems:

• Your baby may be repeatedly getting tired and falling asleep before he gets enough milk.
• She may have a weak sucking reflex that leaves her unable to get enough milk from your breasts if you're nursing – or even from a bottle, although this occurs more commonly with breastfeeding.
• A cleft lip or palate would interfere with breastfeeding. These conditions are addressed with special bottles and nipples and the help of feeding specialists. (A cleft lip and palate are usually repaired over the course of a baby's first year.)
• Being tongue-tied could make it difficult for your baby to nurse well and get all the nourishment she needs. It can also affect bottle feeding, though that's less common.
• If you're feeding your baby formula, preparing the formula incorrectly can lead to failure to gain weight.
• If you're nursing and you've had trouble getting a breastfeeding routine going, your baby may not be getting enough to eat. It's possible that your breasts are not producing enough milk to sustain your baby or that your hindmilk isn't letting down.
  A third of your breast milk is known as foremilk, which is readily available for your baby. When you start to nurse, your body instinctively releases the hormone oxytocin, which stimulates the flow of the rest of your milk, the hindmilk. This is known as the letdown reflex, and you'll know it's happened if your nipples feel tingly or your breast milk spurts. Hindmilk has more calories than foremilk.
  If you're stressed out or in pain, the letdown reflex can fail to kick in, preventing your baby from getting hindmilk. When this is a chronic problem, it can result in failure to gain weight. To encourage the letdown reflex, try to find a relaxing place to nurse.
• Some babies who are fed on a strict schedule rather than on demand (whenever they indicate that they're hungry) can get less nutrition than they need. Most experts believe that it's best to let your baby nurse or bottle-feed for as long as he wants when he wants.

Other common causes:

• If your baby has been ill, his body may need more calories and nutrients. An illness may also hurt your baby's appetite.
• He may have chronic gastrointestinal problems such as diarrhea, reflux, celiac disease, or a milk intolerance.
• If you have postpartum depression or several other young children vying for your attention, you may be unable to give your baby the attention he needs to be sure he's getting enough calories.

In rare cases, failure to gain weight can turn out to be a result of a lung problem, such as cystic fibrosis; a nervous system problem, such as cerebral palsy; a chromosome problem, such as Down syndrome; heart disease; anemia; or a metabolic or an endocrine disorder, such as growth hormone deficiency. If any of these is the cause, it's important to catch it early.

How does a doctor treat failure to gain weight?

Once you and your doctor figure out what's causing the problem, you can both set about correcting it by treating any medical issues and increasing your baby's caloric intake, if necessary.

Getting your baby back up to a healthy weight may mean supplementing breastfeeding with formula or, for a baby who has started on solids, offering more high-calorie foods. Once she's old enough for them, good choices include whole milk products such as cheese, cottage cheese, yogurt, ice cream, and pudding (but hold off on offering cows' milk until age 1), eggs, avocados, whole-wheat breads and pastas, pancakes, mashed potatoes, and hot cereals.

In severe cases, a baby with failure to gain weight may need to be hospitalized so that she can receive intravenous feedings and be monitored closely.

I'm new to nursing. How can I tell whether my baby is getting enough to eat?

If your baby's younger than 3 months old and you're breastfeeding him exclusively, you'll know he's getting enough milk if:

• He wets six to eight cloth diapers, or five to six disposable diapers a day.
• He has several mustard-colored bowel movements a day for the first month. After the first month, he may have bowel movements less frequently or even skip a day or two in between.
• When he's nursing, you can see him moving his jaw and hear him sucking. You may even hear him swallowing, if the room is quiet.
• Your breasts feel softer after a feeding than they did before.
• He's gaining about an ounce each day for his first three months. (After that, doctors look for a gain of about 0.5 to 0.6 ounces a day until 6 months, 0.4 ounces a day for babies between 6 and 9 months, and 0.3 to 0.4 ounces a day for babies from 9 to 12 months.
• For other suggestions, read more about how to tell if your baby's getting enough milk.

If your baby tends to get sleepy during feedings, keep him alert during feedings. You can try:

• gently tickling his feet
• undressing him
• changing his diaper before or in the midst of a feeding
• engaging him in some quiet play
• sitting him upright to burp him when you're switching from one breast to the other

If he doesn't finish nursing on both sides, empty your breasts by pumping so you can keep your milk production up.

If you're concerned about your baby's weight or food consumption between regularly scheduled checkups, ask to bring your baby to the office to be weighed once a week. For accuracy, make sure you always use the same scale. You can also get a scale to use at home. Medela rents accurate baby scales for home use. Call (800) 435-8316 (option 3) for information.

While breastfeeding doesn't always turn out to be the best option for all moms and babies, don't assume that you should switch to formula because you're having some problems. Ask your doctor for advice and perhaps a referral to a lactation consultant.

There are things you can do to increase your milk supply, for example, and tips that may help you help your baby nurse more efficiently. You may well be able to resolve the issues without giving up breastfeeding before you intend to.

Does failure to gain weight mean that my child will always be smaller than he should be?

That depends on the underlying cause of her poor weight gain. If your baby has a long-term medical condition, for example, it's possible that she may always be smaller than average. On the other hand, if the problem is easily reversed, she may catch up by growing faster than usual for a period of time.

How Come Doctor Says Baby Gaining Ok but He's Going Lower Percentile

Source: https://www.babycenter.com/health/illness-and-infection/failure-to-gain-weight-in-babies_1621

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