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On Breastfeeding and Growth Charts

November 22, 2009

Last week, I posted an item about my baby’s seeming diagnosis of Failure to Thrive (FTT). The dietitian was adamant that I should stop nursing, give her 3 bottles of formula a day, etc, etc.

After talking this over with my husband (the most vociferous male supporter of nursing I’ve ever come across), I decided to check the facts once again. Here is what I found.

The Israeli Ministry of Health uses growth charts developed by the US Center for Disease Control  (CDC) in 2000. These charts were developed following observations of both breastfed and formula-fed babies. Based on these charts, my baby, who was born in the 25th percentile, dropped to the 3rd percentile by the age of one (this means that she weighs less than 97% of babies of her age).

However, in 2006 the World Health Organization (WHO) introduced new charts, reflecting the suggested development of breastfed babies. More recently, UK health authorities used WHO data to develop their own charts for nursing babies. The revised charts show that breastfed babies tend to gain weight fast in the early months, then taper off in their growth.

On WHO’s charts, my baby is in the 15th percentile, gaining significantly after her dip at the age of 6 months. Combine that with her steady growth in height and normal development and the picture becomes all that less worrisome.

What I’d like to know is how is it possible for a pediatric dietitian not to be aware of this information released over three years ago and widely available in both English and Hebrew. Furthermore, even if the Ministry of Health doesn’t deem it necessary to update the charts the way the Brits have done, why doesn’t it, at the very least, inform practitioners (including Mother and Child  Care – Tipat Chalav nurses) of these new standards?

As for us, we’ll continue to monitor our daughter’s growth. I have another appointment with the dietitian next month with printed charts ready and waiting for her perusal.

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10 Comments leave one →
  1. November 22, 2009 4:58 am

    The answer to your question is yes.

    I also wanted to mention that it’s normal for children to drop or gain in percentile between 6 and 12 months. In the early months, they follow the percentile of their birth weight more or less. After 6 months they switch to the percentile they are more likely to be as adults, i.e. their genetic predisposition is more significant. It happened to my daughter, born at almost 4kg. and dropped off the charts. She was under observation until a couple of years ago, she caught up in height at puberty (just like her mother).

    • Leah permalink*
      November 22, 2009 7:58 pm

      @MIL – Thank you for your comments. As always, you have troves of experience in this. I didn’t know the percentile kids reach by the end of their first years, sticks around for life. Interesting.

  2. Rainy permalink
    November 22, 2009 9:02 am

    Somewhat new reader/lurker here, found you via a kosher carnival I think… I just wanted to say, it is totally possible for a health professional to be unaware of new research or guidelines, especially if they aren’t keeping up on journal articles or if the licensing board that governs them doesn’t require CEUs. Or possibly the dietitian in question went to school a long time ago? Guidelines change all the time, but it isn’t unusual for someone who has been practicing for a long time, coming from an “old school” mindset (in any healthcare field) to be somewhat resistant to new guidelines and ideas that are at odds with what they were taught.

    It is NEVER a bad thing to get a second (or third) opinion and do some research. Especially when the advice seems so totally counterintuitive – I’m gobsmacked that someone told you to wean your baby and put her on formula and a 4 hour feeding schedule for FTT, especially if she has known allergies. Breastfed babies, as you have discovered, have their own growth charts. Seems like you are covering all your bases by keeping an eye on it with your healthcare professionals, doing your research and continuing to nourish your child in the way you feel is best.

    Chiming in with an opinion here because I’m a student nurse/lactation consultant and so this post caught my attention. I wish you guys well, good luck with all this, and good health.

    • Leah permalink*
      November 22, 2009 8:01 pm

      Rainy, Thank you for stopping by and for your warm wishes. I remember reading somewhere that nowadays health professionals need to read two articles EACH DAY to stay updated. That is a tall order. Still, they must follow the trends. Otherwise, what’s the purpose of research.

  3. November 22, 2009 7:18 pm

    See you’d think the new charts would have made it into the child health records by now. My 4 wk old is being weighed against the 1996 charts, where as even my 2 yr old was plotted on a breatsfed babies chart. Ridiculous if you ask me!

    • Leah permalink*
      November 22, 2009 8:02 pm

      Jo, Congrats on your baby. i have never even heard of 1996 charts, though some of my kids were born before 2000 and were probably plotted on these.

  4. keren permalink
    November 29, 2009 6:39 pm

    The problem is also that Isreali baby health clinics advocate a diet that is likely to make a baby lose weight, and then encourage them to stop nrusing.
    From the age of 6 months they tell you to cut feeds and add the sorts of foods that you and I would eat when we are on a diet, fruit and veg, carrot, courgettes, apples and oranges! who wouldn’t lose weight, when eating this instead of Mother’s milk!

    • Leah permalink*
      November 29, 2009 7:14 pm

      Good point Keren. In the 13 years since the birth of my eldest daughter, they’ve changed the feeding guidelines at least 3 times. It seems, every time I bring a new baby to the clinic, they pull a new bunny out of the hat.

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