One big parenting frustration we have had since our son was about 9 months has been his weight. He has always been small, as in right around the 5th percentile. But at his 9 month appointment, he fell below that. Actually, considerably below that. Of course, as a mom I freaked out! The doctor even mentioned the words “failure to thrive” which made me so scared! I felt out of control, so I started doing more online research into the difference in growth between breastfed and formula-fed babies. And I wish I had done it sooner! The buddy was not exclusively breastmilk fed anymore (like he was for pretty much the first 6 months of his life, wahoo!), but up until he was 9 months old he had at least 3/4 breastmilk and 1/4 formula, which is still pretty miraculous considering the fact that I have never produced a single ounce! 
When you look at babies in the US, in 2008 fewer than 50% of babies were breastfed at all after 6 months, and by 9 months that number was around 30%. And only 18% of babies were breastfed exclusively up until 6 months. Even at 1 week, the number of exclusively breastfed babies is just slightly above 1%. So, the buddy had been getting way more breastmilk than the average American baby! (All of this fascinating information came from this article on Kellymom.com. Check it out! There are tons of charts and graphs and it’s so interesting!!)
This got me interested in seeing if I could find a growth chart that was based more on babies fed breastmilk and so I looked at the WHO (World Health Organization) growth chart information. Apparently most babies around the world are breastfed, so this chart is supposed to be used for breasfeeding babies in the US up until 2 years of age. I had to convert all of the buddy’s weights from lbs. to kgs., but I’m pretty confident that our pediatrician used the CDC chart (based on all American babies) instead of WHO because when I plotted Little Piñata’s weight along THIS growth chart, he pretty much followed the 3rd percentile the whole way, especially after he reached one month.
Sure, he’s still little, but I am frustrated that our pediatrician, who knows that he’s given 1/2-3/4 breastmilk would use a chart where the vast majority of babies are given all formula by his age. Formula has more calories, so of course babies on formula would not only weigh more than he does, but also grow faster!
I tried not to stress out about it and just tried to get our sweet, happy baby to eat more. I attempted to show this information to the doctor at his weight check 2 weeks later (and again at his 12 month appointment), but she didn’t seem to care.
Why did I have to find this information myself? And why don’t doctors use the WHO chart for breastfed babies? Sadly, the answer I discovered is that most pediatricians use the old CDC chart because it’s the chart that comes with the computer program they purchase. And that most pediatricians aren’t trained much in infant/toddler nutrition and are also up-to-date in their knowledge of growth charts.
Thankfully, at 13 months we have found a pediatrician we’re comfortable with and that didn’t stress us out about Little Piñata’s weight. But, it’s a good reminder to be your child’s advocate and to do your own research if what the doctor is saying just doesn’t sit right with you. I’m so glad we didn’t just start filling him with empty calories and stuck to feeding him whole foods! He may never leave the 3rd-5th percentile, but if he’s healthy, happy and developing well, then we’re happy too.
WHO Growth Charts
More on difference in growth between breastmilk-fed and formula-fed babies
Did you have a smaller baby and have weight gain concerns with your little one?
Growth Charts part 2 of 2
1. Baby Growth: It’s Not a Contest by Mrs. Yoyo2. Growth Charts by Mrs. Pinata
GOLD / nectarine / 2884 posts
I needed to read this today. We have had weight gain issues and today my paranoia was rearing its ugly head again. Two more months until I can introduce milk! I’m counting down the days…! Not intending to wean right off, but will be glad to have another fat source at my disposal.
blogger / nectarine / 2010 posts
We used a couple of different growth charts too since Little M fell below the 5th after 6 months. He was EBF until 6m and then mostly BF with some solids until 1 (he’s still BFing but gets mostly solids now.) Thankfully our pediatrician didn’t bat an eyelash at the declining percentiles. But she did make note of the fact that between 16-18 months he went from the 2nd to the 15th percentile! And she attributed it to his finally taking longer naps – not anything to do with food. Who knew!?
pomelo / 5628 posts
The WHO chart is definitely supposed to be the standard. I think my ped uses it. Unfortunately my baby is still way below on that one too!
They definitely have WHO charts with pounds too!
cherry / 206 posts
I really loved this post, thank you! My EBF DS was 14.4 lbs at 4 months and now at almost 1 year is only 16.2 lbs. He definitely has fallen way off the chart, even when looking at WHO. He’s eating quite a bit of solids and BF 5x a day still. The doctor is concerned but at each appointment, he is slowing a tiny gain which she sees as a positive. I, myself, was never on the growth carts. I only weighed 15 lbs at 1 year. I know genes aren’t in his favor for height or weight but would still like to see him growing at a better rate. We have our 1 year appt in a few weeks so we’ll see how that goes.
kiwi / 549 posts
Our pediatrician, and apparently all the doctors in our insurance system (GroupHealth), use the WHO charts; hopefully that becomes more widespread. X is still in the 5th percentile for height/weigh on the WHO charts,, but at 19 months I’ve [mostly] stopped worrying. And his pediatrician was never concerned, though there was a point where they should have been– but that’s a different story. Anyway, glad your LO is staying on the curve and just fine.
nectarine / 2667 posts
Thanks for this! I’ve been worried about my 9 month old’s weight/eating & took him to see the pediatrician. She said he was in the 50% and not to worry, but when I looked up the chart online he was in the teens. But the WHO chart has him closer to 50%, so maybe that’s what she used? She knows he gets mostly breast milk, plus some solids. I
her.
pomelo / 5866 posts
My daughter was born in the 75% percentile and kept dropping by 25% brackets until she was 1% around 1 year old. She was officially labeled Failure to Thrive but the doctor could see her own personal (miniscule) growth pattern developing and didn’t sound the alarms –She was so happy, active and their were no medical issues aside from colds. There were periods where I struggled finding a balance on whether to feed her healthy or fatty foods. Then when she went through her toddler picky period, I worried a little more…bento city! I was just relieved in her 12-24 month period where she inched up slowly between 1-5%. I was still part-time (often-time) breastfed all the way until 2 years old so I’m positive that had a lot to do with it.
coconut / 8305 posts
THANK YOU for posting this!
P has ALWAYS been small (under 3% at birth for head & weight when considering her gestational age) and our pedi not only used the CDC chart (despite the CDC saying not to use it until age 2) but we ultimate got “fired” b/c I didn’t accept his “failure to thrive” since by the WHO charts she was still following her curve. (low on the % but holding steady)
I found it incredibly saddening that our pedi never considered P’s gestational age when plotting her birth weight and even moreso that he used out dated info. To make it worse, when he began getting pushy about solids & I told him I simply couldn’t get her to eat them (she still had the tongue thrust reflex) he couldn’t give me any tips other than “nurse her less… if she’s hungry she’ll eat) and also couldn’t give me any info on what foods would have more calories than breastmilk (I found out myself that would be only avocados & sweet potatoes), rather he told us to feed her baby cereal knowing she was soy & wheat intolerant.
We’re looking at a pedi out of town (2 1/2 hours away) that we’ve heard great things about in regards to being supportive of breastfeeding and up to date with infant nutrition. Fx that it goes well!
Thanks again for sharing your journey & I look forward to a post about all that breastmilk that bebe had!
pea / 8 posts
Thank you! My little girl is 5 months and has slowly been making her way down (25% at birth down to 5% currently). She is almost exclusively breastfed with a little formula. My doctor told us not to worry but since I love stressing out, I’m now worried all the time that I’m not making enough milk for her. I can see that she is a healthy happy baby but it’s hard seeing her not match the “standard” of a healthy baby.
blogger / pear / 1563 posts
@Mrs. Sketchbook- I DO think that adding in milk can really help, especially if they like it!
@Mrs. Stroller- That’s so interesting about the longer naps! I’m hoping that he takes a jump up at his 15 month apt. but I DO have to remind myself that higher percentages don’t equal healthier. But, I suppose it would put my “mama” heart more at ease to have him out of that 3rd percentile area.
@Mrs. Green Grass- YES! I’ve found some WHO charts since that have it in pounds. I’m so glad you and many others have pedis that use the WHO chart! It’s so strange to me that it’s “supposed” to be used, but EVERY Dr. that we called in our area still uses CDC. Maybe we just live in a backwards place.
@CHAI728 I think that’s really good to remind the Dr. that you were little at that age and that you turned out healthy! Once I shared this issue with people I was amazed at how many others have struggled with the same thing and I realize that maybe we’re just not using growth charts in the way that we should and are allowing too much stress to be associated with them!
blogger / pear / 1563 posts
@RED_SEATTLE- Glad to hear your insurance and pedi use the WHO chart! I bet that is part to do that you’re in Seattle! They’re much more on top of things out there (IMO).
I’m curious to hear when the Dr. SHOULD have been concerned. We have done a lot of blood tests to be sure DS isn’t gluten intolerant or anemic or anything.
@MEWTILL – I bet your Dr. must use the WHO chart! They’re kind of hard to find online because the CDC is so much more widely used.
@808LOVE – You know, I think it’s SO good for kiddos to get breastmilk for as long as possible! Of course that’s not always possible, but when you can, I say that’s better than trying to get your child to a particular place on a chart for sure.
@RUNSYELLOWLITES Ack! That sounds SOO stressful! We also got VERY frustrated that the only advice our pedi gave us to get DS to gain weight was to give him baby cereal. But, when we looked, foods like avocado, liver, cheese, meat, coconut oil, etc. all had WAY more calories than adding oatmeal to a meal! Even breastmilk has more calories.
It’s frustrating because then it makes you doubt OTHER things your pediatrician tells you to do too!
I hope you get into the clinic that’s further away. 2.5 hours is a LONG way, but I think if it puts your mind at ease and is a Dr. that you trust, it will be so worth it in the long run! It took us about 4 months and a new Dr. coming into their practice, but we FINALLY got into the family practice we wanted to bring our son to.
@CRAFTYMAMA I wonder if you checked the WHO charts if it would be different. We ALL obviously want what’s best for our LO’s, so when Drs. stress out, all we do is stress out, which is likely not great for the baby anyway!
guest
My baby was mostly formula fed, and high on the charts, so I didn’t deal with this, but my (online) friend Ashlee did. Here is her post, which is similar to yours: http://wheremyheartresides.com/2013/02/09/growth-charts-be-gone/
grapefruit / 4923 posts
that’s so frustrating. no easier way to make a parent freak out than talk about “failure to thrive” and low weight gain, when the baby is being compared to others on a different diet!
blogger / pear / 1563 posts
@Kelsey Thanks for sharing that! I actually read that post right at the time this happened and it was so encouraging.
@Edelweiss Thanks! You’re right… SO frustrating!! I think even when your child is on the same growth curve, but a low one, it makes you nervous enough already, but a Dr. mentioning FTT just gives you even MORE stress!
GOLD / wonderful grape / 20289 posts
I have the opposite problem. LO is a big girl and eats a lot…. I have been known to ask my doctor if she’s gaining too much.
blogger / pear / 1563 posts
@Artbee Ha! So interesting! Has the Dr. given you a hard time about it? Because of our situation I wonder if Dr.’s worry about kids above the growth chart like they do with babies under the growth chart.
blogger / persimmon / 1398 posts
Mini Michelangelo was (is!) teeny tiny compared to the charts. (I’m pretty sure he’s not even on the chart at 5) so I can feel your pain here. But luckily we had a pediatrician who took a very different view point on it, and calmed my internal freak outs instead of exacerbating them!
blogger / pear / 1563 posts
@Mrs. Paintbrush… YES! Hear, hear for all the little ones out there not on the charts, but healthy and happy as can be.