Infant Weight Loss: What to Do When the Doctor Says Your Baby Isn’t Gaining Weight with Rosan Meyer, PhD, RD

Katie Ferraro (0s):

Checking in about CPR. Have you taken your Infant refresher CPR course yet? Great idea If you're just starting solid foods, because there's no higher risk of choking with BLW compared to spoon feeding, but choking is still a very rare, but real risk and knowing CPR can help save your baby's life. So I'm always a stickler that anyone helps feed or watch my baby has to know CPR too. I know you guys all took CPR, but that was like before your baby was born six months ago, it might be time to brush up on your skills. So there's this online CPR course that I take each quarter and I recommend it for anyone else who's starting solid foods soon. The online CPR course super affordable. It's like less than 50 bucks, but my affiliate discount code Katie 10 will take an additional $10 off that course. So if you head to the site bit.lee/onlinecpr course, you can register the code.

Katie Ferraro (45s):

Katie 10 takes the extra $10 off. Good luck getting your CPR skills up to snuff. And once again, that website is bit.lee/onlinecpr course. And the $10 discount code is Katie 10.

Rosan Meyer (59s):

If we create anxiety with our healthcare advice, that actually is counterintuitive and it can actually lead to more pressured mealtime pattern. What we don't want is that there's a more forceful approach to, gosh, my child is not eating. So I'm going to force more of these energy dense foods because I feel the pressure.

Katie Ferraro (1m 18s):

Hey there, I'm Katie Ferraro, Registered dietitian, college nutrition professor and mom of seven specializing in Baby-Led Weaning here on the Baby-Led Weaning Made Easy podcast. I help you strip out all of the noise and nonsense about feeding, leaving you with the confidence and knowledge you need to give your baby a safe start to solid foods using Baby-Led Weaning. What do I do if my baby is losing weight after we started solid foods? I recently got an email from a mom named Maria B who had a similar situation. And it made me think of my friend and colleague Rosan Meyer, who specializes in growth, faltering and Infant growth.

Katie Ferraro (2m 1s):

And I was like, I gotta get her take on this mom's situation. So in today's episode, we're gonna learn a little bit about Infant weight Loss. And what do you do when your doctor says your baby's not gaining weight? So Rosan Meyer is a pediatric dietitian. She is originally from South Africa, but she practices in the United Kingdom. She specializes in food allergies, feeding difficulties, nutritional support, and faltering growth. She's a researcher having published lots of articles on pediatric nutrition and allergy feeding difficulties. And I always go to Rosan when I have questions about what we formally called failure to thrive or growth faltering or issues related to growth and development, especially regarding growth charts, because she does a lot of data and a lot of research in that area.

Katie Ferraro (2m 49s):

So she was previously on the podcast. And so this is a really important episode. It's actually one of our most downloaded episode with Rosan. It was episode number 110, Catch Up Weight: Why Starting Solids Early Will Not Help Your Baby Gain Weight with Rosan Meyer. So if you are exploring or looking into this idea of catch up weight, it is imperative that you listen to that episode. First that's episode 110 today, we're talking a little bit more just about general Infant Weight Loss. If you have a dip and you're going in the wrong direction during the transition to solid foods, what can you do. This episode and interview is a little bit on the longer side, but there was like when I went back and listened to it, there was absolutely nothing I could cut because it's all pure gold.

Katie Ferraro (3m 30s):

I feel like especially every master's level nutrition student and dietitian, pediatric dietitian should be listening to this because these are really real situations that happen in the doctor's office. And oftentimes we are relying too much on the clinical data and not enough on our gut instincts as parents and practitioners. So with no further adieu, I want to introduce Rosan Meyer talking about Infant Weight Loss. And what do you do when the doctor says your baby is not Gaining weight.

Rosan Meyer (3m 57s):

Thank you having me, Katie. It's always a pleasure. And you always pick a topic that I'm very passionate about. So I'm looking forward to having this discussion. Well,

Katie Ferraro (4m 6s):

I get these email from parents and I'm like, well, I don't know the answer, but I know who does. Maybe you you'll come back on the podcast. So I've shared your background a bit about the previous episode we did on Catch Up Weight. And that was in the intro to this episode. So our audience is familiar with your work, but just curious to know, catch us up. What sort of projects are you working on right now that you are most excited about?

Rosan Meyer (4m 24s):

Oh my goodness. Katie. So it's boring in that sense, I'm still doing a lot of the growth studies. I'm still doing migrating more into the allergy side. I'm doing a fantastic fpie, a food protein induced enterocolitis syndrome project at the moment, looking at the interaction between feeding difficulties and also growth and just done a little bit more in terms of a systematic review on feeding and growth. So all of that is supposed to be published soon, but yeah, that's my new work, but it's still in the same trajectory that I did in the past.

Katie Ferraro (4m 57s):

Well, we had Marion Groetch on the podcast recently teaching about fpies, which was great. We wanted to wait a really, really, really long time before we covered that topic because it's every parent who has a baby who vomits, they immediately think it's fpies. And so we wanted to make sure we had like the right context there. So I'm interested to see what you guys cover up within that area. But today we're here to talk about Infant, Weight Loss and parents and caregivers have a lot of, you know, understandably anxiety about this topic. And that's, you know, whether the weight loss in their baby is real or perceived. So there was one email I just got recently from a mom. It stood out to me and then I had forwarded her email to you asking if you would come on the podcast and talk about it. So if it's okay, I'm just gonna read this mom's first email. And then we're gonna break down the individual parts of her concerns.

Katie Ferraro (5m 39s):

The email is from a mom named Maria B and she said, Katie, I had my daughter's nine month appointment and found out that she lost a bit of weight between appointments rather than gaining. We've been doing baby-led weaning religiously. We're at two to three meals a day in up to 73 different foods now, and I am nursing. Is there anything you can recommend having them check could an Iron deficiency have caused the weight loss? Are there any recommended foods I should add to gain weight quickly? They're checking for a UTI. So a urinary tra infection and I'll have the lab result in the next couple of days. Her pediatrician mentioned that if it comes back as a UTI that might have caused the weight loss, mom says, I just wanna get her back on the right track and help her put some weight back on with some calorie dense foods.

Katie Ferraro (6m 21s):

So my first question Rosan is about the nine month appointment and the quote from the mom. She lost a bit of weight between appointments rather than gaining. Of course we don't expect growth to go down between appointments, but just, you know, top of mind, what do you think could be going on here?

Rosan Meyer (6m 37s):

So, okay. It's great to break it down. So she said I lost a bit of weight and, and the first thing I, I did discuss it in our previous podcast, that weight gain is not necessarily, you know, a straight line. So the question is, did she lose weight in terms of weight or did her growth percentile come down? Because I think those are two different things. If there was just the, the growth center, we had a slight dip, I wanna say it's perfectly normal. You can get slight dips in particular if activity changes and, and that's, she didn't share the developmental stage. Her child is by eight, nine months. Some of the children that become are really very good sitting up and starting to roll in all of those things.

Rosan Meyer (7m 18s):

So you do often get an activity boost around that period of time. Then the next aspect is, of course, she's on baby-led Weaning. And it sounds like she's following your program. And I know your program is great with energy dense foodsi with proteins. You bring them in so actively because you're so aware of the Iron, you ring it and also foods that have got good fats and things like that. So I'm assuming that is going, but I think the breastfeeding rate can be looked at and seen what is her regime in terms of daytime, nighttime feeding? Is there any feeds that need to be improved? So I think there are lots of aspects to take into account.

Rosan Meyer (7m 59s):

So I normally break it out. What is a bit of weight loss? Is it just a small drop can be quite normal, is where are we with the activity range? Because of course energy expenditure can change. And thirdly, we can look at the solid food intake, which I'm sure is fine, but also at the breastfeeding that she's having vitamin and minerals can also be involved. So critical vitamins and minerals, zinc, iron, vitamin D you know that as a dietitian, but if dietary intake is optimal, you've got vitamins, vitamin D in particular, then it's often rare. It's normally not weight loss with zinc, but it's length growth that is affected.

Katie Ferraro (8m 36s):

And then mom asked, is there anything you can recommend having them checked? So she questioned maybe an iron deficiency or a urinary tract infection again, without knowing more about the baby's medical history, Rosan, what are some common underlying causes of weight loss of this nature in a nine month old?

Rosan Meyer (8m 52s):

So iron deficiency is one of them. It doesn't sound like it. Zinc, as I already said, we don't normally see the weight loss. It's more, if she came back saying length, I would definitely look at length, illness as stool, frequency and consistency. You know, I think she didn't talk about that. She talked only about her UTI. Yes. Any inflammatory response can lead to weight loss at this age, but I think she would've mentioned if there was diarrhea or as an inflammatory cause, but otherwise, as I said already, it's really your activity and an imbalance within macronutrients. So energy, protein, carbohydrates that that can lead to an acute weight loss,

Katie Ferraro (9m 32s):

If it even is real weight loss. And we're gonna talk about inaccuracies in data gathering.

Rosan Meyer (9m 37s):

Exactly that again, okay. Here. I want to reinforce here, you know, if you crossing lines properly, that's a different situation where if it was just, like I said, a little bit of a dip that really, I normally kind of do my basics, but then let them come back. Because most of the time you see them kind of catching up again.

Katie Ferraro (9m 58s):

And an interesting thing too, with parents is like, sometimes you question yourself like this mom said, you know, looking for all these things that might be wrong, but I always remind parents that you actually know your baby best. And so if your nine month old is wearing nine month old clothes, and last month was wearing six month old clothes and the clothes are fitting, as you would expect. I said, that's actually a good indicator of growth. If all of a sudden the clothes that used to fit her are now baggy. Oh my gosh. Well maybe something's different. Same thing with the diaper size. Wow. These diapers, you know, she's not going up in diaper size anymore. And just paying attention to the little cues that they don't have to be super clinical is it doesn't sound even from the initial email like that, mom was super worried about growth herself because things like a UTI. If your baby has a UTI, you are gonna know it.

Katie Ferraro (10m 40s):

You're the one watching the diapers every day. You're gonna smell it. If your baby has diarrhea, you're gonna know it. So even if you don't have a clinical background, I always advise parents to be an advocate for your baby. And if don't freak out, just cuz the doctor says, oh, they've lost a bit of weight. If you don't don't have other, you know, mom data points to back that up. Maybe we really do need to look at the data. And so any thoughts there about just using some nonclinical measurements to determine whether or not you think your baby really is losing weight?

Rosan Meyer (11m 7s):

A hundred percent. And you know, as you can hear from our accent that come from South Africa, you know, so we say to parents, your child does not develop a normally and does not achieve normal milestones. If you have a child that's not achieving the macro micronutrient intake. So you know, their iron deficiency, we've seen iron deficiency, honestly, for it to be so bad that it actually impacts on growth. You can see other aspects in regards to more lethargic. They're not as alert as normally. So that's why I'm saying yes, iron is, but from what she's writing, there's writing there's no indication that, oh my gosh, my child is not doing those things, but the visualization is extremely important.

Rosan Meyer (11m 53s):

Then the clothing within Europe, we have clothing ranges that are really good in terms of ages. We have clothing ranges, 50 Pitter Patter, for example, in France, we know that they're absolutely too small. And so we know you need to be advanced, but Marks and Spencer has got great. So I think having your clothing ranges changes is great. Looking at the coloration also of your child and then the other really important aspect of how is my child is my child happy is my child actually grizzly the whole day? Which means I'm not achieving. I'm not getting enough sleep. I'm not getting the right nutrients. You're right. That is so important. And I think we, and I include myself.

Rosan Meyer (12m 33s):

We often over clinical do and look at the gross child and just expect there's always supposed to be weight gain, but there's not always exact weight gain.

Katie Ferraro (12m 43s):

When you say the coloration of the child, what do you mean?

Rosan Meyer (12m 45s):

So for example, is my child rosy and is my, has my child always been rosy, but now my child is extremely pale and the complexion just looks ashy. You know, you can parents again, trust your instinct. If my child does not look well, has my child outside of looking pale dark circles under the eyes and just does not look quite right. If you use a example of a UTI, you know, outside of the, the smell of the urine, these two don't feel well, you can often see that they've got a mild temperature. So I think here again, you know, Katie, you know, as a parent, you look at a child going, you really don't look, well, I know how you looked 10 days ago.

Rosan Meyer (13m 27s):

This is not right. And that's again, going back to what is a parental instinct and I really trust parental instinct.

Katie Ferraro (13m 35s):

This is not clinical at all, but my kids always smell weird when they're getting sick. Like I'm not super like into, like, I don't have a very good sense of smell I would say, but I can tell you the day before a kid gets sick, cuz they smell funky. I'm like, oh crap, it's coming. So again, those things you kind of just know instinctively and I love your yeah, yeah. It's unique. And not that pleasant smell!

Rosan Meyer (13m 55s):

You know, I have parents that say to me, Johnny has got, you know, he starts looking, you know, really pasty around the eyes. I know by tomorrow we'll have a slight fever, and then we will have the cough.

Katie Ferraro (14m 7s):

Yep. So another part of the moms question, very typical. She said, are there any foods you recommend to add weight quickly? Again, baby's eating two to three meals a day. Nursing; baby's had 73 different foods. So at nine months of age would adding energy dense foods be an appropriate recommendation if there was like true documented growth faltering or do we wanna focus on fortifying the breast milk? I know we touched on this the last time we interviewed, but people always ask about those energy dense foods.

Rosan Meyer (14m 34s):

No, it's a great question. And I think I wanna go back to one of my previous podcasts that we did together just to say energy density does not mean high fat. Okay. So I just wanna come back to, what do we mean with energy dense energy dense for me always means it has a combination of protein and maybe some fat, but it's not just one aspect of a macronutrient because of course to do catch up. We want not just fat catch up. We want to have the lean muscle mass and we want also the gross added to that. So that's the first aspect. So looking at the energy dense food is just part of an air of the whole picture if at nine months.

Rosan Meyer (15m 15s):

And again, I don't know this child, but you would estimate that in this child, at least 50%, if I think of your 73, I know your lists, Katie, with 73 foods, you'd be thinking depending on their skills, we could look at around 50% from food and 50% from breast milk, unless this is a child, you know, that is really into more food. And you've seen those where if I've seen those that are still leaning more to breast milk. So that means we cannot just say, oh, food is everything we have to also say, in addition to your energy dense foods, which you've got on your baby-led weaning chance, we also need to think what is happening with the breast milk, because that is a critical part of the nutrients.

Rosan Meyer (15m 60s):

So I think the advice needs to come from both sides. And here, I like to use an individual approach. We know, talk about this case as a general, but we need to kind of, I talk about what is the frequency, what's the length of breastfeeding? How often does my, the child still like feeding? Is that effective breastfeed? Are they distracted during feeds? And the same for foods? Are they? Where are they? Although it's 73 foods that they're introducing, is it effective? It's still a lot adding, you know, falling onto the floor. So I think, I think it's a combination between the two

Katie Ferraro (16m 32s):

And mom also mentioned at the closing - I just wanna get her back on the right track, help her put some weight on. This is the part of the email that I think is so hard for me because this mom is doing everything right. She's offering a variety of food. She's giving her baby a lot of time to explore and learn how to eat. And the episode that Rosan is mentioning that we did previously, that was podcast episode 110, it was all about Catch Up Weight and was called "Why Starting Solids Early Will Not Help Your Baby Gain Weight" that's episode 110. So if you go to BLW podcast.com/110, there's a lot of good info in there. And Rosan shared all of these amazing growth chart resources and a lot of her team's resources for helping you to really determine your child's weight. So this whole idea of catch up weight.

Katie Ferraro (17m 12s):

We kind of talked about in that episode that if a baby doesn't know how to eat, it's a ludicrous recommendation to tell a parent, well, give them more food to help them with catch up weight. So we covered that. But for this mom, it kind of sounds like really textbook transition to solid foods during the weaning process. And yet the mom is worried about losing weight. Just, I know you kind of covered it, but in summary, what would you recommend to this mom like next steps if she was in your clinic, obviously you'd have real data if she was in your clinic. So it's a little bit of a, a hard question to answer

Rosan Meyer (17m 39s):

Katie, normally what I would do if we had real, what I would say for you to thrive, you know, really crossing percentiles, then I would give a very tangible plan in terms of saying which other foods is your child eating? And from the 73 foods, I would pick the foods that would be providing a more higher energy density. And secondly, I would also give a very clear plan in terms of breastfeeding and thinking, where can we fortify breast milk? And really supportive of that. The third and most important aspect for me is to reassure them. And I think that is, that is most, probably the most important part of this. If there was, if it was slight a slight dip, you know, then most probably my advice would not be so extensive because you could provide advice that over medicalizes a situation -that actually adds onto stress.

Rosan Meyer (18m 30s):

So I think this whole I'm concerned about the way to gain. I'm already doing all of this and you pointed it out. Every parent wants to do the best. And it sounds like she's doing already everything. I would therefore also really focus on reassurance. And I would normally put in a place what I call a touch base in about two to three weeks time where we do a reweight just because in many of them too, I see absolutely just that dip going up because it might have been, there was a stool just before, the way in, you know, and that that dip was just 300, 400 grams as a result of a very big nappy.

Rosan Meyer (19m 12s):

And so I think that for me is really important because one important aspect here is that if we create anxiety with our healthcare advice that is actually counterintuitive, and it can actually lead to more pressured mealtime pattern where your plan in terms of baby-led weaning, we really try to follow the child's pattern. We really like them to explore, and what we don't want is that there's a more forceful approach to, gosh, my child is not eating. So I'm going to actually force more of these energy dense foods because I feel the pressure.

Katie Ferraro (19m 47s):

You've taught us previously about the importance of accurate data in tracking growth. And so if the height measurement is somewhat offered, the scale being used hasn't been calibrated or the baby just had like a huge blow-out diaper, maybe weighed once with a diaper, and once without a diaper, all of these can lead to inaccurate measurements, which in turn unnecessarily stress parents out about weight loss. What can parents do to be advocates for good growth measurement in their doctor's office?

Rosan Meyer (20m 11s):

I think that's a great point. Nothing takes the parents' power away from looking at how the measurement is taken, number one. So we have shared, and Katie you've shared also that previous podcasts where I, I really talk about how a measurement should be taken. So you talk about advocating and I think there's nothing wrong to say, hang on a minute. I don't think, do you mind, can we redo this? Can you put my child back on the scale? Or I saw that, you know, the heel was not properly flexed or the knee was not pushed down properly, which can make a sense or two centimeters difference. Can we do that again?

Rosan Meyer (20m 51s):

I'm going to pick my baby up. I'm going to calm my baby down and also do not take an answer of, don't worry about taking off the nappy. No, you take off the nappy. Don't worry about taking off the socks. No, you do take off the socks. And also all of those small little details can mean really a drop of length of that amount. That can be a half a percentile drop. So it's those type of things. So what I would suggest is number one, educate yourself before you go for your appointment in terms of how a measure soon should be taken. Don't be scared to ask, can you repeat that? Don't be scared to say, can you actually, let me help you?

Rosan Meyer (21m 35s):

Because I've said this before, you cannot have just one person do a length measurement accurately. You need a partner. And the parents are ideal partners to help with the supine lengths there.

Katie Ferraro (21m 43s):

And that is so important because I encourage parents to just close your eyes and think about the last time you were in your doctor's office with your baby and how did they obtain your baby's height? It is in this country, I would say almost a hundred percent of the time, unless you're in a clinic setting, incredibly inaccurate, they don't use, you know, weight boards and there's not a solid plate underneath them. They're not always laying down. They'll, they'll have one year olds that they can stand up. They'll be doing standing up height as opposed to laying down. I mean, and we've talked about this too in the past is that it's very, very hard to nicely tell the office that everything they're doing is wrong. They're very, very busy and the way they get your baby's height is oftentimes a reflection of how busy they are. And there's never more than one person doing it. So that's a really important message.

Rosan Meyer (22m 25s):

It's really important. And you know, if I take this mom, one of the first questions, if a wait is dropped, is ask them, how was it done? Can you tell me a little bit about the equipment and something we might not have discussed in the past? Was, was it a digital scale or was it, you know, I still see the old I'm getting with my child. I still see that in the UK. I don't know if you have that - I get onto the scale with my child sometimes?

Katie Ferraro (22m 50s):

Okay. I don't see that, but my pediatricians often does not have digital scales. It's all the old school slide scale.

Rosan Meyer (22m 55s):

That makes me give me palpitations to be honest, because the truth is, if you look at the World Health Organization that are growth charts are based on digital scales. So, you know, those are very simple guidelines. So if I had an email like this from my mom and the feedback was, was a digital scale Rosan, and you know, it might have been that I still get that the, there was a light nappy on, I would say to them, actually, don't get too worried. Let's have that repeated, but you can just stop that pain by being a bit more proactive. And I know for parents, it is difficult, but as a healthcare professional myself, I would not be offended if somebody says, do that again.

Katie Ferraro (23m 35s):

For me, if you're nice about it. Exactly. And so this mom ended up, I followed up with the mom to see how things are going. So it's three weeks after she initially emailed us just to see, you know, did you get any results back from the UTI? And I wanted to kind kind of close the loop here for us for this interview. So mom wrote back asked, did you ask for a reweigh, I always tell parents, like the squeaky wheel gets the oil. I'm very nice about it and have a good relationship with my doctor's office. But I always ask for redraw, if the hemoglobin comes back low and half the time, it's not really low, they just need to redraw it. I always ask for reweigh, I always ask for re-measurement of height if they don't match the numbers that I did at home before I came. And so she was saying, mom wrote back, sadly, the scales were correct. I had them weigh her on two different scales. At that initial appointment, I took her to several lactation appointments in the past two weeks to see if that could potentially be an issue.

Katie Ferraro (24m 16s):

And we did weigh feeds. The lactation consultant thinks the pediatrician's advice at the six month appointment to stop all night feedings is what caused the weight drop. She said that pediatricians often look at baby nutrition as one size fits all. And they're just following the medical advice. And I was following the medical advice I received. And then as a result, my milk supply dropped. So she said the timeline fit, especially with her daughter eating three solid meals a day and having those calories to prevent further weight loss. And then mom followed up to say, baby gained one and a half pounds between the nine month appointment two weeks ago and then her reweigh on Thursday. So can you talk a little bit about a recommendation to stop night feeds for a six month old baby for a mom that's nursing?

Katie Ferraro (24m 57s):

No problem.

Rosan Meyer (24m 58s):

It's really a concern to hear a one fits all approach because the reality is, as I already said, you know, you have percentages of nutrients that come from breast milk. And at six months, you're not expecting that all of the nutrients come from solids. In fact, at six months, if I were to just go by the data and not buy an individual, you would still say, especially also with baby-led weaning, you would say that 70, 75% off your nutrients come from breast milk. So if we then take your overnight breast feeds and I'm assuming that might be two,

Katie Ferraro (25m 32s):

She had two, yeah, midnight and 4:00 AM. She had ceased doings

Rosan Meyer (25m 36s):

So in my hand that can easily, easily be 300 kilo calories. So if you subtract 300 kilo calories and a child is not there with solids during the day, you can absolutely see a child kind of drifting off with their percentiles. And so the lesson we need to learn here, or two - number one is there is no one approach for all children. And so for me, I always say, you don't just go and cut out the nighttime feeds if a child is not there. And six months is for me quite early, to be honest, you know, I, I, I don't know this child, but it's really quite early. So I would really say to parents follow the more gut feeling approach.

Rosan Meyer (26m 18s):

And, and I think that's the baby-led weaning approach is the approach for following your child's approach for solid feeling. But breast milk is exactly the same. You follow the approach of what a child demands, but don't follow the approach of what a book says.

Katie Ferraro (26m 33s):

Or what a digital course says or what something on TikTok or Instagram says.

Rosan Meyer (26m 37s):

All of that says. And if I may also here, put in, I think finding also a pediatric dietitian that is really pediatric trained that really follows, you know, has that training is really a good suggestion as well, to really tailor advice to the individual rather than to follow some general advice. And I wanna say what I'm really glad that this has really worked for this mom.

Katie Ferraro (27m 2s):

And then what she said was a follow up was at the weight check on Thursday, the pediatrician was shocked that she recovered the weight so quickly and gained extra. The only change I made was reintroducing night nursing; midnight and 4:00 AM nursing sessions, the diet suggestions to add more calories we were already doing with baby-led weaning using good fats, combination of wholesome ingredients, etc. I have to check, but I think we're only seven foods away from 100.

Rosan Meyer (27m 26s):

Katie, just, we are both work. Also. We work with patients, but we work both work in the scientific area. If you just think about, if we work on the approach that at nine months she had 50% of the nutrients should have still come from breast milk, but she was not getting that. It doesn't take a lot whilst I it's a theoretical calculation to just say those two breastfeeds, give her plus 300 kilo calories. And that makes you gain, regain your weight.

Katie Ferraro (27m 53s):

And I love that. I don't wanna get too deep in the weeds on the math, but where we're coming from is guys at six months of age, when your baby starts solid foods, they don't know how to eat. So 100% of their nutrition is coming from Infant milk, breast milk and or formula. And our goal ultimately is by 12 months of age, the majority, not exactly a hundred percent, but most of baby's nutrition should be coming from food. And we're less reliant on Infant milk. So the halfway point at nine months, where Rosan is coming from with these numbers is you can guesstimate that still about 50% of your baby's nutrition needs are coming from Infant milk. And if you cut half of that out in the middle of the night, obviously the baby's gonna have some weight loss.

Katie Ferraro (28m 34s):

So I, I just loved this case study that it's not over, but that it is trending in the right direction for mom, that she went with her gut. We do also have to acknowledge that, you know, what the lactation consultant said was helpful is that many times pediatricians, especially in this country, in the United States, I don't know how it is in the UK and in South Africa and other parts of Europe as well. But over 90% of our physicians have never taken a dedicated nutrition class. And you guys go to your doctor and ask questions about Infant feeding and very often get outdated, incorrect, and even sometimes downright dangerous feeding advice. So seeking a second and a third opinion. And as Rosan said, looking for a pediatric dietitian who is trained in pediatrics and infant feeding is so important and you do have to be an advocate.

Katie Ferraro (29m 19s):

If you truly think there is an underlying issue. And in this case, it was great that the lactation consultant in this country they're required to take at least one nutrition class that they had the basis to say, gosh, Maybe you dropped the night feeds too early, And that could have something to do with it. And mom was just trying to do what her doctor said. So again, I know we're weighing a lot of people's opinions here, but it was nice to hear that mom kind of tie it all together in a way that helped her baby regain some of that weight.

Rosan Meyer (29m 40s):

But, you know, Katie, I think maybe useful. I know we are coming to the wrapping up, but a useful suggestion because even for me as a dietitian, if I start looking at, you know, when the scale starts tipping more to solid foods, I'm always careful to really make dramatic changes. So I normally say to parents, look, if we are making a dramatic change and let's face it cutting up night feeds at six months is a really dramatic change, I put a safety point and then saying, can you make that change? But can you weigh in three to four weeks time again for me? And, and so if, if any parent listens to this and you get that type of advice, because the reality is neither me or Katie get this personal one to one with you, but you can always go and say, "okay, I'm not sure about this."

Rosan Meyer (30m 28s):

So what I'm going to do, I'm going to put in what I call a safety way in. And that here with me, with my parents, as I said, Katie knows that I've produced these videos and we do it at home with them. You need a good digital scale and we do it. And so I do it with them and saying, you do it. You send me the weight. I do actually, when they had a weight done in a, in a clinic, for example, I say, what have you got at home? Let's repeat it at home. That's the same scale. We repeat it in one month time, once we've got that. So even me, who's trained when I make those type of changes. I question myself, is this the right thing? Let's put some safety points in, so you can do that as well for yourself as a parent.

Katie Ferraro (31m 10s):

Okay one more question since I have you here. I'm curious about your thoughts regarding the "Growth app". So it's growthchart.app. I just had more parents starting to ask about it, and I actually just started using it to put like all my own kids heights and weight it, I like that it incorporates World Health Organization and CDC growth chart. But just curious if you've done any work with those app creators or know any thoughts about them, again, just kind of hearing more about it from parents lately.

Rosan Meyer (31m 33s):

So I have not done myself, you know, not collaborated, but I use the apps. You know, I use the WHO app all the time. And of course, several UK apps. And what I suggest to parents is whatever app you're looking at, look at, what is the database they're using? The one that you reference uses both CDC and WHO and I think that's great to know what they're using and the second aspect to it, those apps, as long as, you know, again, the data that you put in needs to be good data to give you a reliable answer. So if you know that the weight and the length that you put in is good, then I think it's a great way to monitor your weight. I don't know what the situation is with the pediatricians in the US, but in the UK, it's pretty central because we have a national health system.

Rosan Meyer (32m 17s):

So the parents have growth charts and all of those type of things. So it's quite easy. But if you do not have a system where you have this consistent, you know, looking at growth charts, then it's good to have an app.

Katie Ferraro (32m 29s):

And I do think we need to do of not making more work for you, but it would be awesome to do a separate episode on growth charts. If you could just briefly explain, like, you know, the difference between CDC and World Health Organization and what they're based on and why we use some for some ages and different ones, just to understand that there are variations in this data too. So the data's only as good as the data points that you're gathering, but then also what database is it being compared against? Because one baby on one growth path can look very different than if you use a different set of charts. And again, it it's sometimes too much data and overwhelming to parents, but we don't want them to feel like terrible parents when they leave the office and hear something like Maria B heard, which was your baby lost weight. What's wrong with you? What are you doing wrong? Because this mom was doing nothing wrong, other than made a tweak that was suggested to her.

Rosan Meyer (33m 13s):

Absolutely. Katie, you know, I love the topic, but, you know, just to kind of say that one would be a gross reference and the other one would be a gross standard. And so those are really differences in terms of what you're expecting from a growth chart, but it's a complicated topic and I am a strong believer in empowering parents. And that's why, you know, if I can reinforce advocate for your child, ask check that the measurements are accurate. These apps are there, If, as long as you know, which references they use are there to empower you further, you know, you can use them. And it also allows you to track over time. And we can do, we can in a future podcast can discuss, you know, also the finer many of the application of Z scores also, or Z scores, whatever you might call.

Rosan Meyer (34m 1s):

And they, I train my parents also to use them because they can also be really, really useful. So I think we can talk about that in the future as well.

Katie Ferraro (34m 8s):

Well, Rosan, thank you so much for your time. I appreciate it so much. Tell our audience, where can they go to learn more about your work and find more of your resources. I'll link as many as I can on the Shownotes for this episode, but then they always go searching for you.

Rosan Meyer (34m 20s):

So I'm the CEO. I've got my Step by Step Kidz Nutrition. So if you look at Rosan Meyer, and you look at Step by Step Kidz Nutrition you'll find me. I have webinars on feeding, feeding difficulties, and most importantly, free growth assessment; how do you actually measure and plot? What I will do Katie, again, I'll give you the link for that, but I think that's so important that there are resources out there and that parents feel free to actually access those. But again, I wanna thank you for having me, as you can hear, it's a topic I love and that topic that I feel passionate about.

Katie Ferraro (34m 56s):

Well, thank you so much. It was great chatting with you as always.

Rosan Meyer (34m 59s):

Thank you very much.

Katie Ferraro (35m 1s):

Well, I hope you enjoyed that episode with Rosan Meyer. She is one of my favorite people to chat with. I love hearing about all the research she's doing around infant growth and nutrition, food allergies, growth faltering. She is such a down to earth researcher. You guys they're really hard to find actually. So when you find the good ones, I gotta just keep having her come back and back. I hope we can get her on for a growth chart episode too. I'm gonna link all of the resources that Rosan mentioned on today's podcast in the Shownotes page for this episode, which you can find at BLW podcast.com/ 266. Thanks so much for listening. See you next time.