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April 24, 2012

One Year

The petite miss turned one on Sunday. Although she's been more clingy the last month and starting to throw fits when she doesn't get what she wants, she is a ball of joy. She laughs and will initiate games (chase and push mom off the bed are her two favorties). She points at everything and is fascinated by the world. She's walking and climbing the stairs.
It is absolutely amazing to see her personality develop and to teach her new tricks (high five!).
Overall, she is healthy and on track.

I try not to pay too much attention to milestones and growth charts, but every time a well baby appoitment rolls around, I kind of have to and then start to hyperventilate a little.
It seems like every chart is different and if you've filled out the ASQ for your pediatrician's office, you know that not all of the activities are expected at that age, but where do you draw the line for concern?
Her motor skills, problem solving and social skills are all right where they should be or ahead. Her communication may be a little behind (according to many sources, she should be saying at least "mama" and maybe one other word) or it might not (our doctor says she wouldn't even mean "mama" at this age). So far, none of our development fears related to her being SGA have materialized.

But her growth is another issue. She's fallen off the curve and we have a referral to a nutritionist.
There are a lot of issues tangled up here. One is our pediatrician. I like her, but she's older and I don't know how current she is on some matters. It's hard to get much of a read since the appoitments feel so rushed and it mostly feels like she's simply hitting the talking points. It's hard to tell if she's giving us the official hospital line because she has to (no cosleeping) or because she genuinely believes it's wrong. (Tangent? She did ask if the babe was sleeping in her crib and my reply of mostly, about half the time, yeah seemed to give her pause until I clarified that she went down in her crib, but then after the second wake up at 2 am, I'd be too tired and take her into bed and she said, oh, that's fine. Also, I know it's common for breastfed babies to still be waking at night and it was nice to see her similarly dismiss that instead of insisting she should be sleeping 10 hours at a time.)
Knowing that the doctors see so many patients, I can be understanding, but I do worry that she's not well versed with SGA babies, since it's not the norm. (Preemies and IUGR babies are more common and though we share some of the same concerns, so far the kiddo seems to just be small for no discernible reason.)
I can't find good information on this, so I don't know what's available to the doctors.
What it boils down to is that the wee one was in the 5th percentile for weight at birth through about 6 or 7 months, then fell off the chart. We weigh her on our Wii Fit and she went through about 3 months with no gain, then starting gaining again and then stopped again the last month. Her head size (5th %) and length (5% at birth to almost 20% currently) have stayed steady, but her weight is down to 0.55%.  So the question is is there a problem or is this just her growth pattern?
I have read about the problems with comparing breastfed babies to formula fed (and even the updated charts include formula fed, so skew the charts slightly but not as bad as the old charts). I have read that IUGR babies (again, not a whole lot of information relating to strictly SGA babies) have higher rates of obesity as adults, possibly related to overfeeding in an attempt to get them to "catch up" on the growth curve.
I also know that malnutrition, especially at this age when her brain is making and pruning connections can have life long implications.
So what does one do? I just try to make sure she's happy and healthy. I think we're doing a great job. My inclination is that this is just the way she is, but we'll know a little more after we meet with the nutritionist. In the meantime, I'm following my instincts. I'm trying to offer her more snacks (there are not enough hours in the day) and I continue to breastfeed on demand, which means every 2-3 hours. (I've gotten conflicting info regarding content of breastmilk at this age, with some saying it's not as nutritionally significant now and less fatty and some saying it's the same, especially since she's still feeding so often. Again, my instinct says evolution blah blah blah, so boob it is.) We do the best we have with what we've got. (I feel a little like Donald Rumsfeld right now.)

I worry that maybe I'm not worrying enough, but then I'm too busy and happy to care.



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