Understanding Your Infant's Growth Chart

In this episode of the Milk Minute, we break down your baby’s growth chart and what those numbers and percentiles really mean. Learn how to interpret and understand what’s "normal" for breastfed babies. Whether you're a parent, provider, or lactation specialist, we’ll help you feel confident in choosing the right intervention when needed. Tune in for a reassuring look at your baby’s growth journey!

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Listener question: What do you do when you have an open crater on your nipple?

Mentioned in this Episode:
Peditools.org for help with measuring baby's arm circumference

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Transcript

Hey everybody, welcome back to the Milk Minute. Welcome back everyone. I think it's important that you know that Maureen is fully laying down right now while we record. She earned it. I need you to know that I went to a birth last night That happened at one in the morning, and then I came home and I went to sleep for like two hours.

And then I got up and I went and worked all day in Heather's clinic. She had to drive two hours also to get there, and she crushed it, of course. But now she's laying down in my basement. And we've been saying, yeah, we've been saying for like four and a half years, what if we just laid down and we fixed it?

So the mics came down from the ceiling. So we could just, I mean, if we did that though, that would guarantee that this podcast would remain for like at least 10 more years. Absolutely. It would also just like our pace of talking would get because we would start to fall asleep. Hey, you know what? I have to shout out.

to the Busy Moms Healthcare Clinic today, though, because it was a great day. Oh. I feel like, for the first time in a while, I got to tell people that their babies were great, and they didn't suck, and they were gaining weight, and they were eating the way they were supposed to. Your babies never suck, but sometimes they're sucking at life, and we have to help them out.

I said it all nicer than that, but Sometimes they need to suck harder. I just, you know, sometimes I get tired of it, Heather. I come to your clinic and I tell people everything is wrong and they have to change everything they're doing. Yeah. Over and over and over. Yeah. It, it does, it does wear on you, but only when you're burned out.

Yeah. And that's not usually the thing that's burning you out. It's like all the other stuff on top of that stuff, cause it is really emotional. I think it's just the emotional piece. It's not like it's hard to tell people that things are. Difficult and that they have to change what's difficult is that I feel it so viscerally for the patients repeatedly Yeah, well and I hate when they come in they're like, I think it's gotten better and I'm like your weighted feed Actually only showed your baby transferred five milliliters and we love you so much and it's not over but we're not quite there yet Yeah, it's so hard It's so hard emotionally, but yeah, I think in general, this has been the longest Halloween season of my life.

It's like, stuck. Darktober, you know, it like just won't end. It's probably November now, thank God, when this podcast airs, because shit like this. Okay, you ready? Yeah. So like, I get a message from the school that's like, Oh, don't forget, you got to pick up your cookie dough orders for the banned fundraiser between two and five today at the school because no one works.

You know, like, everyone's available to pick up cookie dough between 2 and 5. So, the kids sold it. And I know Theo went out and sold some. So we had to go to the school, and go find the cookie dough, and guess what? The little fucker never turned in the cookie dough orders. Oh my god! So now, I have to go find the cookie dough.

The envelope, which is questionably where, I don't know. Hopefully it's just checks that people can cancel and not just a bunch of cash laying around. So he never turned it in because ADHD and also because mom is busy and there's no oversight. And it's just like, what a pointless hour of my day. I'm so sorry to everybody that Theo sold cookie dough to.

Sorry. I hope you weren't waiting on it. Cause it ain't coming. I hope you all forgot. Hope your checkbook balances. Oh my god. You know, I, okay. So Recently I took some time off work to work more to go to a four day spinning babies class. And if you're not familiar, spinning babies is this organization that promotes like physiologically normal birth with like body work and positioning and things like that.

It's great. So I went to this advanced class because I, sorry, did you hear my elbow crack? Oh my god. I don't know what happened. She's falling apart. I went to this advanced class in Wheeling. It was so wonderful and it was just what I really hoped it would be, honestly. We're like, it was a group of 40 people.

In this class, which was kind of crazy. And it was mostly midwives and a lot of labor nurses and some massage therapists and some pelvic floor PTs and people from all over the world. So it was one of those great group experiences where I was like, Oh my gosh, we're like in a hot tub with a midwife from Australia.

You got to go in a hot tub? Oh yeah. Oh yeah. The, the hotel. I stayed in a hotel, not a cabin because I was like, I fucking live in a cabin in the woods. Yeah. I don't need to stay at one on my like sort of vacation. Yeah. There's a pool and a hot tub and a sauna. It was at Ogle Bay. So it was like not the fanciest stuff, but it was there.

Okay. That'll do. It'll do. But it was like so invigorating to hang out with these folks. And I got to drive up my friend's midwife from Greece. Malamo, who is, I hope you listen, but maybe not. She's great. And we hung out a little bit there and I got to drive her back. So before she flew back to Greece, I actually like Went out to a bar with my friends.

No, you didn't. I did. We like went out to Big Timber in Elkins. Which I like honestly haven't done in, I don't know. So you drank like beer. I drank actually like one hard cider. Because I had to drive home. But I stayed till like 1 a. m. That's crazy. Were you laying down like you are now, or were you sitting completely upright?

No, no, we were outside. They have this big fireplace outside, and we were like bebopping around, and like, just having lots of fun, talking to everyone. I was, I was like, oh my god, we're closing out the bar. Fun. Yeah, fun. Wow, did it feel normal? Like, oh yeah, oh hey you, haven't seen you fun side of me in a long time.

Actually, it did, and it was lovely, and I was like, oh my god, I might not do that again for five years, but wasn't it nice? Yeah, I mean, I guess you can stay up till 1 a. m. and just like not have a baby while you do it. Yeah, or just like not be charting. Or like answering emails or it'll all be there tomorrow.

That's awesome. Well, good for you. That's great. Yeah. I'm just working on getting healthy. You sound so much better. I am. Yeah, I feel better. My energy is coming back. I'm back to my old antics. I've got a sense of humor again, which is really nice. Still coughing, still doing that gross stuff, but overall I'm going to live and that's very exciting.

So today we are going to talk about how to understand your infant growth chart and if you should be freaking out or not. We hope that you don't freak out. Like, even if you listen to this episode and you're like, Oh, actually, maybe I should be a little bit concerned. It's probably still okay. Nothing is.

imminently dangerous, you know, it's just information and we want to help you understand that information. So you know how to, you know, do the right intervention. And this is also for professionals that work with babies. So nurses, lactation consultants, I mean, maybe we even have some pediatricians, but for the most part, from what I've seen, pediatricians have a good grasp of the fact that the growth chart is really just one piece of information.

So we're going to get into some of that today. But first, we have a question. The question is from Samantha, who's in our Facebook group. And she says, I know the most recent nipple wound healing guidelines have changed, but what do you do when you have an open crater on your nipple? She was asking specifically about like what creams to put on.

And like, is it lanolin? Is it? Yeah. Yeah. So if you have any questions. open areas on the nipple. We want to stop immediately using all-purpose nipple ointment. So that is going to disrupt the skin barrier and the acid mantle of the skin and prevent wound healing. We don't want that. So what we're going to do is get some poly mem dressing, which you can actually get on Amazon.

It's not cheap, but you won't have to use it forever. You just use it until the actual open wound closes and you can put a little bit of hydrocortisone on the tip of the nipple and cover it with the poly mem. And you use that same dressing until it's saturated. So you can, you can reuse it is what I'm saying.

You don't have to invest like 700 in poly mem. You use the same one for several days. And you can also use some Medi honey every other time. Instead of hydrocortisone. Why every other time? I don't know. Just because the Medi honey is really, really good. And the stickiness almost grabs some of that exudate and then the polyneme snatches it all together, which is nice when you change the dressing.

So it pulls some of that old tissue out, but the hydrocortisone actually makes it feel better. Yeah. Okay. For pain management. So ibuprofen, obviously, and Tylenol alternating just to kind of help with the pain while you're dealing with that. So that's what we're doing now. So please, if you've been using all-purpose nipple ointment for longer than five days, please stop.

And actually I just kind of stopped using it altogether. I'll be honest with you. Yeah, we have better tools. We just have better tools, man. I'm so tired, everybody. Alright, hey. This isn't an official break, but this is a reminder that if you don't have a gift for your BFF who just had a baby, or you have no idea what to buy your dad for Christmas, and they love chocolate, you should go to YesBrownies.

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I'm talking, they like take the chisels and chunk the chocolate off of giant bricks. Like it is delectable. I would love some brownies. Oh, I know. I could go see if my mom has any. Oh my God. All right, so listen, yesbrownies. com, there for all of your Christmas needs this season. And all right, let's get into talking about growth charts.

Okay, let's start by saying for the growth chart to exist, I know we've said this before, every percentile on it has to represent a normal baby, a healthy baby, somewhere, right? It is possible for every percentile on there to be a healthy baby. Mm hmm. Okay. Yeah, it's not like here's the problem. I think let me just say the way we were raised in our educational system Makes it seem like if you just do better, you'll always get an A And when people look at the growth chart, they think that 90th percentile means you're getting an A Bigger and bigger and bigger.

Bigger is more is better, is American. Okay? And that way of thinking does not actually apply in this scenario. It doesn't. And there's a lot of nuance to, Understanding what your baby's placement on this chart means, and I, I really have to have this discussion with a lot of parents who say, well, what percentile are they at?

And I, if I don't say it, like, it's usually on purpose. Yeah, but then they call you later. I know. Oh, I forgot to ask. I haven't said it because I feel like that number is not useful for what is happening right now. But it might make them nervous. I don't know. I kind of go the opposite way I'll be honest with you because from what I found they typically hunt me down and ask me anyway, and Parents are really smart.

I know I just You know, I hate, I hate when providers are like, they, sometimes they don't even say the weight. They're just like, well, now he's in the 54th percentile. I'm like, we haven't trained these people to know what these things mean. Yeah. It's the way you say it. It's like the tone that you say it.

It's the way your face looks when you say it. There's a huge difference between like, Oh, she's in the 40th percentile and you're smiling and nodding and, Oh, she's in the 40th percentile. So now she's in the 40th percentile. 40th percentile and it's like, Whoa, whoa, I'm reading cues because I don't understand these numbers.

Yeah. So I just watch my face when I say it. I try to really say those things in neutral tones, you know, I'm like, Hey, great news. Your baby's back over six pounds. They're in the 23rd percentile. This all looks great. Which is, I usually follow it up with like, Which is what we would expect to see at this point.

Yeah. Or which is not exactly what we'd expect to see at this point. So, Mm-Hmm. . Let's have a closer follow up and let's just make sure that we're really doing like the supplement that we talked about. So, and also no big deal. And you're not failing. And if your baby is coming off the growth chart, you are not a loser.

We'll be okay. Okay. Take a breath. So let's like banish the common misconception up top that your baby has to continue gaining percentiles. On the growth chart to be healthy. Yeah, that's not actually the goal. So here's one example. And these are the babies that I think have the most or give the most anxiety to their parents.

The ones that are born in the 99th percentile. So they're born giant and everyone congratulates them from the minute they're born. What a big baby! You're 10 pounder! You're such a big boy! Broke the scale. No, truly, I've heard a nurse say that. And we love big babies. They're fat and they're cute and they're, we love all their little chunks and balls.

Yeah, but listen. Little Bradley, Chunky Bradley, we can't expect that he is in the 99th percentile when he graduates high school. Right. You know, some things are going to happen between birth and then, and like, we follow these kids on the growth chart all the way through till they graduate high school. We do.

We look. Hey, are you on? You off? You doing good? And we do not want to see exponential growth for somebody who is already at the top of the chart. Right. Then we're kind of like, now we're doing blood work. Then we're out of the healthy range, right? Right. Like. That is, the chart exists and has parameters for a reason.

Yeah. So what often happens in these cases is we see a bit of abnormally large weight loss. A catching down phase, if you will. Right, right. And then, when they catch up, It's not back to where they were. Nope. And here's why folks because when you're growing a baby It's using your placenta To grow and who knows how your metabolism and baby's metabolism and all of that is working We don't need to get into that But at some point usually around the two month mark your baby finds their place genetically On the growth curve.

So I have seen some babies born in the 90th plus percentile, but the parents are both under five foot seven. And I'm like, okay, well, at some point this kid is probably going to level out and it won't be up there. There's one family I've worked with several babies with them for. Mom is 4'10 dad is 5'6 I know her.

I know her cause she has giant babies. And she has giant babies. And all of her babies are not giant by the time they're six months old. Mm hmm. You know and thank goodness. Thank goodness she's never worried about that because I've told her not to worry. Yeah. Yeah, we have to allow them to settle out into their own rhythm.

And that's a good thing. You want that to happen. And that means I will hold your hand through it most of the time during that catching down phase. We will still see, like, Half an ounce to an ounce a day weight gain, so it doesn't mean your baby's losing weight. They're just losing percentiles. Yeah, and we'll, we'll have good gain.

It might be on the lower end of what we expect, but that's also fine, and it's, weight gain is not the only marker for proper development that we see. And also, as lactation consultants and midwives, we're looking at does the data match the experience? Yeah. So, if baby is Apparently, according to the mom, eating really well, queuing to eat, able to maintain alertness to keep the, or to complete the feeding, and wetting adequate diapers, then that experience matches that.

a very normal catching down phase, but proper weight gain per day. Yes. If we have a significant catching down phase and we are less alert and we're not staying awake for feedings and we're having less wet diapers, I'm intervening. Right. Just like with any other baby, not because of the growth chart, but because I'm looking at the baby with my eyes.

Absolutely. You know, another time. That I really see these growth chart numbers start to freak people out. It's like around four months. And we see babies who were, you know, solidly 50th percentile, suddenly they're in the 40th. And, I mean, like, parents don't know what to do with that. There's these big gaps between pediatric visits, right?

Mm hmm. So you see much larger changes in the chart than we've seen before. And, you know, often I do have people who say, Oh, well, my pediatrician said to start formula. And we're like, wait a minute. Wait a minute. Because, because let's see what's happening at the time. You're going back to work, baby starting daycare.

And now the pediatrician is like, well, are you able to pump to replace it? And you're like, well, barely. And then they say casually, well, if you can't, there's always formula. And then they think they go home and all they heard was your baby's dropping on the growth curve, do formula. And so that's not the answer.

But also the other thing that's happening is your baby is moving in. It's not just a little potato laying on the ground anymore. Often they're rolling, sometimes they're just doing that crazy, like, stretch where they're trying to look behind them and grab onto things. They're burning calories now.

They're, like, alert. Their heads are on a swivel at that point, they're smiling, and they're just burning more calories. So, for the parents who want numbers, Who love numbers. Numbers, give us the numbers. Heather, how much are we allowed to drop? Okay, so we are, after that initial catching down or catching up phase, like after two months and really into the third month where I'm like, okay, we've got a pretty good pattern.

Once we've established that like this child is a 30th percentile child for the past several weights, that's kind of where they've been. After that, if we start seeing that a baby is. Going down on the growth chart. We are asking ourselves. Have they crossed one major growth percentile? Have they crossed two major growth percentiles and Why was there a recent illness?

Yeah, can you explain it? No, no, can you explain what you mean by major growth percentile? So the growth percentile chart if you haven't actually looked at it goes from the 1st percentile to the 5th percentile to the 10th percentile. The next one is the 25th, then the 50th, then the 75th, the 90th, the 95th, and above.

That, of course, is, you know, above 95. So, for example, if your baby's in the 30th percentile, and they drop below the 25th, and then they drop below the 10th, those are two major growth percentiles that has been crossed, and we are Really looking at that then. Yes. So one major growth percentile. We're gonna be like, okay So has the eating pattern changed has there been a recent illness, you know Can you explain this in some way if it's two major growth percentiles?

That is an underfed baby or a baby that is having significant metabolic issues, right? That's a sick baby or something's going on and we need to figure it out. Yep, and the same goes for After they start daycare or they're with grandma. I see this a lot. Grandmas are the worst. Like, thank God for them, but also, you know what I mean?

So like, have they shot up above? One or two major growth percentiles in a short amount of time. Is your mother feeding your child six to seven ounce bottles of breast milk every two hours? You know, are we overfeeding like crazy? Have you started solids early? You know, like, is that part of your culture where your mother in law has decided that Your baby should start solids at four months of age and you don't really have much control over it because you have to go to work and that's your only daycare.

We understand, like these things are super hard, but we're going to see like major changes in the growth curve at that point. Yeah. And, and so it's really not like, have they dropped 5%? Have they gained 10%? We're looking at these larger markers before we are really worrying. So when. Not if, when you go to your baby's health care provider and they say, Oh yeah, well they've dropped from the 35th to the 23rd percentile.

You can ask, how significant is that? And you can also know, just listening to this episode, like, Okay, maybe we're gonna ask some more questions and make sure everything's okay, but we're not gonna panic. Oh yeah, no, that means like, Hey, congrats, your baby is bigger than 23 percent of other babies. Yeah.

Yeah. You know, if you think about it that way, and also it's just information. So like, if you're panicking, remember to look at your kid, are they happy? Are they meeting all of their developmental milestones? Are they growing in length? So that's the other thing. If you're really concerned about the weight, what do you do?

We can also get an overall picture of how the whole baby's doing by getting a length, a head circumference, and an abdominal circumference, and also an arm circumference. So that is another really helpful thing. Hold on. I have to give a shout out. So this is from one of our listeners, Carly Shapiro. So shout out to Carly.

And she sent along a website called pdtools. org, and it shows you the mid upper arm circumference chart, which is really, really helpful. so much, Carly. And if you're unfamiliar with that, it's being considered as a better marker for failure to thrive versus just the weight, the height for weight, etc. Okay, so the chart starts at eight weeks of age.

Two months. Mm hmm. Shocker. It's almost like It matches with what I just said. It's almost like we probably shouldn't, like, diagnose failure to thrive before then. I don't know. I don't know, it's a tough one, but like No, I think we have to sometimes. Sometimes. This feels like a permanent diagnosis though.

I know, I hate it. What are we supposed to call it now? I don't know. Is there a better word for it? Yes. There's a new word for it this year. ? Yes. Hold on. I dunno what the word looks for it now. I'll in a second. But they Carly says that the mid upper arm circumference chart begins at eight weeks of age.

Mm-Hmm. . But there's some merit in getting serial mid upper arm circumference measurements before two months to monitor progress. Mm-Hmm. . It's really important that it's measured correctly though, and not just anywhere on the upper arm. When diagnosing malnutrition, we use a combination of mid upper arm circumference, weight gain velocity, linear growth velocity, weight for length z scores, and reported intake.

Right. And honestly? I don't see a lot of EHRs with all of those on them, do you? Nope. In fact, I've never seen one with upper arm circumference charts. Growth faltering is what we're supposed to call it now. I mean, I see how that's nicer, but interesting. Also known as weight faltering or faltering growth.

And I like that because faltering just makes it seem like we just had a hiccup and we're going to get back to Yeah, it does sound nicer because when you get that like failure to thrive diagnosis, they're like, it's forever. You're, your child is sick for the rest of their life. Oh, I see. They were failure to thrive and you're like, yeah, and I did cocaine once.

What are you going to do? You know? Yeah. It's going to follow them for the rest of their life. No, but that, I mean, it's a really, like these other measurements are interesting for you as parents to know for when you have those conversations with your providers and you say, Hey, have you actually seen this measurement?

What if we took it and like looked up really quick, how that might impact the complete picture here? Ever since I read that email, I have noticed baby's arm circumferences a lot more, I haven't actually measured them because I'm not set up to do that in my. Electronic health record, but just visually, I'm starting to notice a lot more that when I'm concerned about a baby's weight, I look down at their arms and I'm like, Yep, that tracks like that.

That arm is not looking beefy. And You know, this really does like play into looking at the baby in front of you, right? Like when we have a baby who's quote fallen off the growth curve, but they are chubby and they're active and they've got good muscle tone. That is a very different picture from when you look and you see those babies who have little chicken legs and little chicken arms.

I mean, maybe not chicken arms. I don't know what we call them. Skinny arms. And they're just like, they're, they're hypotonic. Noodling? Yeah, they're noodling and it's just a different picture. Their arms just aren't in a flexed position. They're just sort of like falling down at their sides quite a bit. And like the trunk control isn't there at two months of age, like eight weeks and beyond.

That's when I'm really like, what's up with your tone? Like why do we, why are we not building muscle? Like, are you not getting what you need to build the muscle? What's going on? Yeah, we need a lot of protein to build muscles. We sure do. We need a lot of milk. You know, I'm still pissed about how much protein I'm allegedly supposed to eat every day as know, I don't, I feel like our, like, modern day take on adult protein intake is really, I just don't know what to believe anymore.

Yeah, I've heard some people say, like, for as many pounds as you are, that's how many grams of protein. And I'm like, 170 grams of protein? And then I've heard, like, no, no, actually, it's like kilograms, not pounds. And, I heard it's like half your body weight. Or was that water? I don't know. I don't know. I just know that I really struggle to get more than like 60 grams of protein a day.

Like that, that feels like the upper limit I can get without like having a protein shake. Dude, if I hit 60, I'm like, you are amazing. Good for you. No, in 60 is when I'm like, okay, like now I'm going to have cottage cheese. Now I'm going to have Greek yogurt. You know, my grandmother. I ate peaches and cottage cheese every day for lunch for like 75 years.

Sounds really nice, honestly. I mean, that's a lot of peaches and cottage cheese. I love both of those things. I imagine sometimes when you do things consistently like that, I just imagine what it would look like if it was all together. Like, are we talking a swimming pool size of cottage cheese and peaches?

Maybe she's up there in heaven just swimming in a pool of cottage cheese and peaches. I like to think so. All right, we need to talk about the babies that are in the less than first percentile. First of all, if you're born before 37 weeks, really, you're not, this is different. This is different. It's a different growth curve.

And like most people's charting systems don't even allow for that accommodation. So again, I'm just looking at the pattern. I'm not even looking at the number because all it will tell me is less than first percentile every time. So I'm, I'm looking at the actual. Trajectory, like the velocity of the curve, visually, like what does this line look like because it's not on the growth chart.

So those babies tend to, I've found, take a lot longer to get to that three to four ounce feeding from birth. So usually it's about two weeks, three weeks before we get to that three to four ounce feeding where the stomach is stretched out. Those babies that are less than first percentile, they're often like four and a half, five pounds.

They're not taking that much because their stomach just can't handle that much yet. So they're a little bit delayed on the growth curve. They also sometimes take a while before they hit that. that moment in time where their brain suddenly says, you have enough resources to do this. Go, go, go, go, go. And then we'll see like a huge leap.

Right. I think we see this with our term IUGR babies as well. Yes. Yeah. So that's the catching up phase. So the catching down is when you're born chunky and you have to find your place genetically. Catching up is when you're born really small, but you're not meant to be really small your whole life. Maybe.

Maybe. And I've seen this before, and this is hard. Maybe you were born four and a half pounds, but you're actually meant to be in the 90th percentile. And so we have to allow enough time for that baby to cluster feed like crazy. Once they have the resources and the energy to do it and just hang on by our fingernails.

And those moms are the ones that are like, I'm making 30 ounces a day and I feel like it's not enough. And you're like, go baby, go. We're feeding on demand. Yeah. And really sometimes I see this, but to a lesser extent with these like six pound babies who are technically normal. Nothing is technically wrong, but they take three weeks to get back to birth weight.

And it's just like they just have this very slow catching up phase and everything is kind of okay and kind of borderline. They're like a little jaundiced and not that bad, but everything is just enough to make you anxious. Yeah, and then those same kids that you're talking about are the ones that seem to have like, one finger up on the growth curve.

Just like clinging. I mean, these are these are my children is what I'm actually talking about. They're like clinging to that first percentile by one finger and you're like, you're fine, right? And they're like, yeah, sort of. Are you fine? No, I'm good. I'm just going to take a minute to get there. So in the situation where the kids are eating, because I've had this a couple of times where they're eating like 40 ounces a day and now we're still less than first percentile, but the curve is.

Looks fine. So like they're following their own curve, but they're just perpetually small Oftentimes, that's when pediatricians are like, yeah, maybe we should start solids a little bit early Maybe it's your breast milk, which is really rough to hear and I'm always over here going. Maybe we should draw blood Maybe we should look for other causes.

Yeah, let's like double check and make sure we're not Developing hyperthyroidism. Yeah. As a baby which is the only thing on the PKU that can change. So, you know, oftentimes I've heard pediatricians tell me like, We're not hyperthyroid. The PKU is fine. And I'm like, yeah, but it's been four months. Yeah, and shit happens.

Like that's the one that can change. So let's check it out. I'm like, I can tell you, can confirm, I've seen kids transfer five or six ounces at the breast with a weighted feed. And they're less than first percentile. Yeah, and I'm like that kid's metabolism. They're either gonna be the kid That's got a hollow leg that will just eat and eat and eat and eat and they just are skinny bean poles Which is fine, but we just want to make sure that they're okay Like at that point I punt that back to the pediatrician and I'm like just double check because it's not me It's not the milk, right?

Maybe listen to their heart again. Yeah, make sure you didn't miss a murmur like Yeah, yeah, so pull socks on that. Yeah, so in those situations, always a little bit more data is what I recommend. Yeah, just to make sure. I, I know, I agree, because we need some reassurance there. And then here's what sucks. And here's what I also can't explain, and maybe you can help me, but those same families who's got a kid in less than first percentile, you know, but close and they're following their curve.

They start solids at six months and then they jump to the 20th percentile. And then. Everyone in your life go see I told you it was your breast milk or the pediatrician is like yep I told you we could have done this earlier But what kills me is we're still primarily getting nutrition from breast milk, right?

And they're probably not getting significant nutrition from those solid foods for at least a month or two or three after they start them Yeah, so who knows? Who knows what's really happening? I mean, sometimes I wonder if it comes down to the microbiome. If like, we've suddenly expanded the microbiome in a really new way because we introduced solids, and it's not like, calorically the solid foods that are changing things, but the, you know, expansion of the microbiome has had a significant impact on the metabolism.

Mm hmm. Or, like, Yes. And like the first six months of life, the brain volume doubles. So maybe like we got that. The smart ones. Yeah. We got that brain volume. And now the body's like, all right, now let's get chunky. And that's just the way they do it. I don't know, because we've studied breast milk composition and we don't make skim milk.

Right. That's not a thing, you know? And even if we did, like fat is not the end all be all to growth. Like. When we look at, like, how we gain fat and muscle nutritionally, it's not because we eat more fat. That's such a good point. Like, that's not what your dietitian tells you, right? It's because we look at babies and we're like, you're fat, so you must be made of fat because you eat fat.

It's kind of like when you look at a bodybuilder and you're like, look at all that muscle. You must eat a lot of muscle. Do you eat a lot of animal muscle protein? Is that why you have muscle? Yeah. That's why I'm made out of chocolate and wine. Absolutely. When you look at me, you're like, you must, I can tell.

Anyway, the moral of the story is don't panic. It's just data. If you don't understand the data, ask more questions and ask for clarification and ask how serious it is. And also ask yourself, does the data match my experience? And, and understand that not every provider gets as in depth of an education as we wish they would about how to interpret the data in front of them.

And so if what you're hearing doesn't match what you're seeing, you can get a second opinion. Well, to wrap us up today, I'm going to bring us an award in the alcove. Nice. Make it a good one. This award goes to one of our mutual clients, Georgia, who is fantastic. We love Georgia. Who has survived. I, I can't even say it.

Wait, can I also just interrupt? Yeah. Georgia is one of five Georgia's, so she has a baby named Georgia. She's Georgia. Her mom is Georgia. And then I think there's two more Georgia's before that. Amazing. And it's like the most feminist thing I've seen in a long time, and I love it. They all have their own nicknames.

Mm-Hmm. . But their names are all Georgia. So Georgia has survived. A. What? A guinea pig bite to her nipple while breastfeeding. Oh my god. Oh my god. Okay, I, having seen guinea pig teeth before, I am absolutely horrified. So now she can put like a full earring in there? Did that, did that rodent tooth just go straight through like a full puncture wound or what?

I'm fairly sure that she survived this without a full puncture wound, but I just. And how? It bit her through her shirt. So it could have been worse, but oh my God, and she continued to breastfeed after that. Like, I, that might've been the last straw for me. Yeah. To be clear. Oh my God. Would've been like, that's an act of God and I'm done.

Guinea pigs telling you something. Oh, that is awful. Poor Georgia. And baby Georgia. She's got to now suck on a punctured nipple. Good thing they're plant eaters, because otherwise we'd have to go down like a rabies hole. One time, speaking of getting bit by a rodent, when I was little, I saw a baby mole getting chased by a rat.

No, by a cat. I saw a baby mole getting chased by a cat and I was like, Oh no, I'm going to save it. So I, I saved it. I picked them all up and it bit me. And so I went and I told my dad and he freaked out and he thought I was going to get rabies. So he went and caught the mole, put it in a Garbage bag, put it on the deck and smashed it with a shovel in front of me and then called my pediatrician, shout out Dr.

Kalenko, and Dr. Kalenko started laughing hysterically on the phone. My dad was ready to bring this rodent fully in to like get its head cut off and tested for rabies. And he was like, Steve, they're plant eaters. They don't get rabies. And my dad was like, Oh, okay, well, and I'm over there just fully traumatized.

You're like, the little critter I saved is now dead on my porch. Smashed because of me and my incompetence. Yeah. Oh, these rodents. So sad. What, what award are we gonna give Georgia? Oh hashtag, I survived. We're going to give Georgia the, you can't handle the tooth award.

That was good. But she can handle it. She, she can. And she did. Okay. Well, I hope that gave you a little laugh. I hope that you're ending this episode feeling like a little de stressed about growth percentiles. And next time you see your baby's healthcare provider, you're going to be like 46%, whatever.

I don't care. Whatever. At least I don't have a guinea pig dangling off my nipple. All right. Well, we're going to go to bed now. I'm going to go to sleep for sure. Right now. Okay. Much love to all of you. Thanks for listening to another episode of the Milk Minute. Bye.