113: Understanding Infant Feeding & Growth

In this final episode of the year, we navigate the often perplexing world of baby growth patterns. New parents, it's time to take a deep breath! We’re here to reassure you that when it comes to your tiny human’s growth, the individual journey matters more than rigid centile expectations. From understanding why newborns might shed some birth weight initially, to celebrating those steady growth milestones, every story and insight is shared with the aim of easing your concerns. We even explore the cultural quirks of growth tracking, like the tales of our Irish babies and their adorably large heads causing quite the stir abroad! Sponsored by www.happytummy.ie Learn more about your ad choices. Visit megaphone.fm/adchoices

Transcript

SPEAKER_00 0:01

This show is part of the Headstuff Podcast Network.

SPEAKER_01 0:06

The Baby Tribe is proudly sponsored by Happytummy.ie, the exclusive distributor of Bayagaya Probiotics, providing support for gut and oral health for the whole family. Welcome back to the Baby Tribe, folks. This is our last episode of the year.

SPEAKER_03 0:32

Aww.

SPEAKER_01 0:33

I was waiting for you to say that.

SPEAKER_03 0:35

I was like, is he waiting for something? Oh, uhw.

SPEAKER_01 0:38

I can't believe we've made it through another 12 months and without killing each other.

SPEAKER_03 0:42

I was about to say, I can't believe we've survived another 12 months, but come on, yeah.

SPEAKER_01 0:45

A whole 12 months of parents sliding into my DMs asking if their baby's milk intake is normal, if their poo's shape, size, consistency is normal.

SPEAKER_03 0:57

Yeah, and meanwhile, I'm here at home with our kids and they're teenagers. So the listeners are worrying about nappies and feeds, and I'm screaming at the kids about screen time and wondering who finished the milk and put the empty carton back in the fridge, which is one of my pet peeves.

SPEAKER_01 1:11

It's always fusel. He's the one that does it all the time. Although Maggie takes ice creams from the freezer.

SPEAKER_03 1:16

Yes, and leaves the empty box.

SPEAKER_01 1:18

And leaves the empty box. Yes. And after dinner, I open the freezer drawer and I see the box and I go, oh my god, there's ice cream left. And I look in the box and they're all gone. I just despair. Oh. It just drives me insane. So, parents, it does not get easier, it just changes flavour. We are so grateful, guys, that you have been listening, messaging, and sharing your stories with us all year.

SPEAKER_03 1:40

We really do appreciate it. Um, and especially those who left a review and joined us for the Baby Tribe Live. Thank you so much. Um, we will be back next year though, won't we?

SPEAKER_01 1:49

And for those of you who have not left a review, why the hell not?

SPEAKER_03 1:53

I'm like signaling him going, shut up.

SPEAKER_01 1:56

It's a couple, a couple of nice reviews. That's all I'm asking for. It's okay. It's not. No, it doesn't suit you. Stop. Look, I don't want to get into another fight with you, okay? Like we fight enough about the dishwasher etiquette.

SPEAKER_03 2:07

Okay, well, we can't open that can of worms again.

SPEAKER_01 2:11

We can't open that dishwasher stack. It's creative stacking and it's an art form.

SPEAKER_03 2:16

It looks like an angry toddler stacked the dishwasher. Yes.

SPEAKER_01 2:20

And you know what? When you were gone to England for three days, I stacked the dishwasher my way, and guess what? All the plates came out clean. You didn't even know that I did it. Because everything was immaculate when you're in.

SPEAKER_03 2:33

I actually don't believe this, but go ahead, yeah, Karkon.

SPEAKER_01 2:37

Oh, so funny. She's always paranoid that I'm gonna destroy the kitchen, as as we've discussed before.

SPEAKER_03 2:42

I I worry that you'll destroy the kitchen because you destroy the kitchen. It's not a paranoia.

SPEAKER_01 2:46

So I sent her this AI image of the kitchen in absolute.

SPEAKER_03 2:49

No, seriously, I knew it was AI, but it looked like it was still giving me a really horrible, like an itch you can't scratch feeling. Looking at it was awesome.

SPEAKER_01 2:59

I sent I sent the AI picture to my son and I said, Faisal, I tell mom I've gone upstairs and that and that this is what I've done to the kitchen, and and and see what she says. She didn't fall for it.

SPEAKER_04 3:09

I know. I'm like, I'm not crazy.

SPEAKER_03 3:11

I know, I know, but you still you still it still gave you like feels like it gave me really uncomfortable ick feeling in my stomach just looking at it. Because in the picture there was like it looked like he'd made bolognese and it was all just like dripping down the walls because obviously he just left the pot like bubbling on high with no lid, and it was all over the backsplash, running down the wall. Oh, I can't even talk about it.

SPEAKER_01 3:35

Anyway, um, today we're finishing the year on one of the topics that I think worries a lot of parents, and that is baby growth, because nothing sends people into a panic mode faster than a growth chart that looks like it's misbehaving.

SPEAKER_03 3:50

Yeah, and it's this time of year that the maternity awards are still bursting. We were at a do last night and we heard that the rotunda delivered 800 babies in one month.

SPEAKER_01 3:59

In one month. Some some hospitals do that in six months.

SPEAKER_03 4:02

Yeah. I know we felt it was busy.

SPEAKER_01 4:06

I keep telling you, it's all the September and November babies because of the cuddles of at Christmas and Valentine's Day. This is what happens every year. There's like a surge in September thanks to Christmas cuddles, and then there's a surge in November thanks to Valentine's Day cuddles. That's what happens every year.

SPEAKER_03 4:24

I phrase it differently.

SPEAKER_01 4:26

Well, how would you phrase it?

SPEAKER_03 4:27

I phrase the Septembers as too drunk to know better, too broke to do anything else, babies.

SPEAKER_01 4:35

Yeah.

SPEAKER_03 4:36

Okay, because that's December and January.

SPEAKER_01 4:39

Yeah.

SPEAKER_03 4:40

And then you've got the Valentine's Day, St. Patrick's Day.

SPEAKER_01 4:45

Yes.

SPEAKER_03 4:46

Craziness.

SPEAKER_01 4:47

There's still drink involved in making those babies. Arna's population would plummet if it wasn't for alcohol.

SPEAKER_03 4:52

Potentially.

SPEAKER_01 4:53

Yeah.

SPEAKER_03 4:53

Potentially. Yeah.

SPEAKER_01 4:55

I know. It's crazy. Um, so guys, consider this your public health warning before the festive season. All right. We don't want to be seeing a surge in September again. Yeah.

SPEAKER_03 5:05

It's gonna happen every year no matter what. People are people.

SPEAKER_01 5:08

I know, yeah. So what are we talking about today, Anne?

SPEAKER_03 5:11

So I'm picking your brain today, FIF.

SPEAKER_01 5:16

Yes. So switch it on there, love, if you don't mind. It's my brain is always switched on.

SPEAKER_03 5:21

What I want to do is talk about kind of growth patterns for babies, because it is something that you frequently get asked about. A lot of people will be told, Oh, your child is plotting well on a centile chart, or your child is on the higher centile, your child is now on a lower centile, blah blah blah. So some babies are just little people, yeah, and that's okay. And some babies are big whoppers. So, like, at what point does it cause concern? What at what point should people be saying actually this is something that we might need medical advice on? Because I think for people, you always really worry about what your baby's eating. Are they getting enough? Are they growing right? Is this the right period of growth for them? You know, all of those kind of things. So I just thought it might be useful to kind of finish off with that.

SPEAKER_01 6:08

Yes. And when I put up the question box midweek, I got so many questions about all of this. So, what I've done is I've grouped the questions into themes.

SPEAKER_03 6:16

Thank you very much.

SPEAKER_01 6:17

And I'm hoping that we are gonna hit all of those pertinent things that parents want to find out about in terms of infant growth, especially over the first year of age.

SPEAKER_03 6:26

Yeah, very helpful. Over the first year of life, not over the first year of age.

SPEAKER_01 6:30

Do you know why I say first year of age rather than first year of life? Okay. Is because I write papers and I submit them to journals, and sometimes the editors write back and say, don't say the word life, because there's a debate at when life starts. Oh my god.

SPEAKER_03 6:48

Okay, so the first year after birth.

SPEAKER_01 6:50

Following first year following delivery.

SPEAKER_03 6:53

Yeah.

SPEAKER_01 6:53

Yeah. They keep saying, yeah, just just stay clear from saying first year of life, because you know you're into a deep philosophical and ethical conundrum there. Absolutely. So that's why I say the first year of age. Okay, so we'll go first year following delivery.

SPEAKER_03 7:05

First year following delivery. Okay, your child from birth up until the year of one year, you want uh the year of the age of one. Irrespective of life, irrespective of when life starts.

SPEAKER_01 7:16

Okay, fantastic. Well, I want to actually talk about early weight changes because again, even that can send people into a bit of a tizzy, and there's sometimes a misunderstanding of what happens. Yeah, and parents can be made to worry, I think, needlessly, after they go home for a variety of reasons.

SPEAKER_03 7:34

I think that's very fair. So after delivery in hospital, when a child is born, when a child is born, how very festive. Yes, um, when a child is born and they're weighed, their birth, their weight, their birth weight is plotted on a centile that day.

SPEAKER_01 7:49

Yes.

SPEAKER_03 7:50

Okay, so in a scentile chart, just talk about sentile charts very quickly.

SPEAKER_01 7:55

Yes, centile charts are charts that track the growth of babies in three main parameters: the weight, which is what people focus on, the head circumference, which to me is far more important, okay, and the length, another very important thing. My children have big heads because I have a big head just and what a sentile chart is basically you you know the lines that you see. So there's a line in the middle, and there's um two or three lines on either side of that line in the middle. So the line in the middle is called the 50th percentile, meaning that if your child plots on that 50th percentile, it means that if you take 100 babies, your baby will be right in the middle. So there'll be 50 babies that are heavier than that baby, and 50 babies that are lighter. So 50th percentile is bang on average. Okay. If your baby's on the 75th percentile, it means that out of a hundred babies on average, your baby is bigger or there's only 25 that are actually going to be bigger or heavier than them. If you're on the 95th percentile, it means that only 5% of babies are bigger than you, and anything between the 5th and the 95th percentile generally is considered within normal.

SPEAKER_03 8:57

So fifth to 95th. Yeah. So that's a huge range.

SPEAKER_01 9:00

Yeah, well, 10th to 90th, fifth to ninety-fifth, depending on on who you ask. Um, but the key thing then is what we look at is are you remaining on that line?

SPEAKER_03 9:10

Okay.

SPEAKER_01 9:11

Okay.

SPEAKER_03 9:11

So normal growth is tracked along a trajectory for each of those sentiles.

SPEAKER_01 9:20

Yes.

SPEAKER_03 9:21

And then as time passes, your baby's weight gain, yes, growth, yes, is tracked uh over time.

SPEAKER_01 9:30

Yes.

SPEAKER_03 9:31

Um, and they want to check that it's starting off at a say you start off at the 55th sentile, yeah, and that you remain along that similar pattern with a set with a normal trajectory over time. Yes.

SPEAKER_01 9:44

Yes, a couple of points I want to bring up though. And I'll talk about you know whether remaining on a centile is is is what you look for. Yeah.

SPEAKER_04 9:52

But first of all, it sounds like it is.

SPEAKER_01 9:53

First of all, these centile charts are a result of tracking hundreds and hundreds and hundreds and hundreds of normal, healthy babies with no medical conditions throughout the years.

SPEAKER_04 10:06

Okay.

SPEAKER_01 10:06

And then people ask about, well, what happens during the first few days following delivery? Right. Um babies will lose some weight over the first few days after they deliver it.

SPEAKER_04 10:21

Okay, why?

SPEAKER_01 10:22

They lose weight because there is um the kidneys begin to work and get rid of excess fluid in the body.

SPEAKER_03 10:31

And why do babies have excess fluid when they're born?

SPEAKER_01 10:34

So there's a variety of reasons. There's fluid in the lung that slowly gets absorbed. Okay. Um, the kidneys begin to work and get rid of interstitial fluid, so that's fluid that's not in the blood vessels that is sitting, you know, in the tissues. In the tissues that gets absorbs.

SPEAKER_03 10:47

Because they've been in an underwater environment all their lives.

SPEAKER_01 10:49

That gets reabsorbed, and it's a chemical process, so it takes a while for that to happen. And um, most babies lose between seven to ten percent of their original birth weight. Wow.

SPEAKER_03 11:00

And like that's a significant amount.

SPEAKER_01 11:03

Like, imagine if somebody loves 10% of their weight in two days, you will notice the difference.

SPEAKER_03 11:08

You would, yeah.

SPEAKER_01 11:09

Most babies regain their birth weight between a week to two weeks following delivery. Okay. Right? So you lose between seven to ten percent of their birthday. And that's water weight, essentially. Usually water weight. Right. And then you regain your birth weight some somewhere between so 75%. 75% of babies will regain their birth weight by a week of age, and 90 to 95% will regain their birth weight by two weeks of age.

SPEAKER_03 11:34

Okay, and that regaining your birth weight then that is actually just growth, that is through food and growth.

SPEAKER_01 11:46

So people focus a lot on this, and one thing that it that is becoming increasingly obvious is sometimes babies will not regain their birth weight by two weeks of age, and that triggers some concern in the community.

SPEAKER_03 12:00

Because if you're Well, I can understand why, because if that's what's considered normal, then you wonder, is it a pink flag for something abnormal?

SPEAKER_01 12:07

Because that's the best, I guess, gauge of whether the baby's getting enough milk or not, whether they're formula feeding or breastfeeding. Yeah. Um, so but what we have been noticing recently, and there's a couple of small studies that have sort of you know suggesting that is um there's a lot of intervention happening with mums now, you know, labor induction, C-section, treatment for pre-eclampsia. Treatment for pre-eclampsia, hypertension, and things like that. And sometimes they go on f on fluids and a drip before they deliver. Sometimes what we notice is these babies delivering to mums that have received intravenous fluids and treatments like this are really puffy at birth.

SPEAKER_03 12:45

When you say really, really puffy, they still look like normal babies, they're just a little bit puffy.

SPEAKER_01 12:50

They have puffy eyelids, you know, they've kind of full cheeks and round faces. And you know, a lot of a lot of mums show me pictures and then they say a few days later, and it's not but all babies look a bit different when they're born versus how they look a day or two later.

SPEAKER_03 13:04

Yeah, they really do.

SPEAKER_01 13:05

However, these babies I think have 100 to 200 grams of extra fluid that they lose. Okay. That is not part of their birth weight that they will not regain by two weeks of age. Okay, right? So let's say the baby was born at 3.2 kilos.

SPEAKER_04 13:18

Yeah.

SPEAKER_01 13:18

Right? 0.2 of that is excess fluid that they need to get rid of. And by two weeks of age, they're back to three kilos, not 3.2.

SPEAKER_03 13:25

And people begin to worry to say But three kilos was their actual weight. Real birth weight without any additional fluid.

SPEAKER_01 13:33

So, what is far more important because you asked the question is whether let's say a baby was born on the 75th centile, and by two weeks of age they're only on the 50th centile.

SPEAKER_04 13:41

Okay.

SPEAKER_01 13:41

Right? They're not back to the 75th centile. That means they did not regain um, you know, enough weight. I would be far more happy if they maintain on whatever centile they're on at two weeks.

SPEAKER_04 13:53

Yes.

SPEAKER_01 13:53

And continue to grow on that. Yes. Rather than having to push to go back up to the city.

SPEAKER_03 13:59

So a centile that is not necessarily their destined centile. Their natural centile.

SPEAKER_01 14:05

Especially if their head and their length don't fit with their weight. Yes. So, I mean, in general, and there's always exceptions, in general, the baby's head circumference, the baby's length, and the baby's weight generally fall on similar scentiles. The baby's proportional, they'll be on the 50th, all three of them. Sometimes if you have really tall parents, that the length may be on a much higher scentile than the other.

SPEAKER_03 14:26

Or if you're like me and you have a giant head and you have a child with a big head, our head children need big heads.

SPEAKER_01 14:32

Yeah, so we had Hobbit children with big heads and um and they're very love us so much that we talk about them like this.

SPEAKER_03 14:39

It's amazing.

SPEAKER_01 14:40

So so our daughter grew into her head, so she had the same head size when she was two years of age that she was at first. So sorry.

SPEAKER_03 14:47

It's true though. It's all because she's a big brain, she's very clever.

SPEAKER_01 14:50

Yes, the Celtic teens. And the other thing I wanted to mention as well during the early weight gains is we say that babies on average gain about 30 grams a day, right? Between around 200 grams a week, but that is the average. Yeah. Okay. A baby tracking on the 90th centile will gain far will gain far more than that in a week because their line is steeper than the 50th percentile line. And a baby that is growing on the 25th centile will gain less than that average, right? So the key is are you tracking along a centile that you settle on after two weeks following delivery?

SPEAKER_03 15:27

Because that is your bespoke personal personal growth pattern.

SPEAKER_01 15:31

I have a lot of parents coming to me worried at two weeks and at six weeks that were there were concerns raised in the community by um various healthcare providers because they have not regained their birth sentile. So they were born on the 75th.

SPEAKER_04 15:47

Yeah.

SPEAKER_01 15:47

They come to me there on the 50th, but they're tracking on the 15th beautifully. And the mothers are often breastfeeding and they're being pushed to give formula or feed more, or if they're formula feeding, they're asked to give the baby more feeds, and the baby's like fuck up.

SPEAKER_03 16:01

Bursting.

SPEAKER_01 16:02

I don't want I don't want anymore. And they're pushing the pushing the bottle away.

SPEAKER_03 16:07

And the important thing is this is a well baby who's eating, drinking, peeing, alert, yes, developing normally, normally hitting milestones. Can I just talk about what you said about the the interventions and fluids? Okay, because I really don't want women to feel that they cannot avail of medically indicated or personal pref personally preferred interventions because it's going to cause their baby to come out very puffy and have an abnormal birth weight and be not right.

SPEAKER_01 16:42

That's a very good point.

SPEAKER_03 16:43

Can we can we just address that? Because that is not what you're saying.

SPEAKER_01 16:46

No, what I'm saying is not that you shouldn't be doing this. What I'm saying is Just bear it in mind. Healthcare providers should bear that in mind when they're assessing a weight at two weeks and take that into consideration.

SPEAKER_03 16:57

That's fine. Yeah, you know, sometimes people need oxytocin. Absolutely. Sometimes people need um need to get an epidural because that's they feel that they need that for their best birth uh um experience. Yeah, you know, and there's a m a multitude of different things that people will need to provide safe or um yeah, kind of care that care that is geared toward maternal satisfaction. This isn't a risk issue issue for their babies, yes, this is just a context.

SPEAKER_01 17:28

Yes.

SPEAKER_03 17:29

Okay, that's all I just wanted to be super clear on that.

SPEAKER_01 17:32

Yeah, so another couple of things um uh to talk about in terms of expected growth pattern over the first year, right? So the World Health Organization charts are based on breastfed babies.

SPEAKER_04 17:45

Yeah.

SPEAKER_01 17:45

Okay, a breastfed baby tends to have rapid early weight gain and then it's slower. Okay, and a formula-fed baby has a more steadier kind of growth curve. Okay, okay, in general, oftentimes to be honest with you, I don't see that in in real life.

SPEAKER_03 17:59

Um but it potentially is a pattern that exists.

SPEAKER_01 18:02

It's a pattern that exists.

SPEAKER_03 18:03

And again, it's gonna be muddied by some people top up, some people blah blah blah.

SPEAKER_01 18:07

Yes. And then what I'm about to say next is in very general terms, okay, right? Taking into consideration what I said about the different growth trajectories based on the different centaws that you're on. Between zero and three months, babies generally gain about 30 grams a day or around 200 grams a day. Okay. By about four to six months, they double their birth weight.

SPEAKER_04 18:26

Yeah.

SPEAKER_01 18:27

By a year, they triple their birth weight. Okay. So a three kilogram baby will be roughly around six kilos at six months, yeah, and nine to ten kilos at at a year.

SPEAKER_04 18:35

Okay.

SPEAKER_01 18:35

And that's very rough. Yeah. Right? Um, length. They gain twenty-five centimeters in the first year. That's a lot. Yeah. Yeah. And their head circumference increases by about a centimeter a month for the first time.

SPEAKER_03 18:50

Unless you're our first six months, yeah.

SPEAKER_01 18:54

Yeah. So these are the sort of general kind of growth patterns.

SPEAKER_03 19:00

Did we ever tell people what what we were told about our lovely children?

SPEAKER_01 19:04

What?

SPEAKER_03 19:04

When he got referred to get their heads reviewed.

SPEAKER_01 19:07

Well, this is this is in Canada. Yeah, this is in Canada. When when they're not used to the freakishly Irish heads. Yeah. And they were like, Oh my god, his head is abnormally big. We need an MRI stat.

SPEAKER_03 19:18

No, no, no. They sent us to the first we took him to their pediatrician, our pediatrician, who was a guy of kind of Scottish descent, married to an Irish woman. So thank God he had the context.

SPEAKER_04 19:29

Yeah.

SPEAKER_03 19:30

And he just looked at our son and he went, ah, he's just Irish. And we're like, What? And he goes, Yeah, you know, big head, slightly reduced truncal tone. He'll be grand. That's just how yeah. And I was like, Okay, that's reassuring. But then when I was in med school before somebody was getting assessed for a large head, their child was getting assessed for a large head, and the dude the doctor just looked at the parents and said, Your head is big and your head is big. You're you're like your one over here beside me, the medical student. She wasn't behind the door when they're handing out big heads either. So all I'm saying is that as a population, we tend to have large heads.

SPEAKER_01 20:11

Yes.

SPEAKER_03 20:12

So we can be a little bit reassured. So when does somebody need to worry about a large head?

SPEAKER_01 20:17

Um, we're not gonna do the red flags just yet.

SPEAKER_03 20:20

Okay, fine. We'll do red flags later.

SPEAKER_01 20:21

We'll do red flags later. You're jumping the gun, Anne.

SPEAKER_03 20:24

Okay, that's fine, that's fine.

SPEAKER_01 20:25

I gave you the brief a while ago.

SPEAKER_03 20:27

I know, I know. Look, hey, I'm just chatting. Go ahead. So no, let's go. Okay, so they would be tripling the weight by 12 months. That's what we're back to.

SPEAKER_01 20:37

Things to consider though. Okay. If your parents are short, like our situation.

SPEAKER_03 20:42

Small with big heads.

SPEAKER_01 20:43

Um, like genetics plays a huge role in how a baby grows.

SPEAKER_03 20:48

Yeah, fair.

SPEAKER_01 20:49

Right? So if you're petite, your baby won't hit the 98th centimetre.

SPEAKER_03 20:52

Yeah, and if you're petite and you're married to a ginormous rugby player, I've seen this pattern. Who knows?

SPEAKER_01 20:58

So what normally is gonna do? What normally happens is they're either like really short but on a really high weight scentile.

SPEAKER_03 21:10

They're chunky.

SPEAKER_01 21:11

So they'll they'll be good front row players.

SPEAKER_03 21:13

Oh, there you go.

SPEAKER_01 21:14

Okay, or they're really tall but on a lower skin. On a lower scentile.

SPEAKER_03 21:18

Okay, okay. So again, this is about finding your scentile that's good for you at two weeks and then following it through from there. Okay, good. And that's why it needs to be individualized.

SPEAKER_01 21:28

Yeah, exactly. So, I mean, a lot of babies will drop a scentile when I see them by six weeks of age.

SPEAKER_03 21:34

Yeah. And that's not you're not gonna worry too much about it.

SPEAKER_01 21:38

That's not that's not a big deal.

SPEAKER_03 21:39

They're just settling.

SPEAKER_01 21:40

They're just settling, exactly. Um, and we do track the growth. So babies are measured obviously at birth, they're measured pre-discharge, then they are measured again by the public health nurse a couple of days later after you leave the hospital. Okay, they're checked by the GP at two weeks, and at six weeks, the public health nurse should, in theory, visit at three months, nine months, and And um 18 to 24 months.

SPEAKER_04 22:02

Okay.

SPEAKER_01 22:02

I acknowledge that that does not happen everywhere at the moment due to short staffing, but they're the general times where we check growth in babies.

SPEAKER_03 22:09

And that's when you're going to be tracked across your centology.

SPEAKER_01 22:12

And development. We're taking a quick break to thank happytummy.ie, the official distributor of Biogaia probiotics, for supporting the baby tribe.

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SPEAKER_01 22:49

Visit happytummy.ie to learn more and give your crew the gift of a happy tummy and a healthy smile. We are pausing for a moment to remind you that the Baby Tribe is now part of the Headstuff Podcast Network, Ireland's premier podcast network hosting the best podcasts around.

SPEAKER_03 23:04

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SPEAKER_01 23:29

Your support means the world to us and helps us keep bringing you the content you love. Thank you for listening and for being part of the Baby Tribe community. Now, what are the common causes of slow weight gain over the first few days?

SPEAKER_03 23:53

Okay.

SPEAKER_01 23:53

That's what you were gonna ask me, Ann, wasn't it?

SPEAKER_03 23:55

Um I'm uh I was actually gonna just summarize what you were just saying there, but yeah, sure.

SPEAKER_01 23:59

Go on, summarize it.

SPEAKER_03 24:01

Okay. So I was just still putting me on the spot. So I was just gonna say basically one drop across a centile or two is settling, persistent drops, that's where you need to worry about.

SPEAKER_01 24:18

Yes.

SPEAKER_03 24:19

Okay, and that's where that's where you're gonna be checking things like how much is your baby eating, what's their feeding?

SPEAKER_01 24:24

And by two centiles, I don't mean a drop from the 50th to the 48th.

SPEAKER_03 24:28

No, two centimeters from the 50th down to the tenth kind of the 25th.

SPEAKER_01 24:33

So 50th to the 25th is one centaile drop, 25th to the 10th, and then there's the third.

SPEAKER_03 24:38

Okay, so because the the the chart, the lines that are given on the chart is 50. 50th, 25th, 5th, I think, and then third, yeah. 10th, yeah, 25th, 50th, 75th, um 80, 85th or 95th.

SPEAKER_01 24:51

Yeah, 75th, 95th. Depends on the like different growth charts will emphasize different lines.

SPEAKER_03 24:56

So if somebody is gone from the 50th centile to the 40th centile, that is not a big deal. No, okay, that's just keep an eye on that over time. Yeah, and if things are still going horizontal instead of going on, I do a lot of six-week checks in my clinic.

SPEAKER_01 25:10

Yeah, I rarely see a baby. Well, not rarely, but more often than not, the babies have not regained their birth sentiles. Yeah, because they have a bit of puffiness that they uh got rid of, you know?

SPEAKER_04 25:22

Yeah.

SPEAKER_01 25:22

Um, so what are the common causes of slow weight gain over the first period? Feeding. That's the everybody always worries about that. By far, that is the most common cause of slow weight gain over the first few days, or not regaining your birth weight um, you know, by two or three weeks. Okay. Be it formula feeding, or the fluids bit. Or the fluids bit, be it formula feeding or breastfeeding now. Um I acknowledge we see that more commonly with breastfed babies. And that is not um a slight or a negative comment about breastfeeding or about the mums that are breastfeeding. It is a failure of us as healthcare providers to provide enough support for mothers in order to successfully breastfeed them.

SPEAKER_03 26:07

Yeah, breastfeeding is hard.

SPEAKER_01 26:08

Breastfeeding is hard. I think the support in hospital is lacking still. The support in the community is slowly getting better, but it's highly dependent on voluntary groups.

SPEAKER_03 26:18

Yeah, I think it's an issue in that like our midwives and our public health nurses are so overworked and stretched so thin. Like they would love nothing more than to be able to sit down and spend a really good quality hour, hour and a half with you and and watch you feed and address all your concerns because that's why they went into it and that's where the vocation comes from. So it's it's just a marker of the being stretched thin across the system, you know.

SPEAKER_01 26:43

Yeah, a few misconceptions about feeding over the first few days, especially um when when when in the in the hospital, um babies will feed small volumes very often, regardless of whether you're breastfeeding or your formula feeding over the first um few days. They do not adhere to the feed every three hours BS. That is still being pushed out.

SPEAKER_03 27:05

So, should you be waking up your baby to feed them in the first few days?

SPEAKER_01 27:07

I'll get to that.

SPEAKER_03 27:08

Okay, sorry.

SPEAKER_01 27:09

But I'm talking about during the day, yes, they'll say feed every three hours, and they are sometimes advised if the baby is showing signs of hunger before the three-hour mark, shove a soother in their mouth to tide them over until the three-hour mark. Please do not do that if anybody advises you to do that. Okay, just feed them. Babies feed small volumes more often. Now I want all the listeners to close your eyes. Unless you're driving, don't do that if you're driving or you're pushing. Or if you're walking across the street or across the street. Okay.

SPEAKER_03 27:40

If you're sitting and doing nothing and feeding your child, close your eyes. Otherwise, keep your eyes open.

SPEAKER_01 27:46

I'm I'm still influenced by MECO. We're gonna do some mindfulness now.

SPEAKER_03 27:50

Okay, go on out here.

SPEAKER_01 27:51

Close your eyes and imagine a newborn baby's hand. Imagine them making it into a fist. Yeah, that is the size of their stomach. Yeah, tiny, size of a grape.

SPEAKER_03 27:59

Yeah, you don't fit much in there.

SPEAKER_01 28:00

You can't fit 50 mils in that, especially day one, day two. So they will feed very small volumes very often. Yeah. When they are latching onto your onto your breast, you're not making huge amounts of milk over the first two days. It's predominantly colostrum. Which is rocket fuel. Yes, it is rocket fuel, but they will take small snacks of colostrum very often. So if they are feeding every two to three hours, every one to two hours, that is not a sign that they are a hungry baby, that they are um starving, that or that they're not getting enough. That they're not getting enough. This is their normal feeding pattern. And one thing I find I guess stresses parents out is that the ready-made formula bottles that they are given in the hospital are 70 mils.

SPEAKER_04 28:49

Yeah.

SPEAKER_01 28:49

And they look tiny. And then often the parents will say, Oh, they only took a quarter of it, they're not feeding well, assuming that they have to finish that 70 mils because it does look like a small volume. Um, like 70 mils is a double espresso. Yeah, you know, it's a very small volume. So parents assume that they have to finish that, but they only took 30 mils. And I often reassure them and say, That's plenty. So your baby, day one, generally feeds about 50 to 60 mils in a 24-hour period. If they are healthy, um and I'm making a caveat that this applies to healthy term babies with low risk factors, right? Babies that have you know issues if they are low birth weight, if they are preterm, if there's a history of uncontrolled gestational diabetes, they will need more. But in a healthy-term baby, they don't take a lot of milk in the first 24 hours, and their bodies are designed to withstand that low volume. Yeah, the brain thrives on ketones predominantly over glucose, day one, day two. Okay, and then it switches to glucose production, and that is uh a normal thing to help the baby cope with the the aflomassive delivery and making sure because I suppose in evolutionary terms, like mum's milk wasn't coming in straight away, correct.

SPEAKER_03 29:59

But also you don't know if that mother had been well post-delivery and everything like that. So it's it's a protective thing, is it?

SPEAKER_01 30:06

Yeah, it's a protective thing, exactly. Um, so w when there are no risk factors, babies take usually 50, maybe between 50 and 100 mils day one, about 150 to 200 mils day two, and then it slowly ramps up. Yeah. And they generally, and again, this is very general, they settle roughly on about 150 mils per kilo per day.

SPEAKER_04 30:25

Okay, right?

SPEAKER_01 30:26

Until they reach about a liter to a liter and a bit of milk when they're three months, they don't tend to drink more milk than that until they wean.

SPEAKER_04 30:35

Okay.

SPEAKER_01 30:35

So you're looking at a steady increase in the volume of milk up until three to four months. Right. And then that volume stays steady generally until about six months, until you wean.

SPEAKER_03 30:45

And by six months, you're on a liter of milk. Yeah.

SPEAKER_01 30:49

Right. Even by a year, having six months of slowly introduced solids, some babies are still taking four to six hundred mils of milk.

SPEAKER_04 30:56

Yeah.

SPEAKER_01 30:57

So the decline in milk intake isn't as fast as some people assume. A lot of parents come to me and say, the baby's seven months old now, he's still taking, he's taken maybe two meals a day, but they're still on a full whack of milk. Is that normal? And the answer is generally yes.

SPEAKER_03 31:11

Yeah.

SPEAKER_01 31:12

Right? Um, and we'll talk about that in a little bit more.

SPEAKER_03 31:15

Yeah. But like so feeding issues is one of the primary issues with kind of slow wake-in, is what you're saying. So you've gone through what's normal and expected.

SPEAKER_01 31:25

Yeah.

SPEAKER_03 31:25

Okay. Um, what would be a flag that there's a feeding issue that needs to be addressed, and what other kind of feeding issues would there be?

SPEAKER_01 31:32

Yeah, before I do the red flags, I also wanted to say, um, and then another thing parents are really concerned about is oh, they I haven't seen them pee yet, and it's been 24 hours. Well, there's two reasons for that. Babies generally just pee once in a twin in the first 24 hours, once to twice day two, and three to four times day three. I did not know that. They don't pee a lot.

SPEAKER_03 31:54

And so I always see them pee on delivery.

SPEAKER_01 31:56

Exactly. I was just about to say that. So some babies will pee on their way out, yeah, and then they won't pee for another 24 hours.

SPEAKER_03 32:03

Okay.

SPEAKER_01 32:04

And then they'll pee day two.

SPEAKER_03 32:05

And then the stress is oh my god, my baby's not peeing, they're dehydrated now. Yes, yes. Okay.

SPEAKER_01 32:09

So generally we don't stress, and because often we're asked to review babies at 24 hours because there hasn't been a documented pee between delivery and 24 hours. But when you ask, when you look at the notes, sometimes you see baby peed on delivery documented. That's why it's really important to document that. Okay. Um, if you're a midwife listening, just because we kind of look at that to see, well, they've peed at birth, so that's their bladder going to be empty until and then they're not taking in huge volumes of fluids to actually um colostrum is as laxative, so the thick muconium can like literally drain out for the first two days.

SPEAKER_03 32:46

Spectacular.

SPEAKER_01 32:47

Yeah, it transitions from this thick tarry muconium by day three, day four, it becomes kind of brown, greenish brown, and then the yellow CD by the end of the week.

SPEAKER_03 32:56

Okay.

SPEAKER_01 32:57

And the the frequency of poo's varies a lot as well.

SPEAKER_03 33:00

Yeah, so you hear a lot about this as well.

SPEAKER_01 33:02

Yes.

SPEAKER_03 33:03

And like it's it's to do with the individual child, it's to do with the kind of feed they're getting as well.

SPEAKER_01 33:07

Yeah.

SPEAKER_03 33:08

Um, and so again, I know you don't want to do red flags, but we're gonna have to do red flags soon.

SPEAKER_01 33:12

I'm gonna do the red flags now.

SPEAKER_03 33:13

Okay, thank you.

SPEAKER_01 33:14

Okay, so what uh uh just to finish the common causes of slow weight gain, feeding technique, poor latch, um, underdiluted, overdiluted formula, you know.

SPEAKER_03 33:23

Okay, so if it's hot, if your baby's born in the summer and it's very hot, yeah, you do not change the recommended consistency of your formula. Yeah, you do not need to dilute things to give them more water. Yeah, it's liquid, they'll be okay.

SPEAKER_01 33:37

Um, but feeding by far is the most common thing, the feeding volume. So if you're breastfeeding, we look at latch, we look at technique, we look at tongue tie. Sometimes babies that have delivered by forceps or kiwi may have a sore head, may have a bit of a stiff neck, so they can only feed on one side and the other side is uncomfortable for them. Yeah, so sometimes positioning can be a challenge following an instrumental delivery. So that's something we kind of we look at all of that with formula-fed babies. Granted, they don't have as much issues in terms of weight gain and things like that, but it you know, we can we can still have it. Other things could be if they are medical issues, but this is rare, thankfully, heart disease, infections, yeah, and things like that. We always consider that, you know. Um, and sometimes, you know, social factors, stress, inconsistent milk supply. If the mum is suffering from postnatal depression, we always have to make sure that that isn't a factor contributing to feeding issues, you know. Okay. Without obviously laying blame, but it's something to to to address.

SPEAKER_03 34:36

Well, I suppose mum and baby come as a diet, they come as a kind of a two-part unit.

SPEAKER_01 34:41

Yeah. So when do I worry? The red flags finally, especially in a baby less than six months of age. If by two weeks to three weeks of age they're still at 10% weight loss or they haven't really shown signs that they're approaching their birth weight again.

SPEAKER_04 34:55

Okay.

SPEAKER_01 34:56

Okay. If there is a drop across more than two major scentile lines. So if you were born on the 15th centile and you come to me at six weeks and you're on the 10th centile, there's an issue there. Yeah. Generally. Right? If there are less than once peeing is established, if they're peeing less than six wet nappies a day, or if the urine is quite dark, okay. Okay, if you notice dryness around the mouth, if the baby's lethargic, isn't finishing their feed, sweating, turning blue, and there's no weight gain for a considerable amount of time, like over a week.

SPEAKER_03 35:31

The lethargy bit is a bit tricky to spot. I like you know, says the woman who, you know, wasn't great at seeing it in her own children. Yeah. Um because sometimes babies are just sleepy and they have a sleepy day.

SPEAKER_01 35:43

Yeah.

SPEAKER_03 35:44

You know, and so like when is lethargy lethargy? It's hard.

SPEAKER_01 35:48

When lethargy is is it's it's persistent.

SPEAKER_03 35:50

Okay.

SPEAKER_01 35:50

Right? The baby's um uh you know, pattern throughout the day is very variable, very erratic. They will they should wake up to feed or they should show signs of feeding and feeding cues pretty much every couple of hours, every three to four hours. When they're very little. When they're very little. So if even yeah, so if a baby is sleeping for six, seven hour stretches, especially over the first two weeks and not waking up to feed, there's generally an issue there that we need to look at.

SPEAKER_04 36:17

Yeah.

SPEAKER_01 36:17

And if they are not getting enough milk, they do tend to go into shutdown mode where they try and preserve their energy and they don't wake up as often to feed.

SPEAKER_04 36:26

Okay.

SPEAKER_01 36:26

Because there isn't enough energy. And once you replenish that volume, you will find them waking up and being more vigorous. So oftentimes, when there are challenges with breastfeeding, we sometimes recommend formula while we're working on the mother re-establishing her milk supply or working on the latch, working on maybe releasing a tongue tie if it's there, in order for the baby to be able to get enough strength so that they can actually do an effective latch and milk transfer, yeah, you know, on a temporary basis.

SPEAKER_03 36:54

But there are those unicorn children, and my our our nephew was one that like slept for long stretches early. But it doesn't mean that the baby's lethargic or anything like that, especially if they're feeding well during the day and very appropriate and growing well and doing all the wet nappies and all those kind of things during the day. The unicorn children, very few of them exist.

SPEAKER_01 37:16

Yeah, and you do exist. And you asked me uh about whether you should wake a baby up to feed. I mean, the answer to that is not straightforward, right? Um, generally, babies that have come to the neonatal intensive care unit, babies that are small for gestational age, babies that are born to mothers with gestational diabetes that was not well controlled for whatever reason, babies that are large for gestational age, we tend to say don't leave them for more than three to four hours without a feed in the initial period.

SPEAKER_03 37:43

Because metabolically they're a little bit more prone to low blood sugars.

SPEAKER_01 37:47

Correct.

SPEAKER_03 37:47

Yeah.

SPEAKER_01 37:47

In a healthy normal baby, I always advise the parents to follow the baby's cues, right? A baby, it is unlikely that a baby at a week of age or even two weeks of age will sleep for more than a four to five hour stretch. Right? Um, so what I generally say to the parents is you will find that the baby will wake up naturally through their natural kind of sleep and wake cycles to feed and show you their feeding patterns. So I often say that if you do a feed at midnight, like I wouldn't set my alarm for 3 a.m. You'll be hyper-vigilant anyway when your baby's with you. If you notice that the baby's showing signs of um cue based or they're waking up or they're making a whimper, you know, you can then feed them then. Um you know, if you're nervous, you can wake up and see what your baby's like, but oftentimes the baby will let you know that they need to feed. Remember, back in the olden days, there were no alarm clocks, you know, the babies let you know when they were when they were feeding. So following a cue-based approach to their feeding. Yeah, a lot of the time um I have parents coming to me at six weeks of age for the six-week check, saying, Do we still have to wake our baby up? And I say no, let them. And then sometimes they oh, we slept through the alarm, the baby slept for five hours and we were so worried. That's fine. That's awesome. That's fine. Just to put it in context, a lot of parents don't know this. But when a baby is admitted to our neonatal intensive care unit with significant sugar issues, let's say they have hyperinsulinism, or the baby was born to a mother with gestational diabetes and they're overproducing insulin. Go back, go back to the gestational diabetes episode that we did where we describe this in detail. We do a um fasting challenge on the baby. Okay. Where we before we let them go home, in order to make sure that they are will remain safe, we'll fast them for six to eight hours.

SPEAKER_03 39:40

Oh my gosh.

SPEAKER_01 39:40

To make sure that they can continue maintaining their own blood sugars through fasting period.

SPEAKER_03 39:45

Yeah.

SPEAKER_01 39:45

And they they'll let go home once at eight hours of eight, at eight hours following this the the fast, that they're maintaining their blood sugar. I know it sounds I know it sounds um barbaric, but it is it is it is necessary to see that the baby's remaining.

SPEAKER_03 40:01

And it's done in a supervised.

SPEAKER_01 40:03

Yes, so we check we check the glucose very regularly, and obviously we intervene if it goes below.

SPEAKER_03 40:13

So if a baby manages to sleep five or six hours and they're well and they're feeding well at the rest of the day and make up anything they lost during that five or six hours, yeah, great. Count yourself lucky. You've got a very you've got a child who loves to sleep well done.

SPEAKER_01 40:29

Yeah, yeah.

SPEAKER_03 40:30

Okay, fantastic.

SPEAKER_01 40:31

Yeah, so and so that's the feeding in general.

SPEAKER_03 40:35

Yeah.

SPEAKER_01 40:36

Um, up until six months, and we had a lot of questions about when to wean.

SPEAKER_03 40:43

Now we did so much weaning episodes, and yourself and Katie have dis have discussed weaning as well, haven't you?

SPEAKER_01 40:48

We did a lot of weaning episodes.

SPEAKER_03 40:50

Yeah.

SPEAKER_01 40:51

Now, I'm just going to summarize the weaning literature.

SPEAKER_04 40:56

Okay.

SPEAKER_01 40:57

And as you said, we have like three or four weaning episodes that are really, really good that a lot of parents can read. From lots of different perspectives.

SPEAKER_03 41:04

But the one thing I would say is that we also did talk to Jonathan Horhan about food intolerances and allergies. Yeah. And that does uh no pun intended feed into this as well.

SPEAKER_01 41:16

It does feed into this.

SPEAKER_03 41:17

So, what's your view on all of that?

SPEAKER_01 41:19

So there isn't a cutoff age after which a baby's ready for solids in general. Okay. The World Health Organization's recommendation is six months. But that advice comes from a place where they recognize that the advice they give is universal and it involves a lot of places where food security isn't as assured as here.

SPEAKER_04 41:44

Yeah.

SPEAKER_01 41:45

Where there is um, you know, issues with clean water, availability of food, and things like that. So it's to minimize the impact on babies. However, in a place, thankfully, where resource, you know, um food resources and things like that is not a major issue, waiting until six months sometimes is not um you know the best thing to do.

SPEAKER_04 42:10

Okay.

SPEAKER_01 42:11

The reason for that is what Jonathan Horhan said, and there's a lot of research showing that there is a tolerance window um during which it's good to introduce allergens and foods in order to build immune tolerance for these foods, right? So rather than waiting for an arbitrary cutoff, it's far better to look at signs of readiness in a baby.

SPEAKER_04 42:33

Okay.

SPEAKER_01 42:34

Okay, and those signs of readiness include being able to sit up in a baby chair with support. Yeah. Now, a lot of parents misunderstand this as sitting independently. Yeah. That does not happen until nine months.

SPEAKER_04 42:45

Yeah.

SPEAKER_01 42:46

So a baby's unable to sit independently until nine months of age, roughly. You know, between five and six months, if you put them in a baby chair with support, they can sit up straight.

SPEAKER_04 42:56

Yeah. Yeah.

SPEAKER_01 42:57

They're able to reach out for things and put them in in their mouth. They they show interest in food and they lose their tongue thrust reflex, which is if you put solids in the baby's mouth, they push it out with their tongue. They push it out with their tongue. Most babies at four months will not be ready.

SPEAKER_03 43:17

No.

SPEAKER_01 43:18

Right? Now, another caveat that I want to mention that a lot of parents don't think about, right? Imagine a baby born on the first of November at 37 weeks, and in the room next door, a baby is born same day but at 42 weeks.

SPEAKER_04 43:35

Yeah.

SPEAKER_01 43:36

There's about a month to five weeks in terms of maturity between those two babies. Yeah, absolutely. The baby born at 37 weeks is unlikely to be ready to at four months. At four to five months. Because they are still a month behind. A month behind the baby next door, who at five months of chronological age is closer to six months. Does that make sense? Yeah, no, I don't know. So look at the gestation of your baby. This is why bringing it To signs of readiness is far more important than arbitrary cutoff.

SPEAKER_03 44:04

Every time you say signs of readiness, I think of my sister. When she had her middle child, she she's fantastic at breastfeeding and she breastfed all her kids. But when her middle child was about five months, he she used to have to turn her back on him and hide if she was having a snack. Because he would just look at her with such longing for the food. And she was sticking to the WHO recommendations. Yeah. And I think he and like he was well fed, he was a thriving child. Yeah. But he had such curiosity for her food, then, like, you know, and I just think of it every single time we hear talk about readiness. So probably if you're finding that your child is looking at your food so longingly, that you have to like turn your back and hide in the corner to eat, potentially you might consider the ready.

SPEAKER_01 44:55

Yeah. And so in general, I think sometimes I think four months is too early in general.

SPEAKER_04 45:02

Yeah.

SPEAKER_01 45:02

Right. And waiting up to six months is sometimes not necessary. Does that make sense? So there isn't like an arbitrary cutoff at either end.

SPEAKER_04 45:11

Yeah.

SPEAKER_01 45:12

Um, somewhere between five to six months for me is an ideal window that hits all of those caveats.

SPEAKER_03 45:18

And the food tolerance bit.

SPEAKER_01 45:19

And the food tolerance bit. And start allergens early.

SPEAKER_03 45:22

Yeah.

SPEAKER_01 45:22

One at a time.

SPEAKER_03 45:24

Yeah.

SPEAKER_01 45:24

And once you introduce an allergen in your baby's diet, keep it in your baby's diet. Yeah. Yes.

SPEAKER_03 45:30

And for allergens then, specifically any particular ones?

SPEAKER_01 45:34

So we're talking about the common ones: fish, egg, dairy, nuts.

SPEAKER_03 45:39

Okay.

SPEAKER_01 45:39

Yeah. Um, you know, so you can introduce them in the diet after an initial period of you know, giving them purees and things like that. Go and listen to our weaning episode to get a more of a deep dive into but that there's some good rules of thumb. Yeah, and remember the first two months, they're just experimenting with food. I got a lot of questions about my baby keeps spitting it out after chewing it for a while. That is perfectly normal. They're just experimenting.

SPEAKER_03 46:06

Yeah, they're they're in a curiosity phase rather than seeing it as sustenance.

SPEAKER_01 46:10

Yes, they're not getting they're still getting the majority of their nutrition from their milk. A lot of parents have asked me whether if they are concerned about the iron intake of their babies, should they switch from stage one to stage two formula?

SPEAKER_03 46:23

I was gonna ask you about that.

SPEAKER_01 46:24

Yeah, so I I again, and we talked about this before. The main difference between stage one and stage two formula, they're new nutritionally almost the same. Stage two has double the amount of iron that stage one has and a bit more calcium.

SPEAKER_03 46:37

Yeah, and does that that changeover does that impact the baby's gut in any way in terms of iron tolerance or iron? So there's intolerance?

SPEAKER_01 46:45

There is there is a a theoretical concern. I don't want to concern parents that are on stage two because stage two is perfectly fine. But the hesitancy with it is you don't need it if you are on a well-rounded diet, you don't need that extra iron, and there is a theoretical concern that that excess iron may inhibit the absorption of other um essential micronutrients. But a lot of parents switch for financial reasons. Okay, because stage one falls under the advertising restrictions. Yes. So you can't advertise stage one, and the reason the formula company cynically made stage two is to skirt around those restrictions. So they can so you this is why you see all the ads and then all the influencers talking about stage two, because they can advertise them, but also you can avail of discounts, use your club points, and get and it's cheaper. So a lot of parents switch and they ask me, Can I switch? It is cheaper, and the answer is cause any harm. No, they don't cause any harm. They are not needed, yeah, but that doesn't mean that they are harmful if you start them.

SPEAKER_03 47:49

And your baby is eligible for them after six months.

SPEAKER_01 47:52

Yes. Okay. The ones that are potentially harmful are stage three, the ones advertised after 12 months of age. Right? These ones have a fraction of the protein that cow milk has, yeah, and it has double the amount of sugar, free sugars, that cow milk has. They are sweet.

SPEAKER_03 48:10

That's why toddlers love them, because they're sweet as sweeties.

SPEAKER_01 48:13

They're dessert disguised as science as food. So there is never a situation, and I rarely use the word never, but there is never a situation where stage three formula is absolutely necessary. You you never need it. Okay. You never need it.

SPEAKER_03 48:28

And at that stage, to be honest, they're probably, if there's no cow's milk protein allergy and stuff, they're potentially onto milk.

SPEAKER_01 48:35

And a lot of the time parents ask, What should I do? You switch to cow milk.

SPEAKER_03 48:39

Yeah.

SPEAKER_01 48:39

How much cow milk should my baby take? There isn't a volume. Generally, no more than 400 because too much camel can constipate babies.

SPEAKER_03 48:47

Yeah. But 400 mils.

SPEAKER_01 48:50

Mills, yes. Babies that are eating lots of yogurt, lots of cheese, other forms of dairy don't need to drink cow milk.

SPEAKER_03 48:57

They can just drink water.

SPEAKER_01 48:58

They can just drink water, yeah.

SPEAKER_03 49:00

Yeah.

SPEAKER_01 49:00

Exactly. Exactly. Well, Anne.

SPEAKER_03 49:03

I know we covered a lot.

SPEAKER_01 49:04

We covered a lot.

SPEAKER_03 49:06

And just to kind of summarize, I was about to say, is there anything else that we haven't covered that you feel like you want to say? Because you love asking that question.

SPEAKER_01 49:13

Thank you for asking me that. I want to say a couple of things. Growth charts help us spot patterns. They don't define your baby and they don't define the care that you have provided for your baby.

SPEAKER_03 49:23

Yeah. And then the other thing is that if you have a constitutionally small baby, your petite, your baby's petite, there's nothing wrong with that. They are perfectly healthy. They are just themselves.

SPEAKER_01 49:34

Yeah. And there is no shame in the 10th centile.

SPEAKER_03 49:37

Nope.

SPEAKER_01 49:37

There is no medal for the 90th centile.

SPEAKER_03 49:40

Nope.

SPEAKER_01 49:40

And healthy growth is about consistency and context.

SPEAKER_03 49:43

Yeah.

SPEAKER_01 49:43

Don't compare yourself to other babies. No. Or other parents.

SPEAKER_03 49:48

And you know your child best.

SPEAKER_01 49:50

Yeah, exactly. So Anne, I am a bit sad.

SPEAKER_03 49:54

Really? Why?

SPEAKER_01 49:55

Because I like doing this, and then we're gonna have a break.

SPEAKER_03 49:58

You'll still see me. Like you we I'm not sad. We're down the end of the garden if we live together. You'll still see me every day.

SPEAKER_01 50:04

Like, I'm not gonna miss the parents. No, I'm not talking about you.

SPEAKER_03 50:07

Oh, okay. Sorry.

SPEAKER_01 50:08

I'm gonna miss all the nice comments that I get after every episode. Did you think that I was gonna miss Chat and I'll be able to do that?

SPEAKER_03 50:13

You'll still be trolling for likes on your Instagram. Don't worry, I know you.

SPEAKER_01 50:17

I'll still be trolling for likes. You will.

SPEAKER_03 50:18

Don't worry, you'll still put Buddy on there. You'll be fine.

SPEAKER_01 50:21

I know, I know. Guys, thank you so much for sticking with us. Thank you so much for listening throughout the year. We will be back, please, God, in the early new year with more guests, more insightful conversations.

SPEAKER_03 50:32

I think that's a loose terminology there, but go on.

SPEAKER_01 50:35

We're gonna do more solo guest list episodes. Yeah, because people like that apparently. So to every parent listening, you've made it through another year of the wildest ride there is at all. We'll see you early next year.

SPEAKER_03 50:47

By that we mean parenthood, not the not the baby tribe. And yeah, just just maybe watch the festive cuddles, yeah. Or else you'll have another another one to add to the tribe for September, huh?

SPEAKER_01 50:59

Yeah, and yeah, because me and Anne want to take September off next year. So are we? Yeah, we're gonna go on a holiday.

SPEAKER_03 51:04

Oh, I didn't know this. This is all news to me.

SPEAKER_01 51:06

Yeah, exactly. So yeah, so don't don't have no cuddles, like delay your cuddles. Delay your cuddles for a little bit. Have them now, right now. Turn off the podcast. Find your partner. Have a cuddle, and on this bumpshell, we will chat to you next year. Bye. Bye. The Baby Tribe is proudly sponsored by Happytummy.ie, the exclusive distributor of Bayagaya Probiotics, providing support for gut and oral health for the whole family.

SPEAKER_00 51:34

This show is part of the Headstuff Podcast Network, a hub for the creative and the curious. Shows are produced in association with Headstuff and the Podcast Studios Dublin. Find out more or become a member at Headstuff Podcasts.com.