Low weight gain

[singin_mama]

Well we had a ped appt today and Sara has only gained 1 lb in two months. She was 8 lbs 9 oz at two weeks and 10 lbs at 2 mos and today is 11 lbs.

The NP wanted me to supplement with formula which I refuse to do. Sara is satisfied after a feeding and is having plenty of wet and dirty diapers and is on target with other development. But I am concerned about her not gaining. She went from over the 50th percentile down to the 10th.

So what can I do to beef up my milk and get her to gain more without adding empty calories or formula?

[singin_mama]

Here's the Kelly mom bf chart with Sara's weight marked:
http://i138.photobucket.com/albums/q243/phamphotos4us/saragrowthchart.jpg

[ima062002]

What was her birth weight? Has anything changed for you? Have you been ill, taken meds etc. that would have an effect on your supply the last two months? Has she at all been fussy at any point to indicate that you might make less milk?

Can you tell me what a normal feeding looks like? How much active sucking is going on? There are two things you can do:
- try to feed her more often, meaning offer every couple of hours and see if she'll take more. She might be too interested in the world around her and miss feedings
- cup the feeding breast and start gently massaging when her active sucking slows considerably or stops; like that you get more milk into her.

If you can see that this makes a difference in her intake, i.e. if she takes you up on more feeds and drinks more/longer, I would do that for a couple of weeks and then go back and reweigh her. If she is still not gaining more, then I would first make sure that there are no hidden hindrances that mess with your supply (http://www.breastfeed-essentials.com/hindrances.html) and if not, press the NP to exclude any possible medical issues. I want to make sure you understand that I am NOT implying that something is amiss but if a low weight gain cannot be explained by too little feeding, or low supply, it merits more investigation.

[ima062002]

I just looked at the chart and it shows that she's been steadily declining in percentiles. Have you seen an LC to check your baby's suckling? She might nurse in a way that does not draw enough milk. If you haven't seen anyone, I would probably do that. They have scales where they can figure out how much a baby takes in per feed and that will give you a good gauge if you are making enough if her latch and ability to suck effectively are not compromised in any way. Once you pin point the issue you can move on to find a strategy to fix it. I agree with you that formula is not the answer; at least not at this point.

[singin_mama]

Thanks
What was her birth weight? Has anything changed for you? Have you been ill, taken meds etc. that would have an effect on your supply the last two months? Has she at all been fussy at any point to indicate that you might make less milk?

Nothing happening in life or habits doing and eating the same stuff as ever.

Can you tell me what a normal feeding looks like? How much active sucking is going on? It takes a bit for my milk to letdown, but nothing strange there I've always been that way. She actively sucks for several minutes but doesn't do a lot of sucking after, she's not a comfort nurser at all! Once she's had enough she stops. She just started biting a few days ago when she is done.

There are two things you can do:
- try to feed her more often, meaning offer every couple of hours and see if she'll take more. She might be too interested in the world around her and miss feedings She bites if she's not hungry don't think that will go over well. LOL
- cup the feeding breast and start gently massaging when her active sucking slows considerably or stops; like that you get more milk into her.
I will try this. I have done that a few times in the past and it seems to bother her for some reason but I will try some more.

If you can see that this makes a difference in her intake, i.e. if she takes you up on more feeds and drinks more/longer, I would do that for a couple of weeks and then go back and reweigh her. If she is still not gaining more, then I would first make sure that there are no hidden hindrances that mess with your supply (http://www.breastfeed-essentials.com/hindrances.html) and if not, press the NP to exclude any possible medical issues. I want to make sure you understand that I am NOT implying that something is amiss but if a low weight gain cannot be explained by too little feeding, or low supply, it merits more investigation.

[singin_mama]

I just looked at the chart and it shows that she's been steadily declining in percentiles. Have you seen an LC to check your baby's suckling? She might nurse in a way that does not draw enough milk. If you haven't seen anyone, I would probably do that. .

I will try to get in with the LC at the hosp. I haven't been able to get ahold of my midwife I have tried several times to call her in the last few weeks because I was worried. I am by no means a worry wart but it just seemed like she wasn't gaining enough but since I don't have a scale I hoped I was just imagining it. Now I know I'm not.

[ima062002]

Can you tell me how she is not happy when you do the breast compression? The idea is to only do them when they slow considerably or stop (but with her biting that may not be a good idea); so I would watch her like a hawk and then start moving the milk gently towards her.

Here are:

http://asklenore.info/breastfeeding/additional_reading/movies/compression.wmv

http://asklenore.info/breastfeeding/additional_reading/movies/compression2.wmv

for some videos

[singin_mama]

Can you tell me how she is not happy when you do the breast compression? The idea is to only do them when they slow considerably or stop (but with her biting that may not be a good idea); so I would watch her like a hawk and then start moving the milk gently towards her.

Here are:

http://asklenore.info/breastfeeding/additional_reading/movies/compression.wmv

http://asklenore.info/breastfeeding/additional_reading/movies/compression2.wmv

for some videos


When I did it before it was because it seemed like she wasn't actively sucking very long but still seemed hungry but when I did the compression she would fuss and pull away.

I am thinking more that it is just supply but...She never nurses very long, usually only a few minutes, but she seems satisfied after. I just don't know. I don't feel a strong letdown and I have never really felt 'full' since she was born. I remember asking here once about the fact that I never got engorged in the beginning.

I did think of something that is different this time though. I have been drinking a cup of coffee nearly everyday. Half-caf and on Sundays regular at church. Could that be affecting my supply?

I feel so stupid right now.

[Nipple_nectar]

There is no evidence that suggests that caffeine decreases your supply but and this is a big but, if your baby is sensitive to it, she will nurse less, fuss at the breast and this will eventually lead to supply problems.

I would cut it out for a few days and see if things improve. Here is a link for you: http://www.kellymom.com/health/lifestyle/caffeine.html#milksupply

In the meantime, I agree that compressions would be the way to get in more milk at each feeding. You can also try a nursing necklace to keep her interest while nursing.

Counting wet diapers will also put your mind to rest about her input. You need to see a minimum of six wet diapers in a 24 hour period, if you see that then more than likely the transfer is good and she is just growing on her own curve.

I had a LO that kept dropping in percentiles and there really was no explanation for it. She is a healthy, robust four year old now so in hindsight, I wish I would have just not put so much weight into the charts. If she is happy, meeting milestones and you are seeing the appropriate amount of wet diapers, then I wouldn't worry.

[singin_mama]

Thanks N_N

She does pee plenty. I can't say we have six+ wet diapers a day since we are doing EC and sometimes we do pretty good LOL, but she does pee enough.

[KerryS]

While output is a fairly reliable measure of how much baby is getting, it's only secondary to appropriate weight gain. Meaning, it's okay to use output to know baby is doing well between ped visits, but it shouldn't be used INSTEAD of weight gain to assess how baby is doing.

[singin_mama]

While output is a fairly reliable measure of how much baby is getting, it's only secondary to appropriate weight gain. Meaning, it's okay to use output to know baby is doing well between ped visits, but it shouldn't be used INSTEAD of weight gain to assess how baby is doing.


Would you be concerned about her slow weight gain? And other than the compressions and formula supplementing what might I do to get her to nurse more and gain?

[KerryS]

Yes, the slow weight gain and dropping in percentiles would concern me. Not GROSSLY, but enough that I would take steps to try to increase her weight gain.

Haven't read the other posts closely, but what I would do:

Consult with an LC
Breast compression
Try to nurse more frequently
Pump for 5-10 minutes after each feeding
Turn around and feed everything you're able to pump back to the baby
Take domperidone

I would give it 3-4 weeks of diligently doing the above before I would even consider supplementation with formula.

[dodoe80]

Just My Two Cents:

My ds started out in the 87% and between his 2nd month and 5th month he only gaind 1 lb. 2 oz. and dropped down between the 10-25%. At his 6th month doctors visit he gained 1 lb. I don't know how much he weighs now but he is still continuing to gain weight. My ds always seemed satisfied and the doctor thought that maybe he was born larger and was just dropping to a percential that was one he would follow.

[singin_mama]

Yes, the slow weight gain and dropping in percentiles would concern me. Not GROSSLY, but enough that I would take steps to try to increase her weight gain.

Haven't read the other posts closely, but what I would do:

Consult with an LC I have tried to get a hold of one here but so far haven't heard back yet...I'll try again today.
Breast compression Don't know why, but this makes Sara plain mad!
Try to nurse more frequently Sara bites or just cries if she isn't ready to eat.
Pump for 5-10 minutes after each feeding This I can do
Turn around and feed everything you're able to pump back to the baby Will do
Take domperidone I'm not ready to do that...yet

I would give it 3-4 weeks of diligently doing the above before I would even consider supplementation with formula.

I am concerned. I felt that she wasn't gaining enough even before going to the ped but dismissed it because she seemed satisfied and had enough output and all my babies have been on the petite side.

[Amy_G_]

Just My Two Cents:

My ds started out in the 87% and between his 2nd month and 5th month he only gaind 1 lb. 2 oz. and dropped down between the 10-25%. At his 6th month doctors visit he gained 1 lb. I don't know how much he weighs now but he is still continuing to gain weight. My ds always seemed satisfied and the doctor thought that maybe he was born larger and was just dropping to a percential that was one he would follow.

This was my youngest son. He was born at 8lb, 3 oz, and he gained well the first 2 months, but then slowed his growth rate and found his own curve that was much lower. So I wouldn't freak out about baby's growth, but I would concentrate on a few things. I would NOT take domperidone unless I thought supply was really the issue.

I would try to have latch evaluated, but it's doubtful that is the issue if you have no soreness, and baby seems happy after breastfeeding. I would try breast compressions, but if she's not used to a faster flow of milk, she may be a bit fussy at first. If you put baby on one side per feeding I would sit her up, burp her and put her on the second side and encourage her to eat more. If you normally put baby on both sides in a feeding, I would gradually increase the amount of time on the first breast to ensure she gets the hindmilk. What color are her poopies?

[PSMommy]

Parker and Serra both had a major percentile drop at that age and have now just stayed steady at the 5-10%

[singin_mama]

I am discouraged today. I cannot get Sara to nurse longer or more often. The compressions only seem to make her mad. It is like after the milk stops coming fast she doesn't want to bother. And when I pump after she nurses (10 min per side) I get less than an ounce, more like a teaspoon maybe two. I have tried to get Sara to take what I pump and she will not. She won't take it from a bottle and if I use a syringe she screams so much that she ends up spitting it all back up.

I have paid more attention the last two days to how long she actually nurses and it is only about 3 minutes. About one of those minutes is when she is doing the suck-pause and I can hear her swallowing. That really wouldn't concern me if it was only that since I had another baby that nursed quick like that; but she gained weight just fine being about 14 lbs at 4 mos and was close to the same birth weight.

[Amy_G_]

I'd try to do a weight check before and after one of her feedings. the difference in ounces(same diaper, clothes etc) is the # of ounces of breastmilk she's taking in. And I'd encourage her to eat more often, but not make her scream about it. It's possible that she's just finding her own curve, but be proactive, watch it, a weigh in maybe in 2 weeks to a month, look for signs that she's not satisfied or happy or growing and hitting her milestones, count wet and poopy diapers. and try not to freak out about it. the amount of milk you get after a feeding is not that big of a deal, as many moms don't get much milk after a feeding. try to aim for one extra nursing session every 24 hours, wether it be dream feeds, or while she's awake. How long does she sleep at night? you didn't say how her poopies look?

[singin_mama]

She sometimes sleeps all night, but only rarely. Usually she wakes every 3-4 hours at night. Her poops are usually dark yellow although recently they have been a little green and today kind of 'frothy'.

[ima062002]

OK, one of the missing pieces is that your other babies are petite. That does factor in. I still think you ought to see a LC who could assess the feedings first hand. My son started dropping %iles around 9 mo. He dropped from 50th to minus 5th (over the course of another 9 mo) and then went back up to around the 5th where he is at now (he's 4). I worried, tested etc. Now his sister follows the same curve and I am a lot - A LOT- more relaxed about it. The older one is different. She's around the 25th percentile, pretty steady. Genetics do play a role, but personally I am glad I did check into other possibly medical reasons. For piece of mind.

[singin_mama]

My other kids have all been petite yes, but she was the biggest at birth and the others were 13-15+ lbs at 4 mos. The 13 lbs one was DD1 and she was 6 lbs 14 oz at birth and she had a different father. Take her out of the mix and my babies average 14-15 lbs at 4 mos.

I did get her to nurse quite a bit longer this morning nursing her while she was still sleepy.

[dodoe80]

One thing I should mention is when my DS wasn't gaining very much I did offer both breasts twice per feeding. (he normaly takes both per feeding) Sometimes he would take them a second time sometimes not. I did also add extra pumping sessions and took fenugreek to make sure I was producing enough, for my own piece of mind. Good luck and remember if you do end up having to supplement it isn't the worst thing that could happen. If you just can't make her eat then relax and keep offering chances are if she doesn't take a bottel of breast milk then she won't take a bottel of formula either.

Another thing is the greenish poop, that is usually associated with formilk/hindmilk imbalance.

[singin_mama]

Another thing is the greenish poop, that is usually associated with formilk/hindmilk imbalance.

I knew that. I can see that she might not be getting any hind milk since she nurses so briefly. It isn't like that all the time though. Only once yesterday and then it was normal again.

[Nipple_nectar]

I think it is time to consider that she may be teething and treat her for teething pain. If her gums hurt her when she is nursing, she will associate pain with nursing and will struggle and decrease her nursing time.

Im glad you know that green froth means she needs to stay on the first breast longer. It is actually a good sign that you are not getting alot of milk after a feeding, this means she is more than likely effectively emptying the breast.

[Kitten]

I had weight gain issues with both my two as well. I agree that you should take all the steps necessary to rule out a potential problem (i.e LC, Ped, etc).

Genetics played a huge role in my two dc's overall growth. At birth, ds weighed 8lbs 1oz and at 2 months was 11 lbs, 3 mos 11 lbs 6 oz, 4 mos 11 lbs 12 oz, 5 mos 11 lbs 15 oz. Then at 6 mos he jumped to 12 lbs 8 oz, 7 mos 12 lbs 15 oz, 9 mos 13 lbs 13 oz, 10 mos 14 lbs 7 oz, etc, etc, etc. I could give you all his stats, but you get the picture. He never gained a whole lb over the span of a months time.

I had a fantastic ped that took into consideration every possible thing, he sent us to both a LC and dietitian as well as looked at both dh and I, seeing that we are both small people and were very tiny as children/babies. He was happy that he was gaining, and when I expressed my concern about him only gaining 3 oz one month, he told me that at that time he wasn't concerned.

Ds never nursed for very long, maybe 5 mins at a time.

DD was a bit of a different baby. She was born at 5 lbs 2 oz and at 3 mos was 9 lbs 2oz, 4 mos she dropped to 8 lbs 10 oz, 5 mos 9 lbs, 6 mos 10 lbs 9 oz, 7 mos 12 lbs, 8 mos 13 lbs 2, 9 mos 14 lbs 4 oz, 10 mos 13 lbs 15 oz, etc, etc......

Dd's weight fluctuated all the time, making good gains, then losing weight. This was more concerning, seeing as ds never actually lost weight, he just gained it really, really slowly.

For dd, we tried to supplement until I got my supply up (we knew it was a supply issue) but dd would not take formula at all. I ended up pumping after every feed and in between as well, giving her the extra that I pumped after she fed. The only time I was able to pump anything, was when I started taking dom. When I first started pumping, I could get maybe 1/2 oz. After taking dom, and at my peak of pumping, I was pumping over 10 oz in one sitting. It was a beautiful thing.

Even with supplementing dd with my extra breast milk, she still did not gain with leaps and bounds, only gaining a little over a lb a month. At a year she was 16 lbs 4 oz.

Now at a little of 3 yrs, she is 27 lbs.

I just thought I'd share both my stories with you, seeing as they were similar but handling differently.

I hope you figure out what's going on.

[singin_mama]

I think it is time to consider that she may be teething and treat her for teething pain. If her gums hurt her when she is nursing, she will associate pain with nursing and will struggle and decrease her nursing time.

Im glad you know that green froth means she needs to stay on the first breast longer. It is actually a good sign that you are not getting alot of milk after a feeding, this means she is more than likely effectively emptying the breast.

I'd not even considered teething. I suppose it could be though. Time goes by too fast.

She's not been getting as mad with the compressions the last two days. And last night I think it actually made her nurse a bit longer.

I am going to call the ped this week and hopefully talk to her instead of the NP. Still haven't heard back from the LC. I may try calling the other hospital and talk to the one there.


Thanks Kitten. It is comforting to know that others have had similar problems.

[PrincessEmilysMommy]

My dd2 is a preemie, and was a very slow gainer. In the NICU she gained fairly well, then again she was getting oils to help fatten her up. Here are things the neonatologist instructed us to do, Add human milk fortifier to pumped breastmilk. This gives her extra calories and nutrients w/o the extra volume. I would also pump and refridgerate a bottle then later scoop the fat off of the top and add it to a bottle I just pumped, so she got extra hindmilk. I pumped each breast after each feeding also.

The hospital and ped we have are very pro bfing. They would never suggest supplementing formula over breastmilk. Perhaps adding a little formula to a pumped bottle of breastmilk a couple times each day, but never in place of.