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Poor Weight Gain - Update #10

post #1 of 17
Thread Starter 
We just did my 4 month visit today (DD is actually 4.5 months), and her pediatrician wants her supplemented on formula.

I'm very confused... She has issues with weight gain ever since she was about 2-3 months old, but at our last checkup he told me he wanted us to raise her weight to 2.5-3 oz a week. DD is hitting all her milestones, doesn't appear to be unhappy, and eats on demand all the time. And we got her up to 2.5-3 oz a week...but now the pediatrician's freaking out.

I agree she's small. She's currently 10 pounds, and 24" (according to the doctor, but I measured her at 24.5"). When she was born she was 7 pounds and 21". It seems like she should weigh more... But the doctor told me at our last appointment that we didn't need to worry about supplementing until it was a last resort (he said he'd tell us to see a LC first). But now he's super concerned, and wants us to feed formula (it smells disgusting). I wish he would have told me to see a LC at the last appointment.

I feel like a horrible mother!
post #2 of 17
I can understand your doctor's concern about the slow weight gain, and I'm angry that he didn't send you to an LC before! Not very supportive of breastfeeding!

Get to an LC as soon as possible. You can supplement with your milk instead of formula at the breast, and work on increasing milk transfer while your baby nurses. How are you giving the formula? If you give it with a tube at the breast at least baby is getting your milk at the same time. Are you able to pump? You could give your pumped milk instead of formula.

Have you seen an LC before? Is there any chance your baby has a tongue-tie? Where does she sleep at night and how often do you nurse through the night?

You may like to take a look at the low supply stickie at the top of this forum - lots and lots of good advice about increasing supply and baby's intake.

Also, you may want to see how baby's growth looks on the WHO chart: http://www.who.int/childgrowth/stand...irls_p_0_6.pdf

hang in there and keep breastfeeding!
post #3 of 17
You gotta look at the baby, not the numbers! How are wet/poopy diapers? You say she is meeting milestones and is gaining 2.5-3oz per week, so she is gaining, just slowly. I would not give formula at this point. Keep nursing.
post #4 of 17
Thread Starter 
Quote:
Originally Posted by mysticmomma View Post
You gotta look at the baby, not the numbers! How are wet/poopy diapers? You say she is meeting milestones and is gaining 2.5-3oz per week, so she is gaining, just slowly. I would not give formula at this point. Keep nursing.
That's what I think, too, but the doctor wants raise her weight up so her weight is higher at 6 months... He says then solids will raise her weight. Not sure what to think about that. I am not force-feeding DD rice cereal (only doing baby-led solids), and I don't want her to wean until well after one (hopefully up to 2). I read another thread where someone brought up drizzling olive oil on foods and when I mentioned it to the Dr. he seemed on board with it.

Quote:
Originally Posted by PatioGardener View Post
I can understand your doctor's concern about the slow weight gain, and I'm angry that he didn't send you to an LC before! Not very supportive of breastfeeding!

Get to an LC as soon as possible. You can supplement with your milk instead of formula at the breast, and work on increasing milk transfer while your baby nurses. How are you giving the formula? If you give it with a tube at the breast at least baby is getting your milk at the same time. Are you able to pump? You could give your pumped milk instead of formula.

Have you seen an LC before? Is there any chance your baby has a tongue-tie? Where does she sleep at night and how often do you nurse through the night?

You may like to take a look at the low supply stickie at the top of this forum - lots and lots of good advice about increasing supply and baby's intake.

Also, you may want to see how baby's growth looks on the WHO chart: http://www.who.int/childgrowth/stand...irls_p_0_6.pdf

hang in there and keep breastfeeding!
Thank you!

DD isn't tongue-tied. I asked the Dr. to look for it today, bc I was concerned it could be genetic in my family (my sister was but my mom didn't find out until too late...like years later).

DD's doctor says he wants to see if DD can gain weight with the help of supplements, bc if not, he is concerned she may be experiencing metabolic or heart issues. If she gains, he wants to wean her off it pretty quickly. He gave us lots of hypoallergenic formula (I told him no way to dairy formula as she is sensitive to it).

I saw a LC once in our hospital when dd was born. It was very brief and she gave me a thumbs up for our latch... The problem is it was the football hold and DD outgrew my arms for that very shortly afterwards (more on that below).

I made a call to a local LC today that someone here recommended, and I'm also talking to one tomorrow who is at my birthing center. The first LC I spoke with feels I should use formula right now as DD is so skinny, but in small amounts (2 1.5 oz feedings a night).

When I told her the doctor expected DD to gain 2 pounds in 1.5 weeks, she laughed and said "no way that's going to happen." I have to agree with her. As much as I like DD's doctor and believe he's trying to help, I felt it was a little nutty he wants her to gain so much in such a short time... Of course, I could have misunderstood (DD was crying very loud and it was hard to hear), but I asked twice.

The Plan So Far - LC#1 is planning to hook me up with a hospital grade pump and a special feeder for DD (when she takes formula) that is supposed to make her latch stronger. I'm going to be tested for thyroid issues to make sure that's not the problem. I have a feeling everything is pretty normal, but I have had some symptoms of low thyroid since the end of pregnancy... Of course a lot of that could very well be from being so tired. I had incredible insomnia during pregnancy and stayed up a lot with DD...now I wake up after 4 hours to feed each night (even if DD isn't getting me up).

We tried formula. I am hoping we won't have to do it long (if at all), but I want to hear it from at least one LC, before tossing out the idea. This baby needs to eat!

To me it smells nasty. To DH, it smells like cheese puffs. We tried DD on it tonight (I'm only having DH feed it to her to help avoid nipple preference), she drank it but kept reaching for me the whole time. DD seems indifferent to it. She only took .5 ounce, and wanted Mommy right away. DH thinks she didn't want to drink from the bottle bc her mouth was sore (she's taken BM in the past from a bottle without hesitation). I think she really prefers BM.

I'm going to talk to a few pros about this before completely settling on a plan. DD's Dr. (who has actually been very supportive of EBFing up to this point) knows more than most pediatricians, but isn't totally in the know about BFing. For example, he pushed D-drops, and told me that white babies are at risk for vitamin D deficiency, but everything I read said dark-skinned babies are). That is not a big deal, but it sort of makes me question his credibility on feeding issues.

I have a really strong feeling I'm screwing up the latch. I was doing the football hold when DD was a newborn and infant. During that time, she was gaining fantastically (plus the LC at the hospital gave a big thumbs up to it). However, she outgrew it in the first or second month, and I ended up doing a clutch...but it's hard to tell her if her lips are flanged. When I can see, they often appear flanged 1/2 the time (she sometimes sucks in the upper lip), and it's been hard to get her to do it properly.

I really hope I'm right...bc if so, it may not be simple (though not easy) to fix, and it'd be nice for DD to fatten up without formula.
post #5 of 17
So far it sounds like you have a good plan, and an awesome attitude Of course that baby needs to eat

I hope you start to gets lots of milk by the pump so you can ditch the formula and give extra breastmilk instead - I'm sending good pumping vibes your way.

I think your doctor may have some unrealistic goals for weight gain - but who knows, maybe baby will really start to gain a lot and get back on her curve.

You are definitely not alone in this, Mama. I know a mum who had a happy, quiet baby who never cried and weighed only 9 oz above birthweight at 2 months. He just wasn't transfering milk well, and because of that her milk supply was slowly decreasing. Once she started to supplement at the breast with a tube, he gained normally. It took a while for him to 'catch up' to what his expected growth would be, but he did and is now a wonderful 3 year old who is still nursing

Some babies just don't fuss when they are hungry. So while milestones and temperment are important to consider, so is growth.

I hope the LC gives you some more great ideas, helps with the latch, and you're pumping up a storm soon - and then baby quickly gets back to all her meals at the breast. Good luck
post #6 of 17
Just a comment on the thyroid issues- as a hypothyroid nursing mama I have been shocked at how drastically a small change in my thyroid levels has affected my milk supply.

While getting your thyroid levels checked is a good thing to do, make sure you take the extra step and find out what they are and compare them to the "alt" normal values. Yes there ae two sets of normal -- what every lab in the US uses and what is actually recommended.

A great reference guide to interpreting: http://thyroid.about.com/library/how...yroid-test.htm
post #7 of 17
Is she getting enough hindmilk? I would pump or hand express out most of the foremilk so that she gets the fatty hindmilk. I would also block feed; several hours using only one breast then switch to the other.
post #8 of 17
Block feeding is used to decrease supply - I wouldn't be doing that. What matters for weight gain is the total milk intake, not more hindmilk. Nurse as much as you can, pump and supplement via LactAid if you want.
post #9 of 17
what a pp described about happy babies who really aren't growing describes my experience with DD - born at 7.11, weighed right around 9 lbs at 3 months (and would have been lower had we not started supplementing). Even the LC couldn't believe how good natured she was and commented that those are the "scary" babies - the ones that aren't getting enough to eat but you'd never know it from their temperment.

DD never gained consistently until we started EPing and giving formula to make up the difference (even on my best EP days I made maybe max 14 oz a day). Not saying that's what you'll have to do, BUT, when we did it DD gained like 9 oz in 3 days. Of course she ate like mad at first because she'd been close to starving for months, then settled down. I had talked with this LC about natural childbirth, etc and felt confident that she wouldn't recommend formula unless she felt it was really necessary. The funny thing is my ped wasn't concerned AT ALL - the LC actually called him and made an appt for us because she was so worried about our baby.

She is still skinny now at 8 months but growing ok and looks much healthier overall. I know it is so tough to start formula but ultimately like you said, baby's gotta eat Definitely look into tongue tie - i still think that's what happened to us, possibly combined with mild IGT for me too. But no one has taken me seriously about that and once we went to primarily bottles, it didn't matter as much anymore and I didn't want to take the risk of having to put an older infant under anaesthesia for something that might or might not help our problem.
post #10 of 17
Thread Starter 
We saw the LC today... DD has a bubble palete!!! Anyone got any 411 on this condition?

It's supposed to be rare, but I (and my sister...and probably my nephew) have one too. We are feeding her formula a couple times a day to get some weight on her. During that time I'm pumping with an awesome hospital grade pump. The LC thinks we may be able to stop pumping and formula in a couple months.
post #11 of 17
It's quite common to have a posterior (hard to diagnose if you don't know about them) tongue-tie with a bubble palate. Please read the tongue-tie sticky if you haven't already

CST may help with this condition - you may see something about that in the sticky, I can't remember. If you don't see anything, try posting again with bubble palate in the title - it's not that rare - I'm sure there are Mamas here have experience with it.

Often with a bubble palate you have to work on a deep but 'straight in' latch - the LC will probably have helped you with that. Often babies latch with the nipple pointing up to the roof of their mouth, but for a bubble palate a 'nipple right in pointed to the back of the head' latch often works better.

So glad to hear you are doing better with this and have a plan!
post #12 of 17
Thread Starter 
Quote:
Originally Posted by PatioGardener View Post
It's quite common to have a posterior (hard to diagnose if you don't know about them) tongue-tie with a bubble palate. Please read the tongue-tie sticky if you haven't already

CST may help with this condition - you may see something about that in the sticky, I can't remember. If you don't see anything, try posting again with bubble palate in the title - it's not that rare - I'm sure there are Mamas here have experience with it.

Often with a bubble palate you have to work on a deep but 'straight in' latch - the LC will probably have helped you with that. Often babies latch with the nipple pointing up to the roof of their mouth, but for a bubble palate a 'nipple right in pointed to the back of the head' latch often works better.

So glad to hear you are doing better with this and have a plan!

Both the doctor and the LC looked for tongue tie, but it looks like she doesn't have it. What exactly is CST?

The LC is having us nurse tummy-to-tummy, and it seems to be helping (DD is staying on longer).
post #13 of 17
Craniosacral therapist.
post #14 of 17
Quote:
Originally Posted by mysticmomma View Post
Craniosacral therapist.

To the OP you should really look into this. It worked wonders for us!!
post #15 of 17
Quote:
Originally Posted by Indigomama View Post
Just a comment on the thyroid issues- as a hypothyroid nursing mama I have been shocked at how drastically a small change in my thyroid levels has affected my milk supply.
Please elaborate. Did upping thyroid levels with meds increase or decrease supply?
post #16 of 17
Thread Starter 
Wow... DD gained 4 ounces yesterday!!! :::

She was happy and energetic (per usual), but much, much more vocal and has been trying to crawl. I think what threw everyone off is she's a very amazing happy-go-lucky kid and an early developer... I should have paid attention to this, bc both me and DH were early developers...except he didn't start talking until after he was 2.

Anyhow, iI]f she keeps gaining at this rate (or even a little slower), I bet she'll be back on track by the time she's 6 months. The LC has been awesome!

...I think her palate is genetically formed versus tongue formed (usually they form from a tongue tie...the tongue rubbing the palate). I have one too, and neither of us have a tongue tie. From what I've read of others' experiences, I'm really lucky it hasn't been painful for me to nurse.

There's a good chance we may be able to go back to exclusive BFing in a month or two after DD's gained some size (as long as I can get my supply up or keep it up). Both the pediatrician and LC believe it.

When she was about 2-3 months, we were doing okay as long as I was pumping a lot (I had a cheapy pump). Unfortunately, I dropped the pump, and I think it lost suction. Now, I'm doing different positions with nursing (including tummy-to-tummy and going back to a modified football hold), taking herbs, and pumping with a hospital grade pump (especially when Dad supplements her). My hope is the pumping keeps my supply up and gives us an ample supple of BM if we need to supplement her after weaning off of formula.

I'm feeling really optimistic! :::

I found a couple good links on high/bubble palates:

http://www.brianpalmerdds.com/pdf/section_A.pdf
(techie, but has lots of great diagrams and 411)

http://www.mother-2-mother.com/nippl...htm#HighPalate
(this explains why we were doing good the first month...I was using the football hold a lot, but she outgrew my arm)

If someone can't have their LC look for it, a dentist will usually know what kind of palate a baby has. Pediatricians and midwives not so much so.
post #17 of 17
So glad it's going better.
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