Baby not gaining weight?

[MaddieMay]

My four month old hasn't gained any weight in the past month-I noticed his pants were loose and so we weighed him at home. He is give or take an ounce the same weight he was at his three month WBV (where he was 50th percentile, FWIW). I can tell he's grown in length, but we haven't measured him yet so I'm not sure exactly how much.

He is breastfed and eats about 5-6 times a day and sleeps 8-10 hours at night. Sometimes he cluster feeds every hour and a half in the evenings. He takes a bottle once in a while and will eat about 5-5.5 ounces. He's happy most of the time, has plenty of wet diapers and BMs and is meeting/exceeding his developmental milestones.

Should I be concerned? The reason I ask is I live in a very mainstream community and I'm afraid my doctor is going to freak out on me at his next visit. I don't have a problem standing up to her, but I wanted to get some advice here first to make sure I'm not missing anything.

[PatioGardener]

If I were you I'd rent a good scale and weigh baby (naked) and then again 24 or 48 hours later. At 4 months you would expect a breastfed baby to grow about 0.5 oz a day. Sometimes the scale if off and weight gain is actually fine.

But if baby has really only gained 1 oz in 1 month at 4 months old I would be worried. Any chance you can see an LC?

If the weight gain really is that low, it worries me that baby is only nursing 5 times in 24 hours. Are you offering more often? Can you squeeze in more feeds? Do you co-sleep? Many babies stop sleeping through the night at 4 months and wake to feed more often. Also, at 4 months they often get distracted and need more quite opportunities to nurse.

Here is a great chart to see if baby is following a typical growth pattern: http://www.who.int/childgrowth/stand...boys_p_0_6.pdf

[ewe+lamb]

PatioGardener has pointed something out that nursing 5 times a day isn't really enough, try having a weekend in bed - it's Friday so possible that you can spend a good amount of time together just cuddling together and really getting the nursing time up, if you could consider co-sleeping that would really help squeezing in an extra two or three breastfeeds per night - some babies can take up to 60% of their nutrition at night. Make sure that the baby is still nursing in a good efficient position - we sometimes forget once the nursing is fairly well established.

The only other thing I would like to ask was how was your supply earlier on - in the first couple or three months?

[MaddieMay]

We do cosleep, but he is seriously out like a light when it's bedtime. I wake up several times during the night just to make sure he's okay, but he's a really sound sleeper. He always has been-it's just he's went from sleeping 2 hour stretches, to 4, to 6, and now 8 and once in awhile 10.

I've been trying to increase his feedings in the evenings especially so he has a really full belly before bedtime. I'm hoping this will help.

My supply has been okay as long as I watch my fluid intake. I have about 100oz. in the freezer that I can pull from if needed, but I haven't really seen the need to yet. He always seems satisfied after a feeding, so wouldn't that mean he's getting enough? I let him nurse on one side until he pulls off and then he nurses the other side.

One thing I have noticed though that could be related is that his nursing times have shortened to about half of what they used to be (from about 20 min sessions to 10 min sessions). I had an LC come out awhile ago to check his latch and everything looks good.

The other thing is that he is INCREDIBLY active-super active. When he's awake, he has to be moving. He is a really alert baby-I wear him a lot, which he loves. He is not content to be still, always has to be moving and in the world watching things, bouncing around. Now that I think of it, it probably is a good idea to start nursing him in a quiet place so he can focus more. Maybe that will help.

I'm just afraid that my doctor will immediately jump to formula and I've worked so, so hard to continue nursing in a mainstream community with little support.

[PatioGardener]

Originally Posted by MaddieMay

I'm just afraid that my doctor will immediately jump to formula and I've worked so, so hard to continue nursing in a mainstream community with little support.

If you go in with a plan of action it may help. Formula should never been the first response, but not all doctors know that (as we are all aware ). But having a plan to weigh on the same scale, increase intake etc may be all it takes to get your doc on board. Plus we all are aware of why exclusive breastfeeding is recommended until 6 months - the increase in respiratory and GI illness that comes with not exclusively breastfeeding is something any good doctor would want to avoid.

Good luck with your appointment. I hope the weight gain is better than you think - who knows, really focusing on nursing this weekend may help a lot.

Other things you may want to check: Have you started anything that would decrease supply? Birth control pills? Sinus/cold/flu medication? Eating lots of mint or parsley?
Has baby been checked for tongue-tie? When mom has tonnes of milk at first, sometimes a tongue-tied baby grows well at first but is not able to transfer enough milk when mom's supply regulates.

That's all I can think of for now - hope you get it figured out!

[boobs4milk]

did you weigh him on the same scale as last time? two different scales = two different weights.

my 3 yr old was 5 lbs 1 oz at birth, 4lbs 10 oz at her lowest. at 4 mos she was 14 lbs, 5 mos 15 lbs, and then didn't really gain again until she was 9 mos. she was only 18 lbs at 1 and the peds tried to flip out on me. they didn't want to take into account that dad is tall and slender and i am tall and not heavy/not skinny (medium?). she's almost 4 and 33lbs and 39 3/4" and they still like to give me grief but i think she was just meant to be smaller than 'average.'

bf babies tend to slow their weight gain down around 4 mos and i'm wondering how much of it coincides with them becoming more active? good luck!!!

[Llyra]

My take on this is that yes, babies do slow down on their gain. But usually that happens in the second half of the year, when they begin to gain mobility. Four months sounds way too early for that. So yeah, I'd be mildly concerned, if I were the OP, and I think a mainstream doc will be concerned.

Formula isn't the answer. I think that if baby was gaining well earlier, it's clear that mama is capable of making enough milk to support baby's needs. Frankly, I think, OP, that you're not nursing often enough. Eight times a day, to me, would be my bare minimum for a child not yet on solid foods. Ten times is better.

If it were me, I'd be waking the child in the night to eat, at least twice, until baby's gain is back on track. A baby that sleeps through the night very early is a very common cause of slow weight gain. Your supply needs that stimulation. If a baby is healthy and gaining well, I would never wake a sleeping baby. But in this case, I think I would, at least until things are on track again.

[ewe+lamb]

Originally Posted by MaddieMay

We do cosleep, but he is seriously out like a light when it's bedtime. I wake up several times during the night just to make sure he's okay, but he's a really sound sleeper. He always has been-it's just he's went from sleeping 2 hour stretches, to 4, to 6, and now 8 and once in awhile 10.

So now we have to look at the temperature of the room and your baby, is sleeping, it takes ALOT less energy to stay asleep than to wake up or even not to wake up and nurse - KWIM? Tickle baby, put some breastmilk on your breast really try to get him to nurse every 2 hours at night to begin with, if you do that make sure that you manage to take the time during the day so you don't suffer from tiredness yourself. Your room where you sleep should be of a maximum of 18 degrees, you will only need (and your baby) pyjamas and a light duvet at this temperature.

Other thing is that I would really recommend that someone check his mouth by that I mean actually doing a finger exam in his mouth - an LC but maybe try and find an LC who is also an LLL Leader - there is a different between the two - or at least that is what i find. With a good supply babies can profit from an abundant milk supply and then when the breast needs to be stimulated they don't have the sucking skills hence having someone look at the suck. I can go into more details if you need this. make sure there are no hollow cheeks, that the tongue is ontop of the gums - you should manage to see this just at the side of the mouth - there are lots of other things but lets go with this for the timebeing and see how things go - keep posting and we'll get to the bottom of things!! You are doing a great job!!

[MaddieMay]

Thank you so much for all the advice! I know there is a small WIC office here that probably has a good scale-although we're not on WIC, I'm going to stop by and see if they'll allow me to use it to weigh him. I just don't want the doctor's office in my business until I'm sure there's a problem. His next WBV is in a few weeks.

I'm pouring through my copy of The Breastfeeding Answer Book from LLL and it does seem to agree that he needs more feedings. I guess I thought that feeding on demand would always be enough, but I'm thinking the sleeping through the night is what might be the cause of the lack of gain. It would make sense as that's when he started to level off and not gain.

I can't think of anything I've done or changed recently that would cause it, but I am going to have a LC (no LLL here) check him out again. It can't hurt. I definitely know that the tongue is on top of the gums, not sure about the hollow cheeks.

For now, the plan is to try to squeeze in an extra feeding during the day and then at night as well. Since we cosleep, it's not like it's hard to squeeze in an extra one at night either.

[ewe+lamb]

It sounds as if you've worked out the whys, now we just have to up the nursings - and you know what it's the weekend - why not go to bed with your baby for the next couple of days (or as much as possible) let him have free access to your milk and I'm sure that'll encourage some weight gain and more frequent breastfeeding, make this weekend your bonding weekend with lots of special things for you two, take a bath together, read stories, sing songs and play lullabies, and most of all breastfeed as much as possible.
keep in touch!! Good luck, and have a peaceful and relaxing weekend - ps. just re-check his position just to make sure that the latch and therefore transfer of milk is optimal!!

[AislinCarys]

Also, if I were you I might consider getting an SNS or lact-aid. If the doctor does insist on supplementing, you can assure him/her that you have plenty of frozen breastmilk, and that you'll feed your baby that. And rather than suddenly giving a lot of bottles you can keep baby at the breast for the short period (we struggled with weight gain, and at one point we had to make sure DD gained quite a bit from Thursday to Monday. We gave her frozen breastmilk, 50 ml 6 times a day at the end of feeds, and she gained well enough to satisfy the ped, who had threatened with hospitalization).

You are very welcome to pm me if you want some ideas on how to get a slow-gaining, happy, healthy, stong, pooing, weeing baby to gain, or if you just want to talk. We worked on it for 6 months, and DD is still breastfed at almost 21 months.