EBF 4 month old losing weight

[dailyamayzed]

My DD was 6.9 at birth and 9 lb at 2 months. This week at her 4 month well baby check up she weighed 8.12 (with her jacket on) and 8.8 (jacket off) on the same scale.

My dr is suggesting I supplement with formula, has encouraged me to continue BF'ing but has no advice on how to proceed.

I am trying to find an LC to meet with, but would like some ideas.

Additional info:
I use a nipple sheild since the first week. (healing from cuts) and haven't gotten her to latch with out.

Feedings can last up to an hour. She isn't fussy. She is awake and content (when held or nursing ) all day and sleeps most of the night, usually 11 to 6 ish.

She also grew 3 inches in length and her head grew as well.

We also have been battling thrush for about a month. Could that be it??

I don't mind giving her some formula, but don't want to give up any nursing sessions for it.

Help?

[lalemma]

I am absolutely not an expert, just a breastfeeding mama. Here's some thoughts for you to take with a grain of salt:

First - can you re-weigh her on a different scale, just to double-check that her weight is about right? Does she look to you like she's grown/stayed the same/lost weight? Were you and your partner small babies? The losing weight thing doesn't sound great, but maybe she's just destined to be a pretty little baby? I would be less worried about a baby with parents who were long/skinny babies who isn't gaining than a baby whose parents were big roly-poly babies, you know?

Second - as soon as you hire an LC, can you ask about borrowing or renting one of those sensitive baby scales, so you can weigh her before and after a feeding and see how much she's actually transferring? It seems like there could be several things going on here: either she's not transferring very much (I know many people aren't fans of nipple shields for this reason - my son came home form the NICU only able to nurse with a shield, too. So I relate to how your struggle there - we had to wean him off over the course of a few days.) or she's transferring milk just fine, but something else is going on that leads to her not gaining weight, in which case formula won't necessarily be the answer either.

If your feedings last up to an hour, how much of that time is she actively sucking? Is she just happily camped out at the boob and comfort-nursing for most of it, or is she really trying to eat? I ask because if it takes her that long to get a full meal, her latch might be off.

If you decide you want to start supplementing with formula, sometimes people use supplemental nursing systems (you'll see them referred to as "SNS"), where your baby could take supplemental formula at the breast. Or there's always cup-feeding, if you're concerned about nipple confusion.

And I imagine you'd want to have her eat at the boob first, and then top her off with formula, not the other way around.

However, IF you discover that she's not transferring much milk, and you want to supplement, could you try pumping and supplementing with your own milk after each feed? Do you pump now? How's that going?

Anyway - yes, I think you'll really want to sit down with a LC and see what the two of you can brainstorm in the way of solutions. Good luck!

[strawberryprincess]

so it is really great that she has grown in length and head circumference but the weight loss is certainly worrisome.

if your milk supply is the issue, more nursing more often is the way to increase it. supplementing with formula generally exacerbates the problem of low supply rather than solves it. i know that your baby sleeping so long at night is wonderful, but could actually be part of the problem. trying to nurse at least once during the night may help both boost your supply and her weight.

is she taking a paci? to boost your supply all her comfort sucking should be at the breast.

getting her off the nipple shield should be a priority for you, as that can cause a decrease in milk. and having her latch checked would be a good idea.

also, looking at the number of wet and poopy diapers, and her alertness, acheiving mile stones, and overall contentment can also tell you if she is getting enough milk. Good luck and I hope you find a helpful LC!!

[dailyamayzed]

no paci here. she won't hold onto it. I found a local LC (I live in a small town, so that is amazing) and she is going to come over tomorrow to help. She is going to help me with the shield and possibly a SNS if needed.

We are little people but my baby should definitely not be SO skinny. I have two others that weren't this small. But also didn't have BM this long either!


I am anxious to get her weighed before AND after feeding so we know how much she is getting. Thanks for your help! I'll follow up... I hope to be able to continue EBF'ing!!

[cristeen]

Nipple shields can interfere with your supply I recently found out, because they prevent the direct contact with your breast. I'd suggest working on weaning her off of them and in the meantime add pumpings to try to increase your supply again. I'd also suggest starting supplements like fenugreek to help boost your supply.

I would also recommend that if you need to supplement her, do not use a bottle. Get yourself an SNS or Lact-Aid and supplement at the breast. Switching between the bottle and the breast will only make your latch problems worse.

Definitely find yourself a good LC for help with weaning off the shield.

[dachshund mom]

You might want to check out the domperidone thread. DD was not gaining early on, and I did supplement for a few months, but was able to get off the formula after starting dom. The trick is to only supplement with an ounce or two, after a good breastfeeding session when you get completely emptied, not between. She would let us know if she wanted more. Use slow flow nipples. Have DP feed the bottle when possible.

[PatioGardener]

Getting a good LC to check for a tongue-tie may help too.

[One_Girl]

I read a book on the La Leche League list by a doctor in Canada who works with lactation there and he told a story about a woman who nursed on a strict schedule but was able to do so with her baby thriving by nursing on one side all day and then on the other side all day the next day. He said the baby got a lot of the milk that was really good in fat because of nursing on just one side. I don't think the schedule is a great thing, but having him nurse from the same breast for several feedings in a row may be worth a try.

[dailyamayzed]

I found an LC and she was a huge help! She weighed my DD in at 8 lb 5 oz and she was 8 lb 7 oz after some feedings. She is not an efficient eater and supply has slowed to adjust. SO, the LC has me using an SNS (BM if avail/ formula if not) on one side then switch sides to just nurse, then pump for 10 minutes for extra stimulation. I am going to do this every 2-3 hrs or on demand. Also I am going to start fenugreek and some oats too.

"Sup Nip Pump" is my nick name for the routine

The LC is coming by today to reweigh DD. I am lucky that she lives only a few blocks away! Also she stopped my to see our family doctor and get her up to speed. That will be educational.

I hope this works! Thanks for all the advice... much appreciated!!

[TiredX2]

Originally Posted by dailyamayzed

I found an LC and she was a huge help! She weighed my DD in at 8 lb 5 oz and she was 8 lb 7 oz after some feedings. She is not an efficient eater and supply has slowed to adjust. SO, the LC has me using an SNS (BM if avail/ formula if not) on one side then switch sides to just nurse, then pump for 10 minutes for extra stimulation. I am going to do this every 2-3 hrs or on demand. Also I am going to start fenugreek and some oats too.

"Sup Nip Pump" is my nick name for the routine

The LC is coming by today to reweigh DD. I am lucky that she lives only a few blocks away! Also she stopped my to see our family doctor and get her up to speed. That will be educational.

I hope this works! Thanks for all the advice... much appreciated!!

I'm so glad to hear you got some help!

Are you working on weaning her off the nipple shield as well? As a PP mentioned that can cause supply difficulties.

[pittnurse08]

You're doing a great job, mama I had a similar experience a couple months ago. I started using nipple shields when my baby was 2 weeks old due to severe cracking and inverted nipples. My baby's weight gain was quite slow, averaging only 3 oz/week. Feedings lasted 45 minutes - 1 hour which I think contributed to the issue, because baby had to exert so much effort just to eat. After seeing an LC we started the same plan that you were given and things turned around quickly. You mentioned that baby often sleeps for 7 hours at night, you may want to consider doing a pumping session during that time so that your breasts receive more frequent stimulation. The biggest thing for us was getting rid of the shield. I only had to supplement with pumped milk for one week and baby started gaining 6-12 oz/week even without supplementation. After getting rid of the shield, she became a much more efficient nurser and could easily be satisfied in 10-15 minutes of nursing. I know how intimidating the idea of weaning off the shield is, but you can do it, and it may make a huge difference for you. I don't know if you're familiar with techniques for weaning from the shield, but kellymom has some great ideas http://www.kellymom.com/bf/concerns/...d.html#weaning . Please keep us updated on how you're doing.

[dailyamayzed]

Originally Posted by pittnurse08

I know how intimidating the idea of weaning off the shield is, but you can do it, and it may make a huge difference for you. I don't know if you're familiar with techniques for weaning from the shield, but kellymom has some great ideas http://www.kellymom.com/bf/concerns/...d.html#weaning . Please keep us updated on how you're doing.

Right now the LC is holding off on helping me wean from the shield until we get her weight stable. LO is dealing with a lot of adjustment with the supplements... But the LC also thought she should have her mouth checked. Her top lip/ gum looked like it may need help. Kinda like tongue tie on the top instead.

I am terrified to try and get rid of the shield but I also know we may have to. Thanks for telling me your story, I am very encouraged!

[ShwarmaQueen]

You're doing great!

[CookAMH]

Originally Posted by dailyamayzed

But the LC also thought she should have her mouth checked. Her top lip/ gum looked like it may need help. Kinda like tongue tie on the top instead.

I am terrified to try and get rid of the shield but I also know we may have to. Thanks for telling me your story, I am very encouraged!

If that is the case, I wonder if that is why the shield was needed in the first place. Hopefully getting her mouth checked will lead to a solution in that regard.

[bella99]

I didn't have any supply problems nor did my daughter have any problem gaining weight, but I did use a shield for the first 2.5-3 months.

We weaned off slowly by adding one feeding every other day or so without the shield. Took a little over a week to wean completely and then we were shield free and doing just fine.

My daughter's latch was very shallow and caused me cracked and bleeding nipples very quickly following her birth, but by the time we weaned, her mouth had gotten big enough that I didn't need to correct her latch at all.

Good luck.

[dailyamayzed]

I am almost a week into working with my LC. She's been wonderful and has been coming by every day to weigh the baby and check on how we are doing. At this point her peak weight has been 8 lb 12 oz after a 4 oz feeding with the SNS (formula). I am really stressed out and exhausted and am having trouble keeping up the "schedule". We have actually tried to get her to take milk another way, so that I can exclusively pump while we try to get an idea of my supply, but she won't feed from anything other than my breast. She will nurse with or without the shield, and I have been practicing without... but the priority right now is to get her weight up. I am "tasked" with getting her to eat 4 oz of supplement every 3 hours. My supply does seem to be pretty low from weighing her before and after. About 1 oz per feed/ side. Thats really low for her age.

I was sick with a stomach bug this week for a few days (FUN stuff) so I wasn't eating or taking MY supplements , but I am getting back on Fenugreek and going to eat my oatmeal like a good girl. LOL.

We still aren't sure about her oral motor skills. Still waiting for that to get set up.

My poor other kids. Well, they aren't that poor. Their daddy is taking good care of them,but I DO miss them. . I just wanted that "natural and easy" breast feeding experience you always see in the magazines... kwim??

Again, thanks for giving me an outlet to vent!!!!

[lalemma]

Mama, you are a tough, awesome lady for trying so hard here. Good for you! I applaud you.

[ShwarmaQueen]

Originally Posted by dailyamayzed

We still aren't sure about her oral motor skills. Still waiting for that to get set up.

My poor other kids. Well, they aren't that poor. Their daddy is taking good care of them,but I DO miss them. . I just wanted that "natural and easy" breast feeding experience you always see in the magazines... kwim??

Oh do I ever know! DS was tonguetied, we discovered it only after my supply tanked and he stopped gaining weight. We also had him evaluated by an experienced speech pathologist who found he had exceptional oral motor weaknesses- he scored zero in several areas, meaning there was no muscle tone. We have been doing exercises, which honestly are such a pain, but they do work and have improved his 'elvis' lip (one of his weaknesses) and other areas.

It has been extremely hard for us too. I sometimes feel grateful though, because DD was so easy to nurse, and if he had been first and I hadn't had the great experience with her, I probably would have given up by now. I keep reminding myself that there is a light a the end of the tunnel!

[dailyamayzed]

Originally Posted by ShwarmaQueen

Oh do I ever know! DS was tonguetied, we discovered it only after my supply tanked and he stopped gaining weight. We also had him evaluated by an experienced speech pathologist who found he had exceptional oral motor weaknesses- he scored zero in several areas, meaning there was no muscle tone. We have been doing exercises, which honestly are such a pain, but they do work and have improved his 'elvis' lip (one of his weaknesses) and other areas.

It has been extremely hard for us too. I sometimes feel grateful though, because DD was so easy to nurse, and if he had been first and I hadn't had the great experience with her, I probably would have given up by now. I keep reminding myself that there is a light a the end of the tunnel!

TFS! It really goes to show you that all babies are different! I am kinda dreaming of having a wonderful BF'ing experience and know this is it for me. So I am just going to keep on... and HOPE & PRAY that we get to some kind of normal. Right now, I just want my DD to be healthy!!