Is he gaining enough?

[NicoleS]

Ok, figured I might as well ask you all in here.

History (short version): I have supply problems that are most likely hormone related. None of the galactalogues work for me, even Reglan had only a temporary effect. Because of this I have not been able to successfully BF exclusively any longer than 6 months.

Caleb was 9 lbs 11 oz. at birth and 22" long. He has been about 99.5% exclusively BF'd - there have been a few nights where he was so fussy we tried doing a bottle with half formula/half expressed milk to see if a faster flow/greater volume would help any. On those occasions he's only drunk about 1-3 ounces, and this has been 3-4 times since birth. He is now just over 3 months old.

We had a WIC appointment yesterday and Caleb was 14 lbs. 11 oz. and 25" long. Quite possibly a little longer because he was not cooperative on that part at all. I was a bit concerned on his weight, as he was 13 lbs. 8 oz. and 24" at his 2 month checkup roughly a month ago (it was about a week late because of scheduling conflicts) - so only a pound or so of weight gain. The WIC lady was happy though, said he is proportionate for his height, the size of a lot of the 6 month olds they see, and they like to see a 6.5 pound gain for the first 6 months, so he should meet that easily since he's at a 5 pound gain now at 3 months.

I've always heard double their birth weight by 6 months, so at the rate he's going there is no way we will double birth weight by 6 months - he'd have to be nearly 20 lbs by then! I'm concerned 1) because he doesn't seem to be gaining as quickly as other babies the same age - many started out lighter than he was and are now heavier, 2) Because of all the issues we've had in the past and the fact that it is highly unlikely we will be able to BF a year, 3) During the day it seems like he is constantly on the boob. He does well at night - last night he went from 10 to 5 - but besides that stretch he is on the boob every 2 hours or less, and 4) We went from having at least one poopy diaper a day to only going every 2 or 3 days.

If he goes to bed early enough then I will pump before I go to bed to work on my stash (I try to wait at least 2 hours after he's last eaten) and I get anywhere from 1-4 ounces total. So I think something is there still, but is he gaining enough?

[busymama77]

Sounds like he's doing just fine. Are you EBF or supplementing with formula? Since he is just a little over 3 months, he could very well have a nice growth spurt any day now!!

[mamaw/two]

Sound's like he is doing great! Keep up the good work

[ewe+lamb]

Originally Posted by NicoleS

I've always heard double their birth weight by 6 months, so at the rate he's going there is no way we will double birth weight by 6 months - he'd have to be nearly 20 lbs by then! I'm concerned 1) because he doesn't seem to be gaining as quickly as other babies the same age - many started out lighter than he was and are now heavier, 2) Because of all the issues we've had in the past and the fact that it is highly unlikely we will be able to BF a year, 3) During the day it seems like he is constantly on the boob. He does well at night - last night he went from 10 to 5 - but besides that stretch he is on the boob every 2 hours or less, and 4) We went from having at least one poopy diaper a day to only going every 2 or 3 days.

If he goes to bed early enough then I will pump before I go to bed to work on my stash (I try to wait at least 2 hours after he's last eaten) and I get anywhere from 1-4 ounces total. So I think something is there still, but is he gaining enough?

Personally, I think it sounds as if you're doing really well at the moment, I know it's easy to say but try not to do the comparison thing - doesn't do much for your confidence - and stressing about these sorts of things leads to supply issues. If he's 3 months and on the breast all day then he's actually stimulating the breast getting it ready for a growth spurt and making sure that he'll have enough milk as the pp suggested. If you want to really up his weight a bit you could add in an extra feed during the 10-5 stint of sleeping or if you don't, you could consider co-sleeping. Babies at this age can also change their routine of BM and it is common for some to not have a BM for a few days - but watch out for when it comes along and be prepared especially if you are out and about - bring a change of clothes etc.

You could chart his weight on the who breastfed baby charts http://www.who.int/childgrowth/standards/en/ you can click onto any of these which you feel is relevant. Some babies who don't gain huge amounts of weight are governed by lots of other things, how are they developing at that moment, what size are the parents and how did they grow/gain - there are lots of things but the main thing to remember is that everyone is different and it really looks as if things are going well - don't panic, and enjoy this wonderful time with your baby, if you had problems with your other children it doesn't necessarily mean that you will have the same with this one.

Hang in there, you're doing great - keep posting and maybe see about going to a LLL Meeting - lots of support and information there for you.

[NicoleS]

Ok, according to the charts the pedi typically plots him on (which I'm going to assume are the FF ones) he went from roughly the 80th percentile at 2 months to the 60th percentile at 3 months. On the WHO charts he's dropped some, but not quite as dramatically - I'd guess from about the 75th percentile to maybe the 65th percentile? His length on the WHO chart is holding pretty steady at the 85th percentile.

I have been to see the LC with other kids, and pretty much they said that as long as they are gaining at least 4 ounces per week then they are ok, which he is doing at the moment...

[Llyra]

A baby who was very big at birth (like your DS was!) may not double birthweight by six months.

Have you tried using this, to calculate average weight gain? It also shows normal ranges of weight gain rates at different ages.

http://www.kellymom.com/babyconcerns...alculator.html

[Bokonon]

I agree with the PPs that it sounds like you are doing great!

And were you pumping for your older children when it was determined that you weren't producing enough after 6 months? If breastfeeding exclusively, it would be very unusual for you to suddenly stop producing enough at that age. Breastfed babies take in about the same volume, 19-30 oz./day, as long as they are not being supplemented with formula or solids, regardless of age.

Being on the boob constantly during the day sounds totally normal to me. My baby was still nursing about 15 times a day at 8 months!

[NicoleS]

Originally Posted by Llyra

A baby who was very big at birth (like your DS was!) may not double birthweight by six months.

Have you tried using this, to calculate average weight gain? It also shows normal ranges of weight gain rates at different ages.

http://www.kellymom.com/babyconcerns...alculator.html

Ok, based on that:

Between 5 day appt. and 2 week apt he gained: 15 oz. per week
Between 2 week and 1 month appts he gained: 8 oz. per week
Between 1 month and 2 month appts he gained: 5.5 oz. per week
Between 2 month and 3 month appts he gained: 3.9 oz. per week

According to Kellymom at this point he should still be gaining 5-7 oz. per week, which he has not been.

Originally Posted by Bokonon

I agree with the PPs that it sounds like you are doing great!

And were you pumping for your older children when it was determined that you weren't producing enough after 6 months? If breastfeeding exclusively, it would be very unusual for you to suddenly stop producing enough at that age. Breastfed babies take in about the same volume, 19-30 oz./day, as long as they are not being supplemented with formula or solids, regardless of age.

Being on the boob constantly during the day sounds totally normal to me. My baby was still nursing about 15 times a day at 8 months!

Long story, so short version:

DD1: Pumped and BF'd. At 6 months went on a nursing strike. Tried pumping exclusively and within 3 days had no milk.
DD2: BF'd exclusively. Slow gain between 2 and 4 months. No gain between 4 and 6 months. Lost weight between 6 and 7.5 months when we decided to put her on formula.
DS1: BF'd exclusively. Slow gain after 2 months, went on Reglan at 3 months. Monthly weight checks, didn't gain between 7 and 8 months, went on formula at 8.5 months.

AF comes back at 3 months (and wouldn't you know, I post about this and guess who shows up today? ) and my supply plummets and never recovers. On the Reglan she came back 6 weeks later (so 4.5 months) and then I didn't see her until 8.5 months about the time we weaned. I cannot do the side effects of Reglan again. I've talked to my OB, my doctor, the pediatrician, and paid to see an LC and they all think that it is tied to my hormones and there doesn't appear to be much we can do about it.

And since my gift from mother nature has arrived I fear this is the beginning of the end again...

[beckyand3littlemonsters]

looks like a good weight gain to me, all babies are different and gain weight at different rates, don't worry too much my ds caden started out on the 98th centile and was on the 50th by about 3 mths. my hv just said he was probably born bigger than he should and that his weight was probebly just going down to what it should be

[beckyand3littlemonsters]

all my lo's weight went down by 2 centiles, bf babies often do because the charts are based on formula fed babies.
if i can find their red books i'll be able to tell you just how much they gained or lost.

[Megan73]

Originally Posted by NicoleS

Ok, based on that:

Between 5 day appt. and 2 week apt he gained: 15 oz. per week
Between 2 week and 1 month appts he gained: 8 oz. per week
Between 1 month and 2 month appts he gained: 5.5 oz. per week
Between 2 month and 3 month appts he gained: 3.9 oz. per week

According to Kellymom at this point he should still be gaining 5-7 oz. per week, which he has not been.
...
And since my gift from mother nature has arrived I fear this is the beginning of the end again...

I see you've tried Reglan but I think domperidone could really help you, mama. I agree that his weight gain is below average at this point, although I don't know anything about normal gainpatterns for big babies like your little one.
I suggest domperidone (a drug prescribed for gastric motility that has the side effect of increasing prolactin) because it both increases supply and keeps AF away.
American mamas can chime in on how to get it -it's not available in the US - but can be bought online. Dr. Jack Newman's site has a great FAQ about it.
I took dom for 18 months with no side effects.
I also want to add that not having enough BM for your baby doesn't have to mean weaning. It would likely take only a tiny bit of formula to bring his weight gain up to average - if that's what you want to do - which you could give him in an at-the-breast supplementer.
Good luck!

[NicoleS]

My only concern about dom is the cost...I know the places that sell it online seem to be about $20 for 100 pills...which is only about 10 days worth? Plus if Reglan didn't work that well will Dom be any better? I thought the basically worked the same way, just that Dom didn't have the side effects?

[tatsu15]

breastfed babies gain weight slower than formula fed babies, which is actually a good thing. Formula fed babies are usually bigger, but they are also more at risk for type 1 diabetes so try not to stress.

[PatioGardener]

Originally Posted by tatsu15

breastfed babies gain weight slower than formula fed babies

While this is true for babies after about 4-6 months, it is actually the opposite for the first 4-6 months, when breastfed babies gain more quickly than formula fed babies. see http://www.kellymom.com/babyconcerns/growth/chart1.html

[Megan73]

Originally Posted by NicoleS

My only concern about dom is the cost...I know the places that sell it online seem to be about $20 for 100 pills...which is only about 10 days worth? Plus if Reglan didn't work that well will Dom be any better? I thought the basically worked the same way, just that Dom didn't have the side effects?

They do work the same way, from what I understand, but Reglan can't be used long-term safely and dom can – which means you could get the benefit of it keeping AF away.
I can't tell you if it's worth the money. I think it is, frankly. And given your situation, I'd start at a lower dose - say 30 mg a day – which would keep your cycle away and likely boost your supply enough to EBF since you're so close to having enough milk to have him gain appropriately.
At that dose, it would be $20 for a month – less than the cost of supplementary formula.

[NicoleS]

Two thoughts - 1) if the Reglan didn't work that great is there any chance that the Dom will be better? I was only able to get 2 additional months of nursing with Reglan.
2) would 30 mgs (which I'm assuming is 1 pill three times a day?) be enough? I had to stay on the maximum dose of Reglan to get a result - if I tried weaning off of it at all my supply started dropping again.