Slow weight gain with adequate diaper output?

[sattygirl99]

Okay mamas... looking for some insight because the nurtitionist at wic is very set in her number ways...

DS was born at 8lbs 1 oz, dropped to 7lbs 10 oz and maintained but showed signs of dehydration due to lack of transfer from a severe tongue tie. I started supplementation at the breast via lact-aid with donor breastmilk at 5 days old, got his tongue tie clipped (THREE times) and we're now into week 2 of no supplementing. He is 5 weeks old, nearing 6 weeks.

Last Friday I took him to WIC for a weight check and he was 9lbs 1.5oz (they recorded 9lbs 2oz) and they measured him at 22 3/8 inches long (he was 21 at birth). We were already supplement free at that point (5 days in) and his diaper output was great...

Today I went to BFing support group and re-weighed him... He weighed 9lbs 4oz. The nutritionist is saying he's not gaining well enough but he's happy, fairly content (gas/reflux aside) and he's wetting 10 plus diapers a day, pooping every day to every other day (his poo's slowed BEFORE we stopped supplementing) ... Today he pooped THREE times! I believe he's just a slow gainer due to high metabolism (DD was also a slow gainer and was supplemented because of this same nutritionist telling me she was FTT). Even now DD and DS are slow gainers even though they eat... and eat... and eat. They take after DH.

He does nurse frequently however as long as I follow his cues, he's happy and content after nursing and getting a good burp or 2 out (he's very gassy and refluxy but doesn't spit up much).

My midwife said to not worry about it right now and to let him set his own growth scale and because he's been supplemented since less than 1 week old we don't know what HIS growth pattern is. My husband and 2 of my friends (who work for WIC) also agree with this. But the nutritionist is talking about him falling off the growth chart and such and it freaked me out.

So talk to me about slow weight gain.... If a baby is otherwise happy, peeing and pooping as they should, how much focus do you put on a scale? I plan to email my pedi for reassurance too but I'm looking for BTDT moms... I know I have milk... He actively nurses and swallows, I hear my letdown... In fact, my letdown is quite forceful (probably part of his gas issue).

Please tell me I'm normal... I'm tired of bouncing back and forth between not knowing if I have low supply or just a baby who has a high metabolism... How can a baby who had 12 wets and 3 poops today NOT be getting enough milk? It just isn't possible...

[Marissamom]

some of the WIC nutritionists are VERY hung up on numbers. I would get a scale that you can weigh him on once a week or so, so that he's being weighed on the same scale, at the same time of day, with the same amount of clothing on. because different scales can have up to a pound of difference. and check with the ped, but if you already know that slow gain at this age is normal for your kids and he's getting enough milk, then I wouldn't worry too much about it.

[accountclosed2]

I agree that getting your own scale and weighing every week, at a similar time of day (and after a feed but preferably before a poo - make note though, as these things matter a lot), and wearing the same clothes.

Now I had low supply, and DD always pooed and peed well, and she still was a slow gainer, and needed some more. She was always, strong, healthy and happy (as long as things were to her liking). We chose to give some donated breastmilk in an SNS at times when it was necessary, and as much as necessary (very little, except for a short while much later, when her weight stalled again).

I would be more worried if the baby didn't gain at all for a week or more or lost weight (DD did both, at different times). Although a couple of weeks of no gain isn't necessarily a problem, especially not if the mother is working on supply/working on getting more into baby.

In your shoes I'd work on getting supply up just in case: Eating and drinking well, taking fenugreek, pump if you can and want (I couldn't). And feed effectively, make sure baby is feeding lots, and feeding actively (suck, suck, swallow). Switch nursing can be very effective in upping baby's intake.

That said, DD is a slow gainer, and grows in fits and spurts (slowly, slowly, slowly, and then a big weight/height gain!). And has a father who is tall and skinny, who can't gain weight, and who always was very skinny, even as a baby (despite being formula-fed).

[sattygirl99]

My husband is very tall and lean... He can't gain weight for beans!

I don't know how much more to get my supply up... I leak and feel full after 2 hours, I pump 2.5 oz extra per day on top of nursing him (when I do pump, lately I've slacked), I'm taking 120mg of domperidone and 6 pills of fenugreek a day (have to watch how much, it makes DS really gassy). He's getting lots of milk, sucks and swallows for a good 5 plus min before it slows down and continues for another 10ish or so... I compress to get him more milk and will switch sides when he gets to paci sucking and asleep... Sometimes if he's fussy after the 2nd side, I'll put him back to the first and he'll get another letdown and be fine. Sometimes he doesn't need it. At night, he rarely nurses both sides, unless I intentionally make him mad by changing him to wake him up. He nurses very well and when I pump or express after a feeding, I get nothing but a few drops no matter how hard I try.

DD is 21 months and 23lbs... She's been 23lbs for several months now despite eating me out of hosue and home. She's also 33 inches tall. DS is 4 and 39 inches and 33lbs. He's stuck at 33 lbs for at least 6 months... In fact, the same nutritionist is concerned about DS1's weight gain too however our endo (DS1 is a diabetic) says he's fine because he grew in height and gained a little bit). They both eat like crazy and consume fats and proteins yet are slow to grow. I was little as a child... DH is 5'8 and 155lbs... He could eat fast food burgers daily for months and gain a pound. His mother is very thin as well.

He was weighed on the same scale at the WIC office both Friday and today, both times naked. He was however distressed both times which I've read can hinder proper reading.

[Marissamom]

it really sounds like you just have slow growers. I do to, my 17 month old is maybe to almost 18 lbs. I'm not too concerned because all three of my sisters and I had almost identical growth patterns, and DF wasn't a big baby/toddler/child either. and DD eats like crazy, so I'm not worried she's not eating enough.

[sattygirl99]

Thanks marissamom

I know I was formula fed and tiny as a child... I'm not sure about DH in that regard but I know that as a teen and now, he has always been super skinny (and I'm totally jealous lol). I need to make sure I'm eating and drinking enough, I just came off of a 48 hour stomach virus that kind of hindered me in that. But typically I eat and drink well, lots of protein and calories.

Tonight I've made sure to nurse him both sides. I would take his paci away but then he'll want to paci on me and he gets shallow latches when he paci's at the breast and I don't think I could handle it all night. But I've been very careful to ensure that I'm only giving the paci after I've nursed him and not sleepily giving it back without realizing it LOL. Just now he was a bit restless so I put him to breast and he promptly fell asleep so he obviously wasn't hungry. I'm sure he got a drink though. He doesn't sleep during the day hardly (with 2 loud older sibs running about, it's no wonder) so I can't bear to wake him every 2 hours at night... He sleeps about 5 hours, then 3, then 2. So he nurses reasonably well overnight and soakes his diaper front to back (we cloth).

I found an article about watching the baby and not the scale that fits my son to a T.... And made me feel ALOT better. I will continue with the weekly weight checks for now but I'm not going to fret if that number isn't 4oz or more as long as he continues to gain and grow in other areas. I think I may switch our weight checks to being at our pedi though as I feel she'll be far more understanding and reasonable with his slow gain than our WIC nurtritionist. Or I may just buy a scale and do his measurements at home and take them in to the pedi myself. I know my pedi trusts my judgement (which is why she isn't bothered by my not doing regular well baby visits). As long as he continues to gain and grow, even slowly, that's fine in my book.

Thanks ladies!

[khaoskat]

As a BTDT recently.

You mentioned reflux...

I will say that unless the reflux is under good control (and it took us being hospitalized) it can contribute to slow/low weight gain.

I didn't listen well to everyone who said Zantac was not the best, but it is the 1st step. Once we switched to prevacid he has been 100% better. We are doing catch up weight gain, because he was down so low, due to other complicating issues, but he is on track again.

Sometimes with reflux, they will hurt, even with the Zantac, and start associating nursing with the pain, and slow down what they take in. We saw this with my son, and it took changing pediatricians to get something done other than here is formula.

[OkiMom]

Could you have an oversupply? My oldest was a slow gainer at first, I was threatened with FTT diagnosis and hospitalization because she wasn't gaining. At the next appointment for weight another ped (love this guy) said bull shes getting enough, you just have to much and gave me a few pointers. Next appointment a week later she surprised us all with her gain. It was just she wasn't getting enough of the fat dense hine milk to gain adequately plus having a fast metabolism (my husband is also tall and thin, both girls take after him they eat a TON but are thin).

[sattygirl99]

We have prevacid but haven't really used it... I asked the nutritionist about the reflux affecting nursing and weight gain and she said unless he was spitting up a large amount, it would make no difference. He has silent reflux I did start him back on it tonight .

[sattygirl99]

Originally Posted by OkiMom

Could you have an oversupply? My oldest was a slow gainer at first, I was threatened with FTT diagnosis and hospitalization because she wasn't gaining. At the next appointment for weight another ped (love this guy) said bull shes getting enough, you just have to much and gave me a few pointers. Next appointment a week later she surprised us all with her gain. It was just she wasn't getting enough of the fat dense hine milk to gain adequately plus having a fast metabolism (my husband is also tall and thin, both girls take after him they eat a TON but are thin).

I highly doubt it... I don't have any symptoms of oversupply. I do have an overactive letdown....

I nurse him for a loong time on one side, compress to get him all the hindmilk, switch and do the same and often switch BACK to the first breast for more hindmilk.

[sattygirl99]

My gut says it's the reflux and his dairy sensitivities (which I'm bad about avoiding and need to cut out all direct dairy).... Today I feel like my supply is lower and he's nursing more than usual... And I don't feel like he's nursing as effectively. I'm leaning towards the reflux as being the issue and that's why I asked the nutritionist about it. I'm just unsure if I should supplement through this while the prevacid kicks in or ride it out and just nurse nurse nurse as long as his diaper count is fine. I'm going to try to pump after feedings too.

[ShwarmaQueen]

I'd give it more time. My breastfeeding educator (who is a TT guru) says she recommends giving the babe twice as long to learn how to use their newly freed tongue as the age they were when they had it clipped. It took longer with DS (he was 6 wks) but he also had other issues. He had a slllllllllow weight gain, seriously- like an 1/2 pound a month until he was 8 months or so but is now at a healthy, albeit lean, 20lbs.

Given all your babe has been through, you might consider it normal for him (READ: Not on the WIC lady's chart) and give him more time, lots and lots and lots of nursing, and enjoy your sweet baby!

[ShwarmaQueen]

Originally Posted by sattygirl99

We have prevacid but haven't really used it... I asked the nutritionist about the reflux affecting nursing and weight gain and she said unless he was spitting up a large amount, it would make no difference. He has silent reflux I did start him back on it tonight .

Could the spitting up just be gas from his uncoordinated tongue (swallowing air)?

It was a couple of months before DS learned how to swallow just milk- I took out dairy, soy, and fretted about every thing I ate, then about the time his tongue strengthened the gas went away.

Just throwing out a suggestion. It gets easier.

[sattygirl99]

That's why she said reflux WASN'T the reason for his low gain... He doesn't hardly ever spit up. He IS super gassy and drooling a ton though which happened after the most recent tongue tie clip at 4 weeks old. The first 2 clips weren't deep enough (and I'm not 100% sure this last one was either but it's close enough I may not put him through more).

He has refluxed since birth though, just silently like my other kiddos... He swallows it back down. My concern the last few days or so is that he doesn't want to work for milk after that initial letdown and I think he'll benefit from the prevacid either way. I know supplementing him would keep his suck stronger (literally his suck is stronger with the LA than without but my milk pours out at first) but I don't want to supplement unless I have to.

Thank you mama for your insight!

[khaoskat]

Have you had an upper GI done to diagnose the Reflux issue?

I think you need to do some research on the issue of Reflux. I have not found anything to support what your nutritionist is saying about only those who spit up significantly have issues with weight gain. What I have found is that with Reflux, they either go generally one of two ways -- either over eat to comfort themselves at the breast from the pain, or they start associating the breast with pain and stop nursing.

Your son sounds just like mine.

Severe tongue tie at birth. We had it clipped twice (at 2 weeks and again at 3 weeks) by different people each time. We had just gotten it right when we developed Pyloric Stenosis (your child has not had this), and lost almost 2 pounds of weight. We just recovered from this when we were diagnosed with Reflux and put on Zantac. We noticed some initial results, but still had a very unhappy baby. About 2 months later, I noticed he just wasn't right, and started working with our WIC LC's.

We watched this child gradually slow down his intake week after week after week. He wouldn't work for anything other than that immediate let down when he first latched on. Even WIC LC's were mystified as to what was going on.

Eventually we ended up with a week at Children's, because he just wasn't gaining weight. It was finally contributed to multiple things --- the huge weight loss from the Pyloric Stenosis; his reflux was changed to a dx of GERD; and by the time it was caught my supply had taken a major hit. Thankfully my supply is back and I have been able to pump and get enough out to keep him only on BM except for what we have to add to it to increase the calorie count.

I watched them do the upper GI on him. He was refluxing a lot more than I thought. He did spit up a lot, but man, when your child can barely finish taking in the bottle, and you just watch the stuff continually start coming right back up. We were lucky, he hadn't developed any ulcers or damage, so at least the Zantac was keeping that from happening...but when we changed to prevacid....there has been a huge difference.

We no longer have a child was screams when he is on his back, although he still does not like to be on his back much. We no longer have the huge rights to get into the carseat, or the screaming associated with that.

[LionessMom]

i was a skiiny baby. i was diagnosed as reflux and then gerd. turns out i just have dairy intolerance and some other food intolerances. DD1 is small, skinny and gains weight slowly. she also had spit up, reflux, etc. turns out dairy intolerance at the least. we are getting DD1 and 2 tested later this month.

does your kids have circles under their eyes, bloated bellies, very little bdy fat? when you are fed foods that you are intolerant too it keeps you from absorbing the correct nutrients to grow. since i quit feeding DD1 dairy in all forms, she gained 2 lbs in 2 weeks. she has never done that before. her little belly flattened and i had to let out her adjustable jeans.

if you know your child is dairy intolerant you should remove all dairy. it will take at least a week to clear it out of your system.

[sattygirl99]

See his is nowhere near that bad.... He lays on his back just fine...he enjoys being on his back, as long as he's burped before we put him down. He does hate the carseat though... But he's fine until he's buckled in so I don't think it's anything more than he doesn't like to be 'stuck'... He hates being swaddled and worn with his arms down in a carrier too.

We started the prevacid last night and this morning was the first time he had a significant spit up... Normally it's just a little, this was more than normal. I won't do an upper GI unless it becomes apparent it's really needed... He's already on the prevacid and the upper GI is pretty traumatic for a small baby IMO. We did one with my oldest and it was pure torture for him to have nothing by mouth after midnight the night before... DS2 nurses like 3-4 times after midnight and it would be very traumatic for him to not be able to nurse. It's not worth it for me for a situation that isn't *that* bad, especially when he's already on the medication they'd give him after the scan. I figure it needs about a week to get into his system and then we can re-evaluate from there. In the meantime, I need to try to pump between feeds to keep my supply up. This morning he nursed better so I'm hoping the prevacid will help!

[sattygirl99]

Jenefier, my oldest kids don't consume dairy... They've always been dairy sensitive. Allergy tests show no allergies though and we can't afford an IgG to check for intolerances.... But may work that into the budget for everyone sometime soon.

I'm already working on removing the dairy from my diet in hopes it will help his reflux. so sad because I'm craving ice cream!!!

[LionessMom]

Originally Posted by sattygirl99

Jenefier, my oldest kids don't consume dairy... They've always been dairy sensitive. Allergy tests show no allergies though and we can't afford an IgG to check for intolerances.... But may work that into the budget for everyone sometime soon.

I'm already working on removing the dairy from my diet in hopes it will help his reflux. so sad because I'm craving ice cream!!!

they make rice ice cream and cocnut milk ice cream. it isnt the same though. but i think the rice stuff tastes pretty good with flax seed sprinkled on it.

my GERD went away totally once i quit dairy. and chocolate. if after you removed all dairy, he gets a little better but still has issues then i would look into removing the next biggest food that is commonly a problem. yk, a gradual elimination diet. dont forget to check labels. lots of things have hidden dairy in it i found that out recently.

[sattygirl99]

I'm actually just planning to cut everything and go to a simple diet of meats, rice/potatoes/noodles, fruits and veggies. I'll need to make my own dairy free bread but I can't tolerate eggs anyway and I try to avoid soy but do each processed food so I'm sure I get too much soy that way. I'm honestly thinking of converting my kids to this diet too and see if it helps them... It's hard because we live with my IL's and they have no diet restrictions so they'll have to really think about what they feed the kids.

I don't really consume chocolate but my understanding is dark chocolate is not from dairy, just milk chocolate.

Is butter dairy or an animal fat? I've read a lot of people with dairy issues are fine with pure butter...