DS only gained 1 lb in 6 weeks... so worried

[Lit Chick]

We just had a well baby check, and I am freaking out.

My ped is fantastic, and did not even mention supplementing, just wants to keep an eye on him.  But - she did not know that he only gained 1 lb.  The 6 week visit was with my midwives and I was so distracted that I forgot he weighed 10 lbs then.  Yesterday he was only 11.  He barely grew any inches too, but I'm waiting for my MWs to call me back with that info.

I thought he was fine - he's strong and happy, hitting milestones, but he is and always has been a terrible nurser.  Terrible.  Super lazy.  I thought until yesterday that he was getting what he needed, and just quickly.  But now I'm thinking he's just getting enough to not be screamingly hungry.  He sleeps a ton.  6-8 hours overnight, with loooong naps.  He wakes up, has a qucik nurse, then likes to play then sleeps.  He's totally a schedule kid, completely unlike DS1 who loved the boob and wanted to nurse all the time.  He was skinny too, but tall and active, so it was obvious that he was eating and just putting that into inches not #s.  But this baby is not doing either...

The ped suggested we bottle feed BM for a bit, esp since I'm going back to work anyway, and to monitor how much he took.

Woke for the day at 7am, pumped 2.5 oz.  Baby nursed from the breast for a few moments, did get a little milk, then spit me out as usual.  Took the full bottle.

Nursed a little before his 8:30 nap, but not sure if he got anything, he was toying with me.

Pumped 1.5 oz at 11:00.  Had to wake him at 11:30.  Refused to nurse, but took the bottle and seemed like he wanted more.  Fussed at the breast again, did not take any milk.  Seemed crabby for a bit, then back to happy baby.

He doesn't seem starving.... but he hates to nurse.  Since he took to the bottle, I'd be fine with pumping, but only 4 oz of output in 4 hours????  I'm wondering if his lack of interest lowered my supply slowly....

Anyway, I'm pretty much just venting.  I'm going to keep BFing until Monday when I can talk to my MWs and the ped.... but I so want to give him some formula right now, just so I know he's getting some food.

I have been crying all day, so worried that I've stunted his growth.... feeling so bad that I thought he was such a good baby for sleeping so much and for eating so efficiently.  Now I wish he demanded the breast,

Seriously.... I might just give him formula to stop the worry.... trying to get through the weekend, but I feel so awful.

[Llyra]

It sounds like he's maybe not transferring enough milk-- meaning you have it (since you can pump it) but he's not extracting it from the breast efficiently.

Here's what I'd do-- don't give bottles. This will only aggravate the problem, since sucking from a bottle is such a different process from suckling at a breast. It requires a totally different mouth movement, and babies with transfer problems or an inefficient suck can get even "lazier" if they get accustomed to the bottle. You run the risk that baby will start to prefer the bottle, and start refusing the breast entirely. I've been down that road, and it's a hard one to get off of, once you're there.

He's not going to be stunted, nor is he in imminent danger of starvation! It really is okay. He's not losing weight. A baby this age who really wasn't getting enough would be LOSING weight.

So it's time to get some help teaching him to nurse more efficiently. I would go looking for a good lactation consultant-- your midwife may have suggestions, or your local hospital, or you can go to Medela's website and they make referrals there if you put in your zip or postal code.

Then I'd try and get hold of a good baby scale that's accurate to half an ounce-- your ped or midwife are good resources for this. Take him in at a time when he's good and hungry. Weigh him, then nurse him, and then weigh him again, without changing a diaper or wiping away any spitup in between. The difference in weights will tell you how much he's getting at a feed, which will allow you to calculate very roughly what he's getting in a day.

A good LC might recommend that you try nursing with a supplemental nursing system-- a little tube that runs alongside your nipple, attached to a little bottle of pumped milk. That way baby is rewarded for continuing to suck with the milk in the bottle, without learning bad sucking habits. The continued suckling will help stimulate your supply, so that you don't see a reduction in it.

A good LC might also recommend using breast compressions, to keep baby feeding longer.

A good LC should NOT recommend bottlefeeding, unless it is clear that baby's health is in real danger. Slow weight gain is a concern, but it is not an emergency.

Keep in mind that with a bottle, baby cannot control the flow of milk-- so baby may be full from your nursing, and then will take the whole bottle too, and it'll look like OMG baby was really starving. So this doesn't necessarily reflect on how much baby is getting at the breast. Furthermore, pumping output is no indication of your supply. This last time around, I was nursing twins, and both were growing, so clearly I had enough milk, but I never not once was able to pump more than a half ounce at a sitting, even when away from the twins for four hours.

And even if your supply is low-- nursing more, and pumping more until baby is nursing better, is the solution.

I would caution you against formula- don't let panic lead you into a decision you might not be able to undo. Giving formula even a few times can open the door to allergies and intolerances. It can also significantly undermine your supply, at a time when your breasts really need MORE stimulation, not less. Baby fills up on the less-digestible formula. Baby is full-- in that too-much-Thanksgiving-turkey sluggish way. Baby sleeps even longer, and nurses even less.

Until you can get help, I'd recommend nursing every hour to hour and a half, all day and night, for a few days. Try and get as much into him as you can at the breast, as often as you can get him to nurse. Take him to bed with you, without a shirt on, and keep him at the breast all night, if you possibly can. He needs to nurse, nurse, nurse.

When he spits you out-- if you offer the other side, does he take it? You can try switch nursing-- this is a classic supply-increasing technique that involves switching sides as soon as baby stops actively swallowing, using each side multiple times at a single session. It keeps baby interested-- since baby will often get additional letdowns of milk when you switch-- and it sends the message to your hormonal system that MORE MILK IS NEEDED. It's basically telling your breasts that you're nursing more than one baby-- and that the amount of milk needs to increase as a result. That's why mamas with multiples are able to nurse more than one at a time.

I'll be thinking of you-- let me know if I can answer any questions, and please keep us updated. YOU CAN DO THIS!

[sosurreal09]

i thought babies lose a good amount of weight after birth?! then they gain it back. DD was born 8lbs 6 oz but at her first visit she was 7lbs 3 oz and they said it was fine. next visit she was 7lbs 10 oz and climbed since then. shes 14 m/o now and 20lbs.

[Llyra]

FWIW? 4 ounces in four hours is a great pumping output. Most babies take in about an ounce an hour, on average. So that sounds about right to me.

What you can see here
http://www.kellymom.com/babyconcerns/growth/weight-gain.html
is that the average weight gain at this age is about 5 to 7 ounces a week, but that 4 or 5 ounces a week is the normal pattern for some babies. A pound in six weeks means about 2 2/3 ounces a week. This is assuming that baby was weighed on the same scale-- scales can differ quite a bit sometimes. So if indeed it was only a pound, then that is low-- but not scary, dangerous low.

I'm just making sure I understand-- is he 12 weeks now? So that he was 10 lbs at 6 weeks, and is now 11 pounds? Or am I misunderstanding?

[ShwarmaQueen]

It sounds like what we've been through. I agree I don't think your baby is getting enough milk. Advice I got from an awesome LC is that a newborn sleeping tons can be a sign that their nutritional needs are not being met so they're bodies are conserving energy. 

I would get evaluated by an LC ASAP because there could be multiple factors going on. 

[Lit Chick]

DS2 is 13 weeks today, and yes - he was 10 lbs at 6 weeks, but different scale. 11 lbs yesterday.

My ped is a BF specialist as well.  She was concerned, but not enough to say supplement right away.  I'm less upset than I was, mainly because I decided that if she says so, I will absolutely give him formula.

With DS1, I had to work hard at BFing, especially after I returned to work.  We did it, and I was proud.  However, I was a freaking MESS and really depressed.  I cannot go through that again.  It was one thing to fall completely apart when I had one small baby... now I have a baby and a 3 year old and just no.  I'm not going there again.  I will feel like a little bit of a failure, but it's better than PPD.

Must tend to DS1, thanks for the support all, and I will update later.

[ShwarmaQueen]

Originally Posted by Lit Chick 

DS2 is 13 weeks today, and yes - he was 10 lbs at 6 weeks, but different scale. 11 lbs yesterday.

My ped is a BF specialist as well.  She was concerned, but not enough to say supplement right away.  I'm less upset than I was, mainly because I decided that if she says so, I will absolutely give him formula.

With DS1, I had to work hard at BFing, especially after I returned to work.  We did it, and I was proud.  However, I was a freaking MESS and really depressed.  I cannot go through that again.  It was one thing to fall completely apart when I had one small baby... now I have a baby and a 3 year old and just no.  I'm not going there again.  I will feel like a little bit of a failure, but it's better than PPD.

Must tend to DS1, thanks for the support all, and I will update later.

Well, as a mom who returned to work (w/ DD) and had to supplement after the pumped milk wasn't enough, I empathize completely. But let me emphasize that supplementing shouldn't make you feel like a failure. We are all just doing to best job we can! 

Just curious if the ped has checked him for anatomical issues- high palate, tongue tie (incl post tt) and oral motor weaknesses...the lazy nursing is what makes me curious. 

[Katie T]

I hope everything is going well for you and wish you luck. That said no matter what you choose for your family you will be supported here. Your right it is not worth PPD.

Sounds like you have been given great advise and are with a wonderful care partner, being a breastfeeding specialist.

I had a friend who when through something similar so know how draining it can be. Hugs to you and good luck.

[Lit Chick]

Originally Posted by Llyra 

I would caution you against formula- don't let panic lead you into a decision you might not be able to undo. Giving formula even a few times can open the door to allergies and intolerances. It can also significantly undermine your supply, at a time when your breasts really need MORE stimulation, not less. Baby fills up on the less-digestible formula. Baby is full-- in that too-much-Thanksgiving-turkey sluggish way. Baby sleeps even longer, and nurses even less.

And this is why if I do end up supplementing I will feel like crap.  With DS1, when we ran into trouble I told myself over and over why I needed to suck it up and EBF no matter what.  And I did!  But it was not just hard, it was scary.  This time, I'm thinking that all the bad that can come with formula (including the risk of killing my supply completely) is still better than that.

I'll be thinking of you-- let me know if I can answer any questions, and please keep us updated. YOU CAN DO THIS!

I thank you for your support, I really do.  People like you are why I was able to push through with #1.  And I know that if I made BFing the total focus of my life, I certainly could do it.  But BTDT and the cost this time around would be too high.

This morning, I was in tears and DH was a little annoyed, because he thought I was freaking out about the health of our son, who was all smiles and gurgles.  I was actually freaking out about going back to work in a week, faced with yet another BF challenge, and trying to figure out what I was going to do.  Last time, I went part-time for 3 months.  This time that is not possible.  Last time, when I was losing my mind, I sometimes put the baby down and just screamed into a pillow.  And I cried all the time.  And when I wasn't crying, I was saying the meanest things to DH.  This time, I have a 3 year old and I cannot lose my mind like that for extended periods. 
 

Originally Posted by Llyra 

FWIW? 4 ounces in four hours is a great pumping output. Most babies take in about an ounce an hour, on average. So that sounds about right to me.

That makes me feel good - at least my pump output is solid!

Originally Posted by ShwarmaQueen 

Well, as a mom who returned to work (w/ DD) and had to supplement after the pumped milk wasn't enough, I empathize completely. But let me emphasize that supplementing shouldn't make you feel like a failure. We are all just doing to best job we can! 

Thank you.  I'm sure you understand that initial feeling of failure though.  When you hit a roadbump when EBFing, you tell yourself all the reasons why formula is bad.  Gotta remind yourself why the struggle is worth it.  But if you hit a wall instead of a bump... at least this time I know that if I do supplement, I'm not "giving up".

Quote:

Originally Posted by Katie T 

I hope everything is going well for you and wish you luck. That said no matter what you choose for your family you will be supported here. Your right it is not worth PPD.

Sounds like you have been given great advise and are with a wonderful care partner, being a breastfeeding specialist.

I had a friend who when through something similar so know how draining it can be. Hugs to you and good luck.

Thank you for the kind words. 

[Carma]

I agree. I pump full time at work. Get about 8-9 ounces in a 8-9 hour period, same as with my first 2 kids. She does drink a bit more (does not take pacifier, so prob. extra sucking need at daycare), so I am adding from my freezer stash. But I am sure my supply is good. If you will be going back to work I do recommend to build a freezer stash before returning to work. It will boost your supply and the extra milk might come in handy if you have problems pumping enough at work. Sometimes I pump for 30 minutes, not a drop coming out. Then I nurse DD right after and she immediately has a good letdown.

Carma

Originally Posted by Llyra 

FWIW? 4 ounces in four hours is a great pumping output. Most babies take in about an ounce an hour, on average. So that sounds about right to me.

That makes me feel good - at least my pump output is solid!

[Lit Chick]

Well, we started formula.  And while that first bottle was emotional, it was also a relief.  For the first time, I saw him behave like a normal baby, saw that he really was hungry and for whatever reason he was just not a strong nurser.  He really needed the extra food.  Diapers are soaked.  He's pooping.  He is awake and hungry.  And oddly enough, he is better at BFing.  Not as frustrated I guess.  Before, he would suck down the easy let-down, then stop.  Not cry, not root for more, just stop.  After 2 days with a few bottles, he's sucking at me like he does the bottle - long, slow, strong.  I was not expecting that at all. 

He has always been a really happy baby, but today was just beyond fantastic.  He was even gigglier, so much more awake time... and to finally see him get milk drunk and fall asleep in my arms, just like DS1 did.... I'm really happy.

So, now I just have to see if the lack of growth was 100% due to not enough food, or if there is something else.  He never did that 6 week growth spurt nurse-a-thon... not sure if he was just lazy about it or if his body missed something there.  But I have a extra content little man right now, and YAY.

[happysmileylady]

In that six week time span between the 10# and the 11# weights, was the little one at all sick?  Sometimes being sick can cause a little one to stop gaining or even lose weight for a short period.  Then, after getting better they pop back up, but they have that ground to make up, you know

[Lit Chick]

Nope, he has been healthy since birth.  And it's not just weight - his head circ and his length also stalled.  He's proportionate, but the size of an average 7 week old. 

I'm not really worried - now I know he is getting enough calories, so either he starts to grow or he doesn't, and we move on from there. 

[PatioGardener]

nak

has he been checked for a tongue-tie?  often it makes it difficult for them to nurse, so they get weaker, sleep more, don't nurse as well etc in a downward spiral.  clipping the tie can be a quick fix, if that is the issue.

[Lit Chick]

Kiddo was checked for tie, palate issues, etc.  He's fine.

DS1 got an ear infection, so since we were back at the ped yesterday, we weighed DS2.  He was up 11 oz!  It's amazing the change in him with the bit of extra food.  Same baby, just more.  More giggles, more babble, and instead of just happy coos when he's in his little chair with the toy bar, he's kicking and grabbing and just having a blast. 

We have a nice little routine right now - he nurses like a champ overnight and in the morning, and he takes 12-16 oz of formula over the rest of the day (with the breast before each bottle, though more like an appetizer).  I'm so so happy that he does nurse though!  I was a little worried that he would only want the bottle - but he still needs and wants me too.