10 week old, EBF, low weight gain - UPDATES post 21

[HeatherB]

My 10 week old DD is EBF, as all of my babies have been. I took her in for a 2 month check-up (which is basically a weight check) and found out that she's only 2 pounds over her lowest weight (she's one of my only babies to lose a significant amount after birth, but also started with an extra pound over 2 of my older kids). According to the calculators at kellymom, she's averaging 3.6 ounces per week, rather than 5-8 that's normal.

I have a couple of theories about what might be going on. I'm very suspicious of an allergy and will begin an elimination diet to see if that helps. (She has mucousy stools, chronic snuffly nose, occasional tummy pain, relatively light silent reflux, occasional random rashes, etc.) I am also curious as to whether she might have a bit of tongue tie. (She has a shallow latch, though it no longer hurts most of the time; she releases her latch over and over while nursing [spilling tons of milk out]; possibly making some clicking, but not sure; I can feel the frenulum where supposedly it should be smooth; I suspect my eldest and I have it, as well; etc.)

I've been weighing her here at home the last couple of days to try to see what's going on. I don't have a baby scale but have a postal scale that weighs down to tenths of ounces. I'm wondering if these patterns look normal. Anyone have input?

Friday evening, weighed her at 10 pounds, 0 ounces.
Saturday evening, weighed her at 10 pounds, 1.5 ounces.
Sunday evening, weighed her at 10 pounds, 0.5 ounces.
Then, she had a short nursing (sleepy and all that, having nursed some shortly before). Then she weighed in at 10-2.5, so she took in 2 ounces. She wet her diaper and weighed 10-1.5 after that. She nursed again and wet again and weighed 10-2. Again nursed and had a wet diaper and weighed 10-2.5.

So it looks like she's getting a net gain of half an ounce per nursing (and these are frequent nursings, every half an hour or so, not every two hours). Is that normal? Should I expect her to take in more than two ounces per feeding when she's nursing this frequently? I really don't feel like I have any supply issues (tons of leakage, can collect a couple of ounces *without* pumping from the non-nursing side with a Milkies collector, can feel quite full, and she not only nurses to contentment but also wastes a TON of milk by opening her mouth and letting it all pour out).

We're taking her in, probably tomorrow, to recheck her weight at the pediatrician. I know their scale is significantly off from my MW's scale (which caused a good bit of worry early on), but we're also comparing their readings to their readings, which is where it shows her falling significantly in percentile. I am also having my MW come and check her weight so I have a number to compare to her birth weight and 2 week weight on that scale. (Hoping to do both on the same day so I have some idea of how different the scales are at this point!)

I am indebted for any input anyone can offer at this point as I try to sort out what's going on and make wise decisions for our sweet girl! She is a remarkably happy, content, and quiet little one, and I would not have suspected her having any issues (okay, except for all the allergy symptoms!) save for the concern of our pediatrician.

[Thandiwe]

My last baby was my slowest growing.  He was born with a birth weight between the other two at 8#10oz (1st was 8#4oz, 2nd was 11#2).  But I had massive oversupply because I was tandem nursing, and it just seemed like my body NEVER stopped producing milk!  He exhibited some of the symptoms you list, and I started researching.  What I determined was that he was getting too much lactose (front milk), when he filled up on the milk and fell asleep.  I would switch him to the other side at the next feeding and the cycle began again.  So I started block feeding, where you feed on only one side for a length of time (several feedings), and then switched to the other side.  It made a difference for him.

As he got older, I think about 6/7 months old or so?, he started having a very painful latch.  I developed a really nasty open sore on my nipple.  I struggled to get it healed, and in my darkest moments, desperately wanted to wean him.  It made me cry to nurse on it, it hurt so bad.  I'd get it healed, but then the next week it would develop again, same spot!  I started reading up again, and had an idea that he might suffer from a tight upper frenulum.  Just as I started entertaining the idea of taking him in, he fell one night playing in the bedroom.  He smacked his mouth, and once the blood stopped, I realized what happened: he split his long/tight upper frenulum!  Literally, once that healed, it cured it all!  His latch is no longer painful, and I haven't had a sore since (he's now 11 mo).

He has only been to the doctors once, just for a weight check at like 3 months I think, so I can't tell you definitively what his weight gain curve has been, but he was on the much lower end then, I think it was like 5%??  And according to our scale, he still has gained minimal weight.  He's nearing his first birthday, and the other day with clothes and a diaper, and being weighed on a scale where daddy weighed himself then weighed him together then subtracted, he was 19# even.  So, he's a slower gainer.  I don't worry about it, though, because he seems well otherwise, just petite.

I hope some of this can help you.  It's a struggle to self-diagnose the problem.  The elimination diet is a pain in the rear; I'd avoid it if you can.  I did it for a while after baby #2, and it was in error and didn't really help anything. 

[HeatherB]

Thank you! I have been doing at least some block feeding with her, on the advice of my MW who suggested it for possible foremilk/hindmilk imbalance. I wonder if I need to do longer blocks?

My boys have had "helpful" falls where they broke the gum over teeth that were trying to come through. I love that your BFing issues were cured by a fall!

My older boys were a similar size to yours at a year, so I know that's pretty normal for my kiddos. They never have been super fast growers or super big. Eliana started around 50th percentile (8lb 4oz at birth, though pedi's scale said 7-10 at 6 days - we know the scales didn't match and that she had dropped *some* weight) and is now down to between 10th and 25th, 9lb 14oz at 9w6dwks on the pedi's scale. I think those numbers are all right.

I really do want to avoid elimination if I can. I know with my first two it did nothing. I never could figure out what was up with my 3rd (who also had mucousy stools and reacted to a couple of different foods quite clearly, but we never figured out what ingredients in them it was). I have avoided it thus far because it's such a pain, but if it's an allergy causing the lack of weight gain and not something else, I'll feel quite guilty!

[Thandiwe]

My oldest son had a lot of issues: projectile vomiting, rashes/eczema, and as he got older breathing troubles that have come and gone over the years.  When his eczema was at it's worst, I had just had my middle child so we did the elimination diet.  I stuck with it for 7 months, but it actually made his gut worse.  I found - and this is only my situation - that it was better for him to be exposed to the foods and build immunity.  We went through a very expensive slew of tests on him and discovered he had something like 26 different "sensitivities."  The regimen the holistic pedi prescribed was INSANE and I was stressed, having PPD already with an emphasis on anxiety.  After 7 months of a massive elimination diet, my husband and I came to our senses and realized that his stools were even looser on the diet, his skin horribly flared, and we were exhausted from our efforts.  So, we let loose.  I found things actually improved a little bit.  And over time, he grew out of it.  Now, mind you, this wasn't a diagnosed allergy - I know that would be different.  But for us, the diet was overkill and made matters worse. 

I would try block feeding longer; what do you have to lose?  I will try to find the link to the KellyMom article I read back when DS#3 was a new babe.  Have you checked her upper frenulum?  I knew it was tight on my little guy when I pulled up his upper lip, and the skin flap extended down the top gum, and around, between the teeth towards the roof of the mouth.  It made him have a shallow latch which, as he got older, he compensated for by biting onto my nipple and sucking it in.

But if you don't have a family history of food allergies, I'd set the elimination diet aside for now and try other things first. 

[Thandiwe]

Here's a link to a growth chart on KellyMom.

Here's a link to KellyMom with really good references on the bottom of the page; you should check out a few of the references!  Particularly this one.

[HeatherB]

Thanks! I hadn't read the last link but have been spending a lot of time with the others today. I always feed on one side only, and have been keeping her on the same side within an hour or so of her first having it. Of course, then there are times like tonight when she's nursed no less than six times in the last 2-3 hours (including sleeping for a stretch in there), and I get rather sore and have to switch it up.

I'm curious about the upper frenulum. She doesn't have teeth, of course, but the skin ridge definitely extends down her upper gum and under. On the lower, I read an article linked from Kellymom that said the bottom of the mouth should basically feel smooth. I feel a line in there on her, but not on two of my kids. My oldest has it, and I have it, too. According to that link I'd been reading, that means a definite problem. Of course, the weird thing is we've seen our MW, pediatrician, AND an ENT (she has a 3mm mass on her inner lower lip which the ENT thinks is an enlarged/irritated salivary gland). No one has remarked on her frenula. But, I know that's also not uncommon to miss. So I'll be asking tomorrow when we see pedi and MW.

The whole allergy thing is just nuts. I'd love to be able to test for what she's sensitive to, yet when we tested my DS3, it showed nothing. He was clearly sensitive but they didn't offer the right tests. I'm not sure if the pedi will want to get those same tests for Eliana. Her symptoms are definitely fairly classic, so maybe it's a typical allergy? I so hope it's something she outgrows and won't have long-term issues with, whatever it is!

[Thandiwe]

Yes, motherhood is a complex web of decision-making and worrying!  Let me know if you find anything out.

[Jodie8]

Heather-I would recommend weighing your baby only once a week-a baby can lose a significant amount of weight from peeing and pooping. So if you weighed your baby in the evening (when supply is lowest and she just pooped and peed, her weight could be significantly lower than if you weighed her in the morning after a full feed before she wets/poops/ I hope that makes sense, nut now that I reread your post, it seems that is what you are doing!

But I would seriously only weigh her once, maybe twice a week, otherwise you will drive yourself crazy.

It sounds like you have TONNES of milk-I too wonder about her getting to the hindmilk. I would try block feeding for 3-4 hours for a few days and see how it goes.

[chaoticzenmom]

Is it possible that you have oversupply issues?  The dumping lots of milk out makes me think that maybe she's overwhelmed the overflow and that can cause tummy issues as well.  Maybe you can pump out an oz. and then feed her while thinking of something that won't make you release much milk.  From your description, it sounds like she may be sucking shallow because the deeper suction could be too much for her.  Maybe try pumping out an oz before feeding her and feeding her in an upright position.  Also maybe pull her off a few times in the beginning to calm your letdown (if that is actually the problem).

[HeatherB]

How does oversupply factor in with the low weight gain? Or does it? I've seemed to have oversupply/oald with all four, but we've never had weight gain issues before.

Does anyone know if her transfer numbers are normal? Granted, those were all evening/cluster feeding numbers posted in the op. I definitely won't be weighing her constantly as a normal course. But I am trying to get an idea of where our problems may lay.

Thank you, all!

[Thandiwe]

Originally Posted by HeatherB 

How does oversupply factor in with the low weight gain? Or does it? I've seemed to have oversupply/oald with all four, but we've never had weight gain issues before.

Does anyone know if her transfer numbers are normal? Granted, those were all evening/cluster feeding numbers posted in the op. I definitely won't be weighing her constantly as a normal course. But I am trying to get an idea of where our problems may lay.

Thank you, all!

Well, I can't speak to the transfer numbers as I've never done that before.  But from what I've read, the oversupply can cause low weight gain because they tend to get too much of the foremilk if you're not block feeding.  Since the foremilk contains less fat, they get more lactose than fat.  *If* that's the problem, then I don't really know why it wouldn't have happened with the others?? 

 

[HeatherB]

I'm guessing we're looking at both OALD as well as allergies. Had a weight check and took in stool samples today... She gained 2oz in 72hrs which is just enough for the pedi to be okay with it. Her stools tested positive for blood, as well. After talking with my MW, I think we have a plan of action to address both. I hope it works out and I don't go crazy with it. I'm worried that if I don't get it all right, she won't get better, but it seems like there's so much to get right!

[Thandiwe]

You will, Heather.    It's all overwhelming right now, but once the dust settles, you will actually be grateful to have gotten a bloody stool sample.  From what I understand, that can point semi definitively in the direction of milk allergy, which is more than so many of us get when we stab in the dark and play the elimination diet guessing game.  I would start with milk, and look everywhere.  It's in everything from meats to pills to anything else you can think of.  I think once you get the bulk of it out of your diet and a couple of weeks pass, things will probably start looking up.

Will you be doing formal allergy testing?

[Jodie8]

Oversupply can cause blood in the stools too and can contribute to low weight gain. As another poster replied, the volume is there in oversupply, but not the fat. It is common for babies to have lots of wet diapers, but not so many poops. Also, poops can be green with oversupply because there is so much lactose and the baby isn't making enough lactase to break it down. The lactose irritates the intestines and voila! Blood

With your other kids not having gaining issues-maybe they were able to get out more hindmilk before feeling full. How often does your baby feed?? How many poops /pees a day and what color poop???

I really think you are dealing with oversupply and not allergies. For what it's worth my experience with allergies is that babies gain alot because they comfort nurse so much to ease tummy irritation.

[Jodie8]

oh I alos wanted to mention that the breastfeeding physician here said that a baby's weight can be 9 ounces less if weighed prior to feeding and after peeing/pooping!!!

[HeatherB]

Wow, so many different ideas...

Her stools always smell good - nothing ever bad about them. They are mostly yellow (were bright orange when she was tiny) but sometimes green, moreso recently. Some days, like today, they are SUPER mucousy. Others, you can hardly tell there's any there (but I can find it when I look for it). I've never seen evidence of blood with my own eyes, but don't doubt that it's there at a microscopic level.

I *think* I've seen some correlation between dairy intake and her symptoms. I.e., night before last I had ice cream and this morning she had super mucousy stool. I rarely drink a glass of milk, but I did on two occasions and within 24-48 hours, she was up late with tummy pain.

She's generally a very laid back, calm, sweet, easy going baby. She's rarely fussy except for hunger or being tired, and even with being tired, she often just falls asleep. She sleeps quite well - the mythical "sleeping through the night at 6 weeks of age" baby that I didn't think existed! This is all in huge contrast to my silent reflux baby who never slept, screamed all the time, nursed constantly, etc. He never showed improvement off dairy and never had suspect stools, though. Zantac helped him a lot but he had reflux past 2 years old...

Eliana nurses these days every 2 hours, though she does cluster feed at night. For a while, she was nursing less frequently and sleeping even more. She still sleeps at least one big, long chunk during the day (3+ hours?) as well as smaller naps.

She's not particularly gassy but I did notice tonight that she had some fussiness and then gas a couple of times. It's not typically enough to garner any attention.

The plan at this point is to avoid all dairy for 5-7 days and see if it makes a difference, then have a lot of dairy one day, and avoid again and watch for a pattern. I think that plan makes even more sense if there's some chance it's just all oversupply.

I pumped 4.5 ounces total this evening and as it separated noted that it had very little fat in it. Perhaps more will show as it cools, but for the volume, it was much less than I would have expected even from more recent pumpings. Of course, my goal was to get foremilk, not hindmilk, so perhaps I simply achieved that. One side is now very painful from the combination of block feeding and pumping (having vasospasms, I think, plus it tends to be more sensitive and painful, anyway), but I'm hoping it will be helpful to her. I'm not sure if it's just my looking for it or if she really is nursing a little differently. When she's pulling off, there is not a huge gush of milk, nor is there continual spray soaking everything until she latches on again. The letdown (not that I feel it, ever, but hearing her gulp) is there sometimes and not always, but she still gulps fast when it comes. She has seemed at some points more sated and at other points fussy at an empty breast. Clearly, this will all take some learning for both of us and adjustment from my body to get it all right...

[crystleyz42]

Hi HeatherB,

You directed us here from your post in the Allergies forum.  I have to tell you, after reading through this, I really think your issue is OALD/oversupply and not so much allergies, having been down both paths myself.   So many references to it --- green stools, gassy baby, and even the shallow latch which might be contributing to the slow weight gain -- babies can tend to 'nibble at the nipple' when the milk is coming out faster than they can handle it.

This is what helped me:

1) Nursing in the Laid Back Breastfeeding position.  This might be helpful to you for a few reasons -- a) it can help fix a shallow latch b) it helps increase milk transfer and could therefore help with babe's slow weight gain and c) it is a variant of the 'uphill' nursing position which is recommended for mediating OALD.  (My IBCLC/LLL Leader told me that it would keep my LO from feeling like he was nursing at the "end of a garden hose")  :P

For more about Laid Back Position see:

http://www.llli.org/docs/0000000000000001WAB/WAB_Tear_sheet_Toolkit/01_laid_back_breastfeeding.pdf

and

http://www.nancymohrbacher.com/blog/2010/7/18/laid-back-breastfeeding.html

2)  Block nursing -- but being zealous about the blocks.  I ended up having to get a nursing bracelet to keep track of my time chunks -- I switched the bracelet back and forth with each feeding, and the bracelet helped me keep track of the time increments.  I found that my supply never did balance out -- DS is 11 months old, and he still only feeds on one side/feeding.  IBCLC said some women's supply just works this way. 

(This bracelet was the one that I ended up using b/c it didn't catch on my clothes or scratch my other kids: http://www.toysrus.com/product/index.jsp?productId=3197291&CAWELAID=227628724)

Good Luck!

[HeatherB]

I so appreciate all of the input! I am really hoping it's just oversupply. I'm both trying to pump or express as much foremilk as possible as well as block feeding - though I'm hoping my blocks aren't so long as to be threatening overall supply. But, I suppose reducing supply is part of the point?

I am wondering about this new happening, though... This was the third day off dairy and on the aggressive block feeding/expressing schedule. She generally has a dirty diaper first thing in the morning, and I noticed yesterday's and todays had a lot less mucous in them. Yay! Then, later in the day today she had another bm, much smaller than the typical morning one, and it was almost ALL mucous. Later, the same thing again. Then, late tonight, she had an explosive-sounding but fairly small stool, mucousy but not nearly like the earlier ones.

So, here I thought the lessened mucous meant things were getting better... And then it looks like it's worse. Am I reading these signs wrong? Could she actually be reacting to something I'm eating more of now that I'm avoiding dairy? I'm not really eating anything I wouldn't normally eat, though, i.e., I haven't started consuming vast amounts of soy or anything. I did buy some various cookies and snack foods that are dairy-free, which do contain other potential allergens, but probably none in huge quantity.

I'm not going to change anything up just yet but am really stumped by the weird, super-globby stools.

[crystleyz42]

Don't make yourself crazy with every diaper change.... look for overall trends.  The level of fat in your milk will vary throughout the day (highest  between midnight & 4am, actually) so there's going to be some level of variation throughout the day.  Guts don't react instantaneously, you need to give them time to stop being inflamed and to heal, and the bio-feedback mechanisms involved in your milk (over) production need time to re-balance out.

Stick to the Laid Back Breastfeeding position and your 2 hr blocks. ... and then just quit obsessing for about a week or so.

Also, beware of too much pumping -- it can really create a worse problem.  Any nipple stimulation is going to tell your breasts to create more milk.   The trick is to get you and baby in balance w/o needing the pump.

(BTW-- I'm also a LLLI Peer Counselor, in addition to someone who has dealt with an infant who was IgE positive for dairy (DD) and a mamma who had oversupply issues (DS) so I'm not just making this stuff up.)

Best of luck!

.

[HeatherB]

Thanks, crystley! Don't worry, I don't think anyone's making it up! I really appreciate all the help and advice.

I am mostly watching in detail so that I can log it for future reference/comparison, i.e., did things improve off of dairy or get worse when it's reintroduced. Of course, I'm also hopeful for signs that things are improving overall! My memory is just pretty awful these days, so logging it seems best. (I'm having trouble remembering that I just changed her diaper and need to log it... leaf green in that one! Yikes!)

I was talking to another friend (and LLL leader) who was also suggesting increasing fat intake on my part. I need to be getting more fish oil, anyway, so I'm going to focus on that and finding good fats to eat. I know my diet's not been so great (and rather sparse) since the baby was born, so that seems worthwhile, regardless.

I've done some blocks as long as 10-12 hours and am backing that down now. I'm trying to pump at the beginning of a block (i.e., when the breast is full) and am easily getting about 3 ounces of foremilk (which I feel is confirmed by the distinctly low volume of fat when it separates - much lower than I'm accustomed to when pumping concurrently to feeding or after a feeding with my other babies). Then I'm feeding her on the emptier breast as long as possible before switching. At night, I'm just feeding on one side, pretty much, which isn't far from the pattern we'd fallen into, anyway (helped by the fact that she sleeps at least one long stretch during the night). I've been nursing in laid-back positions or football hold, along with side-lying at night. When I can't pump before switching sides, I'm hand-expressing as much as possible.

And, this is day four without dairy. The original plan was for a rotation diet, going 5 days without, then one day with, and 5 days without. I may stretch that an extra day or two to make sure of what I'm seeing before we trial dairy again. I know dairy can take a while to work its way out, but also would love to identify it one way or another quickly.

I haven't weighed her in a few days and may check her again tonight. I'm really hoping this will all pay off. My MW will do an official weight check on Tuesday on the same scale we've used since birth.