Slow Weight Gain

[howeberry]

My LO just had his 4 mo WBV and I'm finding it difficult to not be concerned by his slow weight gain. He is EBF.

DS was born weighing 9 lbs 8 oz & was in the 56th percentile at his first out-of-hospital check up at 5 days old. Now he's 12 lbs 12 oz & in the 11th percentile.

The Dr was concerned with DS's slow weight gain but suggested DS was never meant to be a big baby and has just settled out sooner than most, which is usually around when they start solids and crawl. The ped also suggested it could be because he burns a lot of calories since he is healthy in every other way. DS is a very active 4 month old & about a month ahead developmentally. Basically, if he's going to be a 11th percentile kid, that's fine, the ped just doesn't want to see him continue to drop.

The solution I was given is to increase feedings. I was feeding DS every 2-3 hours until his 2 mo well visit when the ped said he should be going 3-4 hours between feedings. So I spaced them out as best I could, while still offering when he was possibly hungry. Now the ped wants me to feed LO every 2 hours. I'm feeling like this is easier said than done since DS has become an easily distracted eater. I don't think I have low supply, but now I'm not sure.

Our pediatrician is extremely pro-breastfeeding and the word "supplement" hasn't come up once. All things considered, they want me to continue EBF until he is 6 months. DS is very happy and healthy, just a skinny baby.

Logically if the ped isn't worried, I shouldn't be either, but this isn't sitting well emotionally. I guess I'm looking for reassurance, or suggestions on how to increase my supply and get my baby boy to add a pound or two before his weight check next month.

TIA!

[PatioGardener]

I am so sorry that you were given such bad advice during your 2 month visit. Your ped is obviously supportive of breastfeeding, but not at all knowledgeable about it. Sadly that happens a lot! Now you can be wary of any advice about breastfeeding they give and nip anything suspect (like being told to space out feeds) in the bud!

Babies need to be breastfed on demand. Telling moms to space out feeds results in hungry babies and risks sabotaging mom's milk supply.

If I were in your situation, I would work on both increasing my supply and increasing the frequency of the feeds. I'd try to feed more when baby was sleepy - they often are more likely to take the breast when they are sleepy. I'd co-sleep if I wasn't already and if the environment was safe for that, and I'd try to get at least 10 feeds in every 24 hours, if not 12.

To increase supply there are a lot of tricks - oatmeal seems to help lots of moms, and then there are the herbs fenugreek and blessed thistle. I'd probably want to pump once or twice a day for a couple of weeks just to boost start things and increase stimulation.

The great thing is that our milk supplies are resilient, and with some coaxing most often bounce back!

Also, my baby became very distracted around 4 months and I had to remind him to nurse often - and often we had to nurse in a darkened room or lying down. Also, having a power nursing weekend when mom and babe lounge in bed skin to skin encourages more nursing too!

Good luck!

[Schae]

My son is also a slow gainer, in fact he hasn't gained anything at all in 5 weeks.  I understand your worry - I'm there too! :) What I've been doing is ensuring he bf's more often, I also make sure he totally empties each boob so that I can ensure he is getting the fatty hindmilk. My son is meeting all his milestones, is a happy baby and eats well - for now I'm leaving it. I don't know if this post was helpful at all though. 

[howeberry]

Thanks for the suggestions, PatioGardner. I'll give oatmeal and fenugreek a try. I have been eating a high-protein diet to try to keep my milk high in fat and recently stopped trying to be dairy-free for his gas. Hopefully they'll do something to help.

I've been increasing feedings and he never refuses. Course the tricky part is keeping him latched for more than 5 seconds. I've tried bf'ing in a dark room, in bed, on the couch, with him on the couch and me above, during tummy time. I noticed if I lay on the floor with him, he will roll over to try to get the clothed boob!

We do co-sleep. The only way I can get him to sleep for naps or at bedtime is bf'ing or going for a long walk.

When he fells asleep latched, he often will not release on his own. If I release him, he wakes and re-attaches. My local LLL leader suggested it was because he does not get enough and to switch him sides. So I've been doing this when he releases on his own for being distracted. Sometimes I feel like I'm playing ping-pong with him we switch so frequently. I do think it has been helping, but it's hard to tell since he's so easily distracted!

Schae - It is nice to know I'm not alone :)

[PatioGardener]

I know about the distraction! I have to tell my little one to focus on breastfeeding. He'll take a look at everything and anything instead!

I'm careful with making sure he gets enough feedings in the day/night because he is one of those babies who would be "happy to starve". He rarely cries when he is hungry - and could easily go 6 hours between feeds at 3 months old. Fortunately he'll nurse when offered, and so I just have to keep him interested long enough to get a let down! Recently I've been wearing a nursing necklace to keep him interested.

[mizznicole]

DS1 was born 8-6 and then had a very slow time gaining.  By 6 months he was 11th %-ile.  He is now 50% weight, 11% height at 3 years. 

DS2, OTOH, was born 9# and has stayed in the 90th %-ile. 

[nia82]

Why do they recommend to space out feedings??? DD had her 2 months check up and weighed just below 11lbs (born at 6 and 4.5oz) which puts her in the 30th percentile and her head is in the 8th percentile. The doc wasn't worried at all. I'm not used  to small percentiles as DS always was in th 99th for everything as an infant... I got myself fenugreek just in case. But DD sleeps a lot more than DS, she does up to 7 hour stretches at night while DS nursed every 3 hours on the dot.

My nephew always has been very tiny weight-wise but tall and my sister was never told to space out feedings or supplement, some kids are just on the smaller side. DD doesn't weigh a whole lot and hasn't been gaining much lately, but she's growing taller and taller and otherwise thriving. The doc (we see a FP DO) said as long as she's hitting milestones weight/head size doesn't matter. And look at your family, are there small kids? Then it just runs in the genes. I e.g. was asked whether I'm in school yet when I was in 6th grade! I was small and tiny til 10th grade... That's just how I grew.

[Emelee]

Originally Posted by howeberry 

Thanks for the suggestions, PatioGardner. I'll give oatmeal and fenugreek a try. I have been eating a high-protein diet to try to keep my milk high in fat and recently stopped trying to be dairy-free for his gas. Hopefully they'll do something to help.

I've been increasing feedings and he never refuses. Course the tricky part is keeping him latched for more than 5 seconds. I've tried bf'ing in a dark room, in bed, on the couch, with him on the couch and me above, during tummy time. I noticed if I lay on the floor with him, he will roll over to try to get the clothed boob!

We do co-sleep. The only way I can get him to sleep for naps or at bedtime is bf'ing or going for a long walk.

This is my DD to the letter! While she was 8 lbs 11 oz at birth, at 4.5 months she is 16.5 lbs. That's not bad except she hasn't gained in almost a month! I just started taking fenugreek a few days ago and she's now 17 lbs and holding! I'm hoping to see a nice weight gain because I don't want to start her on solids early. It is SO hard to get her to stay latched and even lying down in bed with the lights out doesn't do the trick.

I definitely think you should try the fenugreek, it's really working for me and I'm so grateful! The oatmeal didn't seem to boost my supply because I had been eating it every day for several weeks with no noticeable changes. I'm curious if it works for you! Good luck!

[howeberry]

I had to take DS to the dr today for pink eye and a quick weigh in had him at 13 lbs 4 oz clothed, so I think we're making progress!

I gotta say I'm surprised how fast fenugreek works. I started taking it Friday and I feel like I'm getting full much faster than before. I've been bad at keeping with the oatmeal. Think I ate too much of it when I was prego (I suspect it's what caused him to be so big at birth)..

[PatioGardener]

Great to hear that things are moving in the right direction! :)

Have you been able to work in more feeds?

Keep going - you're doing great! :)

[Bird Girl]

Was your son exactly on time, or did he go a few days past your due date? My son was 8 or 9 days past his due date, and weighed more than 9 lbs when he was born. He promptly fell off that growth curve, and, from about four months of age to now, age five years, has been under the tenth percentile. I think a few extra days of baking made my son look bigger at birth than he really is, and he adjusted at about your son's current age.

[howeberry]

Originally Posted by PatioGardener 

Have you been able to work in more feeds?

I feel like I'm feeding him all the time again! But it's worth it and he never refuses, even if he eats for 5 minutes before starting his pop on/off "I'm distracted by the world!" routine. I'm going to try a nursing necklace to see if that helps him focus.

Originally Posted by Bird Girl 

Was your son exactly on time, or did he go a few days past your due date? My son was 8 or 9 days past his due date, and weighed more than 9 lbs when he was born. He promptly fell off that growth curve, and, from about four months of age to now, age five years, has been under the tenth percentile. I think a few extra days of baking made my son look bigger at birth than he really is, and he adjusted at about your son's current age.

He was 13 days post dates. I suspect bad dates (now) but the ultrasounds always showed him right on schedule for my LMP.
 

[PatioGardener]

Originally Posted by howeberry 

I feel like I'm feeding him all the time again! But it's worth it and he never refuses, even if he eats for 5 minutes before starting his pop on/off "I'm distracted by the world!" routine. I'm going to try a nursing necklace to see if that helps him focus.

Awww, there's so much love in this post!

I hope the nursing necklace helps.

[mckittre]

Don't have any help for you, but I have one of these slow gainers too.  She was 15 days late and born at 9lb 15oz, but has been slow slow since then (3.5 months old and a little over 14 pounds now).  She spits up significantly too, but seems happy, and I can't get her to eat more than she does.  Part of me worries about allergies, etc...  The other part of me says that I'm a small person, her older brother is a 5th percentile kid, how could I possibly expect her to stay on that 97th percentile curve she was born on. 

[Schae]

My son was 10 days 'late' and weighed 4.16kg (9.17lb) - i think that does make a difference, thanks for pointing that out. Glad your little one is doing better :)

[howeberry]

Update...

We had a weight check this morning and my little guy weighed in at 13 lbs 12 oz, and measured 25.5 inches long. This puts him in the 8th percentile. Doctor is satisfied with this since he's still close enough to the 10th percentile to say he's stayed on the same growth curve in the last month.

The ped did suggest we start solids to get more calories in him. Dr suggested we start with rice cereal or oatmeal once a day for a week so DS can figure out how to eat, then move on to fruits and veggies.

I was really hoping to wait until 6 months to start introducing food. I know DS will still be mostly breast fed, but I can't help feeling discouraged. DS is 5 months 7 days old. He is great with the hand/mouth coordination, but is a little shaky sitting up unsupported. I know LLL says baby should be good at both before starting solids.

I'm trying to decide what to do before running out to buy a high chair and cereals. Would you start solids or wait another couple weeks? Would you start with the cereal or go straight to fruits and veggies?

[PatioGardener]

Originally Posted by howeberry 
 Dr suggested we start with rice cereal or oatmeal once a day for a week so DS can figure out how to eat, then move on to fruits and veggies.

nak
 

I would worry about this advice - cereal and most fruits and veggies contain fewer calories than breastmilk. Here is a good info page from Jack Newman about doctors who aren't supportive of breastfeeding. 

Did he comment on increasing breastmilk intake? With a little one that would be my first approach. Some other info from Jack Newman

http://drjacknewman.com/pdfs/Domperidone,%20Getting%20Started-2008.pdf

http://drjacknewman.com/pdfs/Slow%20Weight%20Gain%20Following%20Early%20Good%20Weight%20Gain-2008.pdf

http://drjacknewman.com/pdfs/Protocol%20to%20Increase%20Breastmilk%20Intake--2008.pdf

And a great site about calories and foods. I would start with high calorie foods like avocado. Mmmmmmmmm, avocado!

[osker]

E was a slow gainer.  At 4mos, I think she weighed 9.5lbs or thereabouts. She dropped her curve right at that visit and was in the .08th percentile for babies her height (10th percentile not using height).  She was a great sitter already and interested in food a bit at that visit but we didn't introduce it then. We upped her nursing, did all the fenugreek and whatnot and waited until 6mos to do solid food. She LOVES food and has really had a growth spurt! She was 30th percentile (ish) at her 8mo WBV and is gaining steadily now.  

Personally, I feel that waiting was the best choice for us. She loves food and never had issue with spitting out sloppy baby cereal or anything like that. She's a very talented eater and greatly enjoys food and new foods in particular!

ETA: If you do decide to start foods, I would NOT start with cereal. Empty sugar, in my opinion.

[howeberry]

Originally Posted by osker 

ETA: If you do decide to start foods, I would NOT start with cereal. Empty sugar, in my opinion.

This is exactly how I feel. If we do try cereal, I'd skip rice and go straight to oatmeal simply because it has more in it.

I think I've decided to wait. I really feel no need to rush this next milestone. We might try handing the little guy a piece of banana just to see what he does with it, but not expect any to be ingested.

Otherwise we'll try with intent on his 6 month birthday, if only to say we tried at his 6mo well visit 4 days later