Slow Gain in 2mo EBF girl; 8oz in a month

[CookAMH]

2mo well check today: 11lbs. A month ago, she was 10lbs 8 oz. Gained 8 oz in a month.  Birth weight [homebirth, no IV] was 8lbs 4oz, back at birth weight in a week and at three weeks she was 10lbs 5 oz. She started off well! Has grown 2" since birth.

- I *think* reflux is resolved through my diet a few weeks ago. Though sometimes when she cries she almost sounds hoarse?

- haven't been able to eat dairy

- she was pooping infrequently (1x a week or 2 weeks) but this week pooped 6 times

- she's sleeping 6-7 hours some nights, usually at least 4-5.

- nursing 8-9x a day (would be 1 or two more but she takes a nice long afternoon nap (3hrs) and has that longer stretch at night

- eating every 2.5 - 3 hrs during the day

- she's content after eating, plays, smiles, then sleeps later

- likes the paci

- overactive letdown generally seems to be resolved. But she was fussing today when nursing like she didn't want the flow (and it wasn't even that fast, not spraying at all) but had only nursed 3-4 min.

- not too interested in non-nutritive sucking or lingering long enough to get more fatty milk

- sometimes takes 2 sides, sometimes one

- pumping isn't = to nursing yield, but I got 4oz from one size yesterday (a decent amount for me)

- doesn't appear to have any pain from reflux like she used to. I cut out OJ and it greatly improved

Dr isn't too concerned but wants a weight check in a week and then possibly consult a LC after that. I've wondered if the fact that I can't have dairy (I miss my raw milk!), I'm having less fat. I've been filling up on more carbs and sugar and didn't think of that until after I left the Dr.  So, I'll be working to have more fat in my diet (coconut oil/milk, butter, nuts) and see what that does.

I'm not really worried too much but am some.  DS (now 2) gained very well though as an infant then slowed a lot. Has always been very solid.

I know she has filled out more in the last week, So maybe earlier on, she wasn't gaining at all with the dairy issues and she's now doing ok? Obviously I don't know if perhaps she gained nothing for 3 weeks then put on 8oz all last week, you know? So, the weight check next week will tell a lot.

Edited by CookAMH - 6/10/11 at 4:45pm

[sosurreal09]

8oz sounds fine to me . If you are worried about fat eat more nuts they are high in fat and protein which is good.

[CookAMH]

2oz a week seems a bit below the 5-8oz average...

Also, I've noticed she's been crying differently lately, very weak and pathetic. DH commented on it too. Could that indicate something more serious? Maybe I'll email her pedi and ask about that.

Edited by CookAMH - 6/10/11 at 9:47pm

[PatioGardener]

I'd be looking for an explanation. 2 oz a week in a 2 month old is not typical. Slow weight gain is a red flag for breastfeeding issues or medical issues. Sure it may be normal for your little one, but it may not be. I'm surprised the doc didn't suggest an appointment with an IBCLC and closer follow-up.

In that situation I would want to have milk transfer checked (by a good IBCLC), I'd want a knowledgeable person to look for tongue-tie (anterior and posterior), I'd probably want before and after nursing weights on a really good scale and if transfer was good then I'd be pushing the doc to take a closer look for medical issues. I'd also try to nurse 12 times in 24 hours for a few weeks, even if that meant snuggling during naps for a dream feed or two.

I'm on the more cautious side of things with respect to slow weight gain in newborns, having seen a "happy to starve" baby put on almost no weight for 2 months and then gain typically once the problem was caught.

Good luck, Mama.

[ewe+lamb]

I agree with PG, this isn't normal and to look for a good IBCLC to help sort things out, whilst waiting for the appointment with the IBCLC I would really think about doing some breast compression to get that wonderful milk into your baby and start getting the weight on. 

This is a really good video of breast compressions http://www.nbci.ca/index.php?option=com_content&view=article&id=34:4-day-old-after-tongue-tie-with-compressions&catid=6:video-clips&Itemid=13

If you are interested then you may wish to have a look at the rest of the videos so that you can make sure that bb is getting a good deep latch and start working on that - laid back nursing one is one that may be of interest to you, BTW, you haven't mentioned if you are in pain, if there is any nipple damage - if there isn't nipple pain or damage then latch is really the thing to start working on.

Let us know how you are getting on!  Good luck!

Edited by ewe+lamb - 6/12/11 at 2:02am

[sosurreal09]

Laid back nursing is great! Sorry for the misinformation from me! My DD has always been thin so 8oz didn't seem too little to me.

[CookAMH]

Thanks, I actually started doing those compressions last night and the videos were helpful. I think her latch is good when the flow is good, I can even feel her tongue sometimes underneath if my finger is too close to her mouth.   The video where the baby is just poking around and pulling back and forth (where he mentions this baby is not getting a good flow of milk) does happen maybe half the time. I think when she's sleepier, she nurses better (ie if I wake her around 11pm or when she awakes around 4-5, those are usually good sessions with no fussing). Mid day is when it's not as good, so maybe my supply is lower then.

I'm starting to think supply as opposed to something with her. My electric pump isn't working though :(. DH and I talked about it and our gameplan is for me to pump following feedings when at home, offer that bottle after nursing for her to get enough, work on supply the next four days and if on Tuesday, I have an increase in supply, then we'll keep feeding and weigh on Friday. If my supply isn't responding or she is still not feeding as well (meaning, fussing a lot, refusing the breast, not emptying at least one breast). Part of the reason I'm holding off bringing in an LC is since she's pooping a whole lot more lately (at least once a day where before it was 1x a week), I think her system might be settling from the reflux and dairy, and I'm gonna see how her gain is this week.

I've offered her pumped milk the last few feedings and she'll eat about 1/2 oz usually. So, she'd take more if she were hungrier right?

I recall the fussiness with my son when he was about 3 mo - getting mad and even startled by the flow, so I am reminded to be leaning back for the milk to flow upward. That does help her.

Off to go wake her from her nap to eat, aiming for every couple hours during the day. Oh and I'm tracking her nursing times and behavior in my weekly journal, she's had 8-9 feedings a day the last couple of days. She slept from 12 to 5:45a last night which is typical for her the last few weeks.

And in recalling her stats the last few weeks she actually gained 11 oz in the last month. So about 2 3/4 oz a week average. Better but still low. 

Edited by CookAMH - 6/11/11 at 5:36pm

[ewe+lamb]

Hmm I just wrote a really long post and it got swallowed up in cyber space - I hate when that happens LOL.

Anyway Alicia, it's a great idea to pump after having fed your baby - the more the breast is emptied the more milk you will make - great!!  However it maybe prudent at this stage to think about using something else other than a bottle, at this stage your baby may prefer the faster flow of the bottle, so finger feeding with an SNS or syringe (with the needle part removed) or cup feeding maybe interesting and either you or your dh can do this.  Or if you do prefer to use a bottle then think about holding the baby in a more sitting position and the the bottle at a horizontal angle rather than vertical, this way bb has to work harder for the milk to come out.  Does that make sense?

So, just for your information, on average a bb of your little girl's age would be putting on around 27g/day I think that's around an oz, 3 dirty nappies and 6 wet ones/day, I know that there are babies who take in less but I think it's interesting to know what the HCP are aiming for!  This is a good link to have as well http://www.who.int/childgrowth/standards/cht_wfa_girls_p_0_6.pdf , the growth chart from the WHO.  8/9 feedings a day isn't bad but if you could get it up to 12 then I think you'll notice a difference, do you feel that this maybe possible? 

Keep up with the breast compression and pumping, focus on a deep latch and i'm sure things will work out just fine, good luck and keep up posted with how you are getting on.

[CookAMH]

Thanks for the support. Two days later (after op), I am much less concerned. I believe my supply has responded, she is pooping all throughout the day and I do believe she weighs more. I know home scales pale in comparison but I did weigh her with me and without me, naked, this morning and it showed 11lbs 6oz. Now, even if it's off a few ounces, it seems to show a gain from Friday from 11lbs.  My hunch still is that her gain in the first part of May was poor if anything because of dairy/reflux, and in the last week or two she *has* gained a good bit esp with all the very normal poops she's having (a good improvement from weeks 4-9) this past week.

I am really happy especially about her poops - in the last 5 days they have gone completely normal in frequency! I wonder if it took that long for the dairy to work itself out of everything. If so, I am motivated to wait longer before trialing it again.

I don't feel it's necessary at this point to wake her every 2 hours through the night too feed her in order to get 12 feedings in, but I am going to focus more on feeding her every two hours during the day. One big reason for that is she is having difficulty with flow and choking and getting so upset. Feedings closer together have a slower flow. With the fast letdown and upset, it's hard to finish the feeding (so today, again, I offered pumped milk). I use the slow flow nipples and since she hates fast flow from me, I'm not worried about her preferring the bottle for it's faster flow. But I will keep an eye on it and thanks for the advice in that regard.

[CookAMH]

I made a separate post about a resurrected issue for us this weekend - forceful letdown (originally an issue in weeks 3-4). What confuses me is if forceful letdown is usually related to oversupply...and before I started pumping this weekend, I didn't have oversupply (ie I had the right amount the last few weeks, usually no upset at letdown) then why wasn't she gaining well if I had just enough? The only explanation for it is the hunch I have - she gained poorly if nothing at all the first half of May (when she was also stooling infrequently), and last week, with stooling regularly, she started gaining fine and we weighed her at the end of that showing a low gain for the whole month. Maybe the gain and my supply has been fine the last week or two and I don't need to be increasing my supply (and thus introducing the very frustrating letdown issues). Sigh. I know nit'll get worked out but I do get frustarted that she's not getting good feedings when she gets SO worked up that we have to end the nursing session.

See my other post if you can offer any advice.... http://www.mothering.com/community/forum/thread/1317343/really-struggling-with-forceful-letdown

ETA: no, I have no nipple pain when nursing

[CookAMH]

She's up 4 ounces from three days ago, I think that's pretty good! I'll get her checked in a week and lay back on the pumping to ease the forceful letdown that we started dealing with again this weekend.

[ewe+lamb]

Great - so she's put on around an oz a day - is that right - maybe a bit more - well done you!!!  How do you feel now?  For the OAL, when you see or feel that it's starting to get too much for your baby try to see if whe'll come off the breast, let the milk pour/run into a little bottle or a towel or something and then put her back on when she's able to suck and is more comfortable with the flow.  By the way an OAL and Oversupply are seen as two separate things, you can have an over supply without the OAL and OAL without the oversupply, sometimes they go hand in hand and other times not - but it's not a given.  Keep it up, you're doing a fantastic job!!

[CookAMH]

Thanks, yeah just over an ounce a day. I'm happy!

Re pulling off - I have been doing that and lately she's been too worked up to get back on :(. But I will keep trying that because it's worked in the past. I think the key is getting her off at the right time, before the flow is to much which for me occurs just before feeling letdown..so waiting until I feel letdown is too late for her to recover.

[CookAMH]

Sigh. Had her weighed again just to see that things were still good, and she's only up 1.5oz in the last week + 1 day. Sigh. I may do a new post about if it's normal for some babies to have slow gain. She's content between feedings, but I do know she could eat more. And there is more milk - she pulls off as soon as the flow slows down and she's done. If she stayed on longer, she'd get at least an ounce more possibly.  I do breast compressions almost every feeding when the big flow slows, and I'm able to get her to stay on a little longer. Max nursing time is 5 min, usually 3-4. And she rarely takes two sides, and one side is a very low producer (pump 1.5 oz). On the better side, I only pump 2-3 oz with nursing her every 2 hours during the day (except for her long afternoon nap that is 3 hours).  Then when supply is up, she struggles with OAL. So, I think the route is to keep supply up (started fenugreek the other day) and get help for having her stay on and nurse well with more supply and she needs to learn to handle the flow. I think her gain would be good at that point.

From other reading, that sounds like pretty low output. My SIL would get 6 oz. I read old posts on here about getting 4-7 oz.  I have never gotten 6 oz and I know my babies have not taken in 6oz in any single feeding either. I'd get 4oz if I pumped before bed with my son (now 2) as an infant, and it had been 4 hours since he went to bed. So it sounds like I need to up my supply big time. Do you think she'd take more milk if it was there?

Any encouragement or ideas is appreciated. I can't afford a LC privately but am going to a drop-in clinic in two days to get some assistance for $10.

She's alert, happy, seems content after MOST feedings, growing in length (haven't measured head) and looks very healthy.  She is still pooping daily since starting that up again 2 weeks ago (after pooping 1x a week before that) and it's usually seedy and always nice yellow (well, she had ONE green one but all others have been yellow).

I could easily offer a pumped bottle but really don't want to become dependent on that. I did pump for one feeding and fed her that bottle, and I had gotten 3oz and it was added to 1oz I had from earlier. She took the whole bottle though I'm not sure if she would have taken more. Should I try giving her a bottle again sometime and see how much she'll take until she's done? I know babies will take more from a bottle so it's not entirely telling.