Slow weight gain and need major support

[Tmama]

I think I'm going crazy but hopefully I can get some responses that will take me down a notch or two.  I just came from my pediatrician with my 6.5 month old.  She isn't concerned about his weight but would like to see him gain more.  He is currently in the 10th percentile and was previously in the 50th back at birthweight.  So here's a brief rundown of his weight per month:

Birthweight -  7 lbs 2 oz.

1 week old - 7 lbs 4.5 oz.

1 month - 10lbs 4.5 oz.

2 months - 11lbs 140z.

4  months - 13 lbs 7.5oz.

4 1/2 months - 14 lbs. 3.5 oz.

5 1/2 months - 14 lbs 10 oz.

6 1/2 months - 15 lbs 0.5 oz.

So...he is gaining but not a ton.  We (my pedi and I) are both aware that babies stop gaining as steadily at this point but she said up to 6 months even - it wasn't a lot.  She said she is not alarmed but would like to see an increase and if he went below the 10th percentile, she would be concerned.  I cried to her as I have been so paranoid about my supply.  I wasn't always worried about my supply - it seems after the summer was over that I thought I was making less milk.  I started with the solids mid-September and he did great.  He was eating oatmeal and rice and I moved on to carrots.  Then, I started taking Fenugreek and I was feeding him oatmeal and he was pooping a ton one particular day - like 5 times in a day (his usual was once a day or every other day for poop).  So, I decided to go back to rice for a couple days.  I did just that and then he just stopped pooping for about 5 days.  I stimulated him with the thermometer and he went.  The he went another 5 days with no poop.  I gave him pear juice (reluctantly but I just wanted him to poop) and he went.  I have been giving him pear juice almost every day to no avail - no poop.  I KNOW breastfed babies can go up to 10 days with no poop but it still makes me slightly upset.  

So - today, I go to pediatrician for his 6 month well visit and he weighed in at 15 lbs and 0.5 oz.  A half pound increase in a month, which is good but just not at the percentile or weight we thought he could be.  She then asked about my supply when I pump, what do I get.  I told her that pumping can not be any indication of supply and she said this is true but if you at least get 2 oz, I would know that minimum he is getting about 4 oz or so....especially if I were to pump first thing in the morning.  I told her I'm lucky if I get an ounce sometimes.  I was sweating at this point...flustered and broke down into tears as this is totally feeding into my worst mothering fear...not having enough milk (I nursed my first son until 3 1/2 with no issues other than the occasional plugged duct).  I told her through tears that I just don't want to give him formula.  She said I'm not going to tell you that.  I said "ever?"  She said no, just increase your feeds and maybe go back to giving him solids.  Maybe not cereal but at least fruits and veggies as she is concerned he is just not getting enough from me and therefore that is why he is not pooping.  I do feed him almost every two hours or so it seems - even overnight.  

I'm now eating lactation cookies for the 4th day and went back to taking fenugreek (I stopped the fenugreek in a paranoia that it caused him not to poop).  I'm going to stop drinking the tea now that I'm back to taking fenugreek as to not overdo it on the fenugreek.  Increasing my water intake and trying to relax.  Also, I did start to give him "lunch" today and gave him some pears.  I know he doesn't NEED solids right now but just want to see him poop.  Hopefully, my milk will increase SOON with my regimen with the cookies and the fenugreek and water but until then...I'm just plain sad and feel like I am failing.

[Megan73]

Take a deep breath. I think your ped is right to your babe needs to gain more but there's no emergency. Really! Your little guy's weight gain is low but not alarmingly so at least to my eye and the info on normal BF infant growth on kellymom.com.
Infrequent poops can be a totally normal pattern for BF babies after the newborn period. Both guys were like that even after I battled low supply and got them gaining well - including supplementing my first son.
If I were you, I'd think about replacing the fruit with more calorie-dense solids - sweet potato, avocado, meat and fatty fish, egg yolks - and consider taking domperidone, a really effective galactagogue. Nurse, nurse, nurse - especially before offering solids. You could also try some power pumping.
I bet you that weight gain will have improved at your next visit.
Big hugs!

[Tmama]

How do I get domperidone?  My OB doesnt write scripts for that sort of thing I was told today...

[Megan73]

There's a domperidone FAQ thread in Breastfeeding Challenges. I'll bump it for you. I think U.S. moms can buy it online - you can probably get the lowdown on that thread. Dr. Jack Newman's site has some great info on how to use it. The typical starting dose is 90 mg a day.
I just wanted to add - please, please don't beat yourself up. I really understand feeling sad - I've been there twice - but please don't feel like you're failing. You've done nothing wrong. You've caught the problem and you're tackling it. Your LO is fine. Hang in there!

[foreverinbluejeans]

I don't think you need to be worried. I don't think you need drugs, herbs, teas, cookies, or anything like that. I think you are feeding your baby the wrong things. Cereals are hard to digest and aren't good first solids. They were invented as a way to get iron in babies before they could put iron in formula. Iron tastes bad and they had problems finding a form they could get in the formula and the babies still drink it. That's why babies used to start cereal earlier, formula babies needed the iron. As you have found cereal and iron aren't so good for the digestive system.

You can give your baby fork mashed banana, sweet potato, or avocado. You can add butter or olive oil for extra calories for weight gain. Most  babies can feed themselves at 6 months. You should find that your baby will nurse and eat better when he doesn't have constipation. Breastfed babies don't need juice.  Since your baby isn't gaining well he may NEED solids. They can be a great source of calories and should always offer nutrition. If is a myth that solids are just for fun. Keep nursing every 2-3 hours even at night. Try staying in bed with your baby and having lots of skin to sking contact.

You can buy scales. Your baby should gain about 4 ounces a week or a pound a month. Maybe a little less from 6-12 months.

[Lazurii]

My niece was 7 lb even at birth.  At 6 months she was 10.5 lbs and now at 13 months she's 13ish lbs.  She is 27" long. 

My sister finally figured out that her daughter had silent reflux.  After she figured out how to control it somewhat her daughter started gaining a bit of weight.  Not a ton, but she's back on the breastfeeding chart curve.

So, I guess what I'm asking is, does your DS exhibit any reflux symptoms?  Crying, screaming, gassy, refusing to nurse but wanting to nurse all the time, green poo, doesn't sleep well, wants to be held forever, spitting up (not always a symptom, it wasn't in my niece's case)?  That can contribute to weight gain issues.

[MamatoAbbyJack]

Are your nursing sessions on the same side long enough? What I mean is, the rich, filling hind milk is higher in fat to aid in weight gain, and also has a laxative effect on baby.

If baby gets sleepy before getting to the hindmilk, or if the baby is already too full from solids to get to the hind milk, it could have the constipation effect, as well as slow weight gain.

IMO, (and I am no doctor), nurse before solids, long and leisurely on the same side. Pump to relieve the other side.  Switch sides next session, and pump the non-nursed breast.  Intro solids (I agree with the no cereal camp) after nursing/or waking, soft/mashed finger foods, so as to not interfere with nursing. Solids at this age are more for experimentation and learning to masticate, not for nutrition so much. 

Also, longer nursing sessions, even if only on one side at a time (as long as you pump the non-nursed breast) will serve to improve supply.

[tincia]

The suggestion about hindmilk is a really good point, however, if u do have a lowish supply, one side won't be enough, but if you can keep him on each side a little while that might help. I am a firm believer that solids are more than jyst fun if you need them to be. Solids are the only reason i was able to get my son off formula. Avacodo is awesome for giving them a nutrient and fat dense solid, my guy wouldn't eat it though unless sweetened with peaches, pear etc.whole goat yogurt is a good one too
i honestly don't think that weight seems soooo low. I live in Ontario Canada and we were just in for the 6m appt last week and the nurse said that for bf babies they r happy as long as they have doubled in weight from birth to 6m
Where do u live? I dont know much about getting dom if u are in the US cause I am fortunate enough to just get it at the pharmacy..it really does work though! My supply has tripled with it and lots of work.
Good luck!

[Tmama]

I live in the US so dom is not going to be easy to get my hands on.  

So...update is I took DS to the gastro and it turns out nothing is wrong with his pooping.  He actually pooped the morning of the appointment...which was this past Wednesday...and yesterday and this morning.  What changed?  I was told to up his solid intake to make up for the lack of the milk he is getting from me.  Do I like it?  Not in love with the idea since I KNOW BM is way more caloric and they want me to continue breastfeeding but just give him 2 meals a day in solids.  I want to DESPERATELY up my milk supply.  I'm taking fenugreek 3 pills 3 times a day and Blessed Thistle the same amount.  I'm eating 2 lactation cookies a day and increased my water.  I play relaxation music to calm down and not stress (I'm now convinced my stress level caused my milk to drop).  On day 3 of taking just fenugreek I felt full and had leaked a little...but that stopped...weird...I wonder if it's even working.  I just added the Blessed Thistle into the equation just yesterday...so I know i need more time but I really want Domperidone.  

I can't figure out who would prescribe it to me since I read it's not legal to prescribe it for any reason than what the med is intended for.  Also, DH isn't on board with dom...he doesn't like that its a medication and that the whole legal thing doesn't sit well with him thinking it could be harmful - even though I informed him it is an L1...even Tylenol is an L2.  Either way, who would prescribe it to me?  I can't get my OB to do it and I think my pedi won't since I am not the patient.  I try to pump...I try to do whatever I can.  I would slice my hand off if it meant I would have a full milk supply.  

The gastro called my pedi after I left since I got emotional with her too since she said his poop is fine...it's his poor weight gain that she is concerned about and in order for him to even stay on the growth chart...he would have to be 17lbs by next month.  Thats 2lbs. in one month...I DOUBT that will happen and I feel so much pressure...so since she called the pedi...my pedi wants to see me next week for a weight check on him.  I need more time, I don't want to hear anything negative...my pedi is all for breastfeeding, she is very sweet...but she would be concerned if his weight keeps dropping off the charts.  No, he's not loosing weight, he is gaining...just slowly (gastro said not slowly...poorly...nice huh?)

The joy of breastfeeding that I felt with my first is now being sucked out of me and I feel so depressed now.  I don't know what else to do.  I'm not going to starve the baby if it comes down to being told I have to supplement...and I know thats 15 steps ahead of things but if that is the end result I will be devastated.  

I am trying to nurse more on the side that I know has more in it...we stay on that one and he just refuses to stay on my right side.  I keep switching him and he will nurse for a minute on the right and then pull off.  When I hand express the right side, I get some good solid sprays.  So I go back to left and he settles down and then if I can, I pump my right side...not much comes out when I pump it but...I do it anyway.

It just plain sucks that it's even come down to this much work.  That is what I always loved about BF in the first place is that it was so easy and no work.  Insert foot in mouth...its not the case this time around.  I just want to up my supply and then maintain it and stop popping all these damn pills (herbs).  I was venting to my own mother that I would be devastated if I couldn't nurse this child as long as my first (3 years) and to offer the comfort that he got as a toddler from nursing.  She said it sounds like it's more about me.  How can that be about me if breastfeeding is FOR the baby?  That is not selfish!

[Lazurii]

Which growth chart is your doctor using?  For breastfed babes he should be using the WHO breastfed chart.  The usual chart in America is one based on formula fed and breast fed babies, but the formula fed babies skew the numbers (usually) since they are (usually) heavier.

WHO chart for breastfed boys

Looking at the WHO chart your baby boy is just fine for weight.

KellyMom article for growth charts

[Tmama]

No, she uses the standard which was part of my "beef" but she replied that this is just what they go by and this is the standard.  It was pointless to argue with her.  However, based on the standard - he is following a downward trend in his percentiles nonetheless.  She has no problem if we maintain where we are but if he continues down, then she is a problem with that.  In order to maintain 10th percentile...he would have to be 17 lbs in the next month...not going to happen!

[Tmama]

Also, I'm trying to bump my supply up majorly but it's almost as if I'm trying to re-lactate my right breast.  The right is just a dud...theres milk but very little in it.  Would More Milk Plus be better than the capsules of Fenugreek and Blessed Thistle I'm taking or is the capsules stronger since MMP has all the herbs just more broken down in a tincture...

[Lazurii]

  My son had a downward trend on his weight and my daughter has a downward trend for her height.  It's just who they are, my son is thin and my daughter is short.  They both started out at decent sizes.  Weight often trends down once baby becomes more mobile (crawling, sitting, rolling, etc.)

Please let me emphasize I am not trying to make light your supply issue.  I just want to say that your doctor, IMHO, has unrealistic expectations for your son and is not using correct data.  That's not good.

Also, about the no pooping thing, my kids would do that when they were starting to launch into a growth spurt.  It was almost like they were digesting EVERYTHING they could out of the milk in order to grow.  And it is possible that your doctor appointment landed right before a spurt making your DS look smaller than he really is, if that makes sense. 

[PatioGardener]

Your docs are using the wrong charts. Even the CDC recommends the WHO growth charts for kids under 2.

 http://www.cdc.gov/growthcharts/

If baby is following a curve on the WHO charts, then growth is normal.

If baby isn't growing on the WHO curve, then increasing breastmilk intake is a great idea. Hang in there!

[Tmama]

Originally Posted by PatioGardener 

Your docs are using the wrong charts. Even the CDC recommends the WHO growth charts for kids under 2.

 http://www.cdc.gov/growthcharts/

If baby is following a curve on the WHO charts, then growth is normal.

If baby isn't growing on the WHO curve, then increasing breastmilk intake is a great idea. Hang in there!

This is true and I did mention that to her.  She then told me it's the standard growth chart that they use and that the truth is there should be a separate growth chart for downs syndrome babies and cystic fibrosis babies and so on but unfortunately there isn't.  Also...she emphasized that she isn't concentrating on his percentile or placement on the chart as she is the trend he is following, which is downward.  That is what she is concerned about.  If he continues down...then I will have to worry.

I just can't wait to at least get to the 1 year mark because I feel like after that point, the threat of someone telling me I have to supplement will stop after DS turns 1.  I am in love with toddler nursing.  It was so nice to be able to nurse my first DS until 3 (never thought we would go or last that long) during the 2's and for most of the 3rd year.  He stopped in my second trimester when I was pregnant with DS2.  I got off track here but the point I am making is that I am praying that DS2 can just maintain his placement on the chart until we get to 12 months at least.  After that point, we can start so many different foods and the threat of formula will not be hanging over my head, kwim?

So...update is I took DS to the gastro and it turns out nothing is wrong with his pooping.  He actually pooped the morning of the appointment...which was this past Wednesday...and yesterday and this morning.  What changed?  I was told to up his solid intake to make up for the lack of the milk he is getting from me.  Do I like it?  Not in love with the idea since I KNOW BM is way more caloric and they want me to continue breastfeeding but just give him 2 meals a day in solids.  I want to DESPERATELY up my milk supply.  I'm taking fenugreek 3 pills 3 times a day and Blessed Thistle the same amount.  I'm eating 2 lactation cookies a day and increased my water.  I play relaxation music to calm down and not stress (I'm now convinced my stress level caused my milk to drop).  On day 3 of taking just fenugreek I felt full and had leaked a little...but that stopped...weird...I wonder if it's even working.  I just added the Blessed Thistle into the equation just yesterday...so I know i need more time but I really want Domperidone.  

I can't figure out who would prescribe it to me since I read it's not legal to prescribe it for any reason than what the med is intended for.  Also, DH isn't on board with dom...he doesn't like that its a medication and that the whole legal thing doesn't sit well with him thinking it could be harmful - even though I informed him it is an L1...even Tylenol is an L2.  Either way, who would prescribe it to me?  I can't get my OB to do it and I think my pedi won't since I am not the patient.  I try to pump...I try to do whatever I can.  I would slice my hand off if it meant I would have a full milk supply.  

The gastro called my pedi after I left since I got emotional with her too since she said his poop is fine...it's his poor weight gain that she is concerned about and in order for him to even stay on the growth chart...he would have to be 17lbs by next month.  Thats 2lbs. in one month...I DOUBT that will happen and I feel so much pressure...so since she called the pedi...my pedi wants to see me next week for a weight check on him.  I need more time, I don't want to hear anything negative...my pedi is all for breastfeeding, she is very sweet...but she would be concerned if his weight keeps dropping off the charts.  No, he's not loosing weight, he is gaining...just slowly (gastro said not slowly...poorly...nice huh?)

The joy of breastfeeding that I felt with my first is now being sucked out of me and I feel so depressed now.  I don't know what else to do.  I'm not going to starve the baby if it comes down to being told I have to supplement...and I know thats 15 steps ahead of things but if that is the end result I will be devastated.  

[PatioGardener]

Originally Posted by Tmama 

This is true and I did mention that to her.  She then told me it's the standard growth chart that they use and that the truth is there should be a separate growth chart for downs syndrome babies and cystic fibrosis babies and so on but unfortunately there isn't.  Also...she emphasized that she isn't concentrating on his percentile or placement on the chart as she is the trend he is following, which is downward.  That is what she is concerned about.  If he continues down...then I will have to worry.

.Sorry I'm confused - does your baby have DS and/or CF? I'm not sure how that fits in here.

As for following the trend - that is exactly what the WHO curves are for. It doesn't really matter which percentile a baby starts at, what matters is that they stay on that curve. For example, a baby at the 15% who follows that 15% curve is growing as we would expect. We now know that we should not expect a typical healthy baby to grow the way the old CDC charts expect them too. So if a typical, healthy baby is following the WHO curve but "falling off the curve" on the old CDC chart, then it really doesn't mean anything. If baby is "falling off the curve" on the WHO chart then there could be an issue with growth, milk intake etc. And to me, "trending downward" means losing weight - which your baby certainly is not doing!

Have you plotted your DS's weights from birth on the WHO chart? http://www.dietitians.ca/Downloadable-Content/Public/LFA-WFA_Birth-24_BOYS_EN.aspx

It looks to me like he is falling of the curve on the WHO chart, but my math is often wrong so double check!

There are lots of ways to try to increase milk supply in mom. Has baby been examined for reasons that would cause poor milk transfer, like tongue-tie or low tone? Have you started hormonal birth control or are you taking cold medicine that can decrease supply? How often is baby nursing? And through the night?

Remember, if you do need to supplement temporarily while you get your supply up, donor milk may be an option.

[Tmama]

Originally Posted by PatioGardener 

.Sorry I'm confused - does your baby have DS and/or CF? I'm not sure how that fits in here.

As for following the trend - that is exactly what the WHO curves are for. It doesn't really matter which percentile a baby starts at, what matters is that they stay on that curve. For example, a baby at the 15% who follows that 15% curve is growing as we would expect. We now know that we should not expect a typical healthy baby to grow the way the old CDC charts expect them too. So if a typical, healthy baby is following the WHO curve but "falling off the curve" on the old CDC chart, then it really doesn't mean anything. If baby is "falling off the curve" on the WHO chart then there could be an issue with growth, milk intake etc. And to me, "trending downward" means losing weight - which your baby certainly is not doing!

Have you plotted your DS's weights from birth on the WHO chart? http://www.dietitians.ca/Downloadable-Content/Public/LFA-WFA_Birth-24_BOYS_EN.aspx

It looks to me like he is falling of the curve on the WHO chart, but my math is often wrong so double check!

There are lots of ways to try to increase milk supply in mom. Has baby been examined for reasons that would cause poor milk transfer, like tongue-tie or low tone? Have you started hormonal birth control or are you taking cold medicine that can decrease supply? How often is baby nursing? And through the night?

Remember, if you do need to supplement temporarily while you get your supply up, donor milk may be an option.

I'm not sure if I'm doing it right but it looks like he is ok on the WHO chart....I'll double check...

No, he doesn't have DS or CF, she said that in reference that every situation should have their own growth chart.  

[Lazurii]

Originally Posted by Tmama 

I'm not sure if I'm doing it right but it looks like he is ok on the WHO chart....I'll double check...

No, he doesn't have DS or CF, she said that in reference that every situation should have their own growth chart.  

Um, EXACTLY.  Which is why there are specific breastfeeding charts with the data coming only from EBF babies.  The information is out there and she's refusing to use it for whatever reason.

[Tmama]

Originally Posted by Lazurii 

Um, EXACTLY.  Which is why there are specific breastfeeding charts with the data coming only from EBF babies.  The information is out there and she's refusing to use it for whatever reason.

I know!   This is how I feel!    I can't understand how she can't just get it!  She kept going back to...this is just the standard that they go by and that it's the TREND that she's worried about.  

[Lazurii]

Then, if at all possible, it's time to find a new doctor.  My little sister (see above) had to do that because her doctor refused to use the breastfeeding charts and FLIPPED on her and she was scared of CPS involvement.  Her new doctor is awesome and realizes that my niece had reflux and is also just a small baby.  Way less stressful for everyone.