Breastfeeding...not enough calories in milk?

[livacreature]

MY DD is being very slow to gain.  She was born two months ago at 6 pounds, 2 ounces and now is 7 pounds, five ounces.  She's grown about two inches in length and is developmentally hitting milestones on or ahead of schedule.  I met with her pediatrician and an LC.  She is getting adequate amounts of milk from nursing, supply isn't the issue.  They both encouraged me to offer one to two ounces of formula after feedings to see if she starts to gain.  I occassionally do formula because I can't pump enough to keep her in breastmilk when I'm at work.  When I worked on Sunday for eight hours, she burned through my 32 ounce supply.  

Anyway, questions.  Has anyone been told their breastmilk may not have enough calories?  Is there a way to up the caloric content (I'm eating enough, lots of fats and protein, but would be willing to reevaluate)?  Has anyone had supplementing help with the weight gain?  She also sleeps through the night and is soooo not interested in feeding then, I've tried waking her up and she just comfort nurses herself back to sleep.

Thanks!

[Megan73]

I replied to your post in the skinny babies thread with some ideas to increase supply and weight gain.
I just wanted to reiterate, though - there's nothing wrong with your milk. It's perfect for your babe! Since she is gaining - albeit slowly - I bet that with a few simple strategies you could increase your supply and get her gaining.
Here's a good link from kellymom.com and a quote:
http://www.kellymom.com/nutrition/milk/change-milkfat.html
"The research tells us that baby's milk intake (the volume of milk - not the amount of fat in that milk) is the only thing that has been correlated with infant growth in exclusively breastfed babies. As noted earlier, average fat content of human milk is highly variable, but has not proven to be significant when calculating baby's total energy intake or weight gain. (Aksit 2002, Butte 1984, Cregan 1999, Mitoulas 2003, Mitoulas 2002.)"
I would guess that she is hungry, though, if she drank 32 ounces in eight hours. The typical BF baby consumes 25 ounces of BM a day.
Edited by Megan73 - 12/14/11 at 11:04am

[womenswisdom]

Have you done before-and-after weights when feeding so that you know how much she's taking in? Being able to pump an appropriate amount doesn't necessarily mean she is able to transfer the milk efficiently herself. I also have to wonder whether your supply is truly an issue if you are not able to pump enough and need to supplement with formula while you are away. It's possible that your supply needs some work or could also indicate that she finds it easier to feed from a bottle and might be having trouble getting enough milk from you, possibly due to an issue such as tongue tie. Just a few thoughts for you to consider...

[Louplus2]

Just wanted to send you hugs mama.

My DS1 was exclusively BF and was a slow weight gainer, maybe an ounce a week at one point. BUT he was gaining and a happy lovely bundle of joy. Hitting all of his milestones ahead of schedule. Same as your DD.

My DS2, is a little chunk, gaining 9 ounce a week, exclusively BF aswell. My diet has not changed at all, between kiddos, it's just the way they are.

Please don't worry mama. Your milk is perfect for your babe. If she is gaining, happy and hittiing all her milestones, why worry. Like my DS1 she is just little for her age, but perfect.

As for her drinking all the milk you left. They go through constant growth spurts, some days they want to eat more than others. She'll also be trying to build your supply up ready for another spurt.

Please if you can, try to limit how much formula she has because it will affect how much milk you produce.

I think with both my babes they went through growth spurts at 10 days, 2 weeks, 5 weeks, 10 weeks, 15 weeks and 20 weeks. Something like that. Brain is still in a bit of a fog. DS2 is 15 weeks so going through a growth spurt. Constant feeding again!!

Well done on feeding your babe, I know it's not easy some times. You are doing a great job.

[foreverinbluejeans]

I know it must be confusing to get conflicting info from medical people and people that know about breastfeeding. A mother's milk can't have too few calories and there isn't any way you can increase the calories of your milk when you breastfeed. If you have enough supply then your baby will grow about a pound a month unless there is something wrong with your baby. If you are sure you have enough milk and your baby isn't growing then your baby needs tests to find out why.

A baby will take milk from a bottle even if it isn't hungry and doesn't need it. That's because a baby can't regulate milk intake from bottles. When you bottle feed you need to measure how much you give per feeding and per day, you can't feed on demand.

Once you start giving formula your baby will nurse less well and your supply will decrease. If you have enough milk it makes no sense to give formula and mess up your supply. I wouldn't worry unless my baby was below the 5th percentile and I wouldn't panic until the baby's weight was getting close to the 3rd percentile. There are weight charts and discussions of how to use them at www.kellymom.com

[Megan73]

Originally Posted by foreverinbluejeans 

I know it must be confusing to get conflicting info from medical people and people that know about breastfeeding. A mother's milk can't have too few calories and there isn't any way you can increase the calories of your milk when you breastfeed. If you have enough supply then your baby will grow about a pound a month unless there is something wrong with your baby. If you are sure you have enough milk and your baby isn't growing then your baby needs tests to find out why.

It would be more typical for a breastfed baby under four months of age to gain five to seven ounces a week. A pound a month would be on the low side and I would have breastfeeding evaluated by a LC. The typical BF baby doubles birthweight between three to four months.