Little one not gaining weight - please help

[SunLine]

Hello,

My DD was born 4/2 at 7lb 3oz and discharged at 6lb 6oz.  Weighted a week later, 6lb 4oz and two weeks later at 6lb 6oz.  I've been working with a LC and at that point we rented a high precision scale to track LO's progress.

She seems to eat well - at least 2oz per feeding, every 3.5 hours or so.  We also supplement with expressed breastmilk to get her to at least 2.5oz with each feeding.  Plenty of wet diapers and very few BMs - maybe a BM every 3 or 4 days.  This isn't uncommon for us as our last two children often stooled just once a week while they were ebf.

The problem is that her weight gain is almost non-existant.  For every 2.5 oz increase in weight, there is a 2.2oz wet diaper.  We will very slowly gain over the course of days, then a BM will bring her right back down.

Brought DD in to get weighed on 5/7 (5 weeks) and she was 6lb 15oz which our ped wasn't thrilled with but at least we were seeing a little progress.  Weighed again this saturday (7 weeks) and she was at 7lb 3oz.  We started her on alternating breastmilk and formula that day, and have moved up to at least 3.5oz of breastmilk or formula every feeding (every 3.5 - 4 hrs).  Seemed to gain well for the last 48 hours, then had a large BM and we're back to a hair over 7lb 3oz.

I don't understand how, with herculean efforts to get her to gain weight including ensuring she's getting enough from breast, then using a syringe to give her additional milk beyond what she would normally nurse, and now stuffing her with up to 4oz of formula multiple times per day, we're only seeing a fraction of an oz in gain per day.  Where does it all go??

We are having my milk tested to ensure it is nutritionally sufficient - aside from that we're lost.  What else can we try?

DD seems to be perfectly healthy apart from being very small and skinny.  When awake, she is alert, has started smiling a little, cooing.  She really seems very happy and healthy.  If we didn't have a scale in our lives we would probably be stress-free parents.  But, we have an almost 2 month old that is eating a tremendous amount and is just barely over her birth weight.  We're so desperate for answers, if anyone can offer any ideas we'd be very grateful. 

[LilMomma83]

We've been dealing with that as well...My DD was only 3lbs over her birthweight at 5 months old (and it took her 7 weeks to regain her birthweight). We haven't figured it out yet, but, I think it was due to her burning too many calories while feeding because of her tongue tie...we just had it clipped 2 weeks ago though, so it's too early to tell if it has helped. I wonder even if you tried soem bodywork with your little one she might become mroe efficient and maybe it would help her gain? I know my DD's jaw was out of place and that was put back during cranosacral therapy which seems to make her move it less while feeding. In the interim until we know for sure what is causing the slow gain they put her on a hypoallergenic formula mixed to 24 cal/oz, she gets a couple bottles of that, a couple bottles of breastmilk with formula mixed into it, and the rest on tap...hat combination did get her to gain a little bit..but, certainly is not a longterm solution. They are also testing her for cystic fibrosis, but, I do not beleive she has that. I just think it was allergies causing malabsorbtion and burning too many calories while feeding. Good luck figuring it out, mama...stay strong!

[LilMomma83]

Oh yeah, I also cut dairy from my diet

[MichelleZB]

It's a good sign that she seems alert, smiling, and happy. It's possible that this is just how she's supposed to grow.

You say she eats every 3.5 hours or so. Is there any way you could see if she'd be interested in eating more often than that? My son was still eating every hour or two (except at night) at about 7 weeks, and of course all babies have different eating patterns, but he was a fast gainer and that might have had something to do with it. Just a thought.

[rtjunker]

 3-4 hours between feedings may be part of the problem. My now almost 5 month old nursed far more frequently than that at two months, probably closer to every 1.5-2 hours, but every baby is different so it's most important to pay attention to your LO and figure out what works for you and her.

Is there a reason you're only feeding every 3-4 hours? If so, please ignore any unwanted advice. I know the general recommendation is that a newborn should be fed 8-12 times in a 24 hour period. So that averages out to every 2-3 hours. But since breast milk is so easy for babies to digest, some are hungry again more often.

Are you paying attention to hunger cues like hand sucking and lip smacking and offering food when DD indicates hunger? If you pay close attention DD may be indicating hunger more often than you realize.

.

How long are you allowing LO to nurse? Sometimes a nursing session can last 40 minutes or more, before LO can empty the breast. As babe nurses the milk changes slightly from beginning to end, so it's important to let LO get the rich fatty milk at the end. If LO pulls off of breast or gets fussy, burp and offer breast again. If there's no interest then LO is likely full.

I also want to note that nursing works on a supply and demand basis, so the more formula you supplement, the more it can decrease your supply, making it more difficult for LO to get enough milk from you.

And of course as PP mentioned there could be an underlying issue with a tongue tie or something that should be checked out, but hopefully it's something you can figure out soon. Best wishes.

Here's a few links with some breastfeeding info

http://kellymom.com/bf/normal/newborn-nursing/

http://www.nct.org.uk/parenting/breastfeeding-how-much-how-often

http://www.cpmc.org/services/pregnancy/information/breastfeeding-frequency.html

[PatioGardener]

I posted this in the duplicate thread. Want to include it here to make sure you see the article. I agree with the PP about feeding often enough as well. My DS was nursing every 90 minutes (from the end of one feed to the start of the next) at that age.

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You may find this article informative - especially with few stools and little weight gain: http://www.llli.org/llleaderweb/lv/lvdec97jan98p123.html

The other thing I would look into is tongue-tie.

If milk supply and transfer are good, I'd ask my doctor to start to look for other reasons - sensitivities to foods, and other medical issues.

Good luck, this must be frustrating for you!

[LilMomma83]

Yes - forgot to comment on the feeding...I would do no more than 3 hours even if you have to wake the baby, I would do more like every 1-2 hours...the slightest sign of hunger.

[foreverinbluejeans]

I agree that 3 hours is too long to go between feedings. Supplementing is a problem even if you use something other than a bottle it makes the baby nurse less well. From and evolutionary perspective human babies are designed to breastfeed pretty much all the time for the first few months. Humans are so adaptable that most babies can do okay if they are forced to breastfeed only 8-12 times a day. The 8-12 times just isn't enough for a percentage of the baby population and they need to be attached to the breast pretty much all the time. A baby carrier helps.  

Lactation consultants may view breastfeeding from a medical viewpoint and be into measuring things, timing things, giving supplement, ect. Some come from La Leche League background and encourage you to understand how breastfeeding works and to connect with your baby. Others may tell you your baby's mouth is abnormal, encourage you to change your diet, eat oatmeal, drink tea, and to take herbs. Everyone may be right! That's why you are getting such a range of answers.

[gemasita]

LLL might be able to help you determine how much she should be eating in a 24-hour period. It's somewhere around 2-2.5 oz per lb of weight.  I'd be aiming for 2.5 oz per lb if she's not gaining quite enough.  There is such a thing as a "catch-up" amount (that is even higher than 2.5 oz per lb) if she's wasn't at her birth weight at one week.