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Slow weight gain and supplementing

post #1 of 14
Thread Starter 

Hi ladies!  My baby boy was born 4 weeks ago tomorrow.  We got off to a bit of a rough start-he had a big bruise on his head from descending crooked and had bad enough jaundice that he was admitted to the children's hospital for a night of phototherapy 5 days after he was born.  As he was being discharged the next morning, my blood pressure went sky high and then I was admitted to the hospital next door for 2 nights for a magnesium sulfate drip.  As you may know, the mag sulf is nasty stuff and when you're on it, you're bedridden so my mom had to stay with me so that my LO could stay with me, too.  Luckily, I had pumped milk so she fed him with the syringe for the most part.  I nursed him some but I was very out of it and didn't nurse him as much as I should have.  When I was discharged, I was told to watch my sodium so for a week, I wasn't eating nearly enough calories.  On 10/15, he was still jaundiced but not bad enough to need phototherapy and they weren't satisfied with his weight gain (or loss, I can't remember what it was).  I was told to let him nurse and then pump-if I pumped at least 2 ounces, give him that and if not, give him what I pumped plus enough formula to equal 2 ounces.  We went back the next day and he was finally back up to his birth weight, 8 lbs. 9 oz.  I was so happy because I had only given him maybe 2 bottles of formula!  So, I stopped with the formula because I didn't want to harm our nursing relationship.  When we went back again on 10/24, he was back down to 8 lbs. 4 oz.  The doctor was concerned and told me to start supplementing with 2-3 ounces of formula after nursing again.  She thinks that my milk isn't fatty enough and told me I need to make sure I'm eating 2500 calories a day.  And I'm trying!  It's hard though, I'm not that hungry and I'm not used to eating that much food!  I'm pretty confident that I'm producing plenty of milk...I only pump once or twice a day and can usually get 3-4 ounces total.  I also hear him swallowing while he nurses.


So since Wednesday, he has been getting formula after every feeding.  He nurses from both sides...anywhere from 15-25 minutes on the first side and 10-15 on the second.  He has plenty of wet diapers...not so many dirty diapers but his doctor has been aware of this, too, and hasn't been super concerned because he's not uncomfortable and his belly isn't distended.  She did a rectal exam on Wednesday and said his sphincter was super tight-and he pooped, a lot, the next day.  It was yellow-ish, peanut butter consistency and had some "seeds" in it.  I should also mention that I'm pretty sure he has a great latch-I haven't had any cracking or bleeding and very little soreness.  We haven't seen a lactation consultant because I can't afford one and they aren't available where we live-I would have to drive 45-60 minutes and pay a $17 toll to get to one.


I'm afraid that by giving him 3 ounces of formula after nursing, what I produce will never be enough to satisfy him now.  Have we started a vicious cycle?  Of course, his weight gain is the most important thing.  Has anyone been in a situation like this?  Do you have any advice or suggestions? 

post #2 of 14
We have just been through this with DS. He did have a tongue tie that complicated things as well. I was never told to supplement with formula though.

My LC had me pumping after every feed and then feeding the excess. I did have to add in 2 oz of donor milk through the day, so one oz at a time after a feeding. I would think that 2oz of formula after every feed would be way too much. They should only be getting about 2oz per feed at a time.

I have found that with DS it's all about finding the "sweet spot" between enough to keep him gaining and not giving too much to pacify the Ped.
post #3 of 14
Thread Starter 

I'm pretty sure he doesn't have a tongue tie-his pediatrician at the Children's Hospital commented that he "has a beautiful breastfeeding tongue" and of course his regular doctor has looked in his mouth a few times, too.  I'd love to cut back on the amount of formula he's getting but don't want to see another loss of weight or not enough gain to satisfy his pediatrician when we go back.  I tried weighing him on my scale at home, which is digital and measures ounces, and it says he weighs about 9 lbs. 5 oz...if that's right, then I'm very happy with that!  How much do you think I should cut back with the formula?  Should I start giving 2 ounces instead of 3 and then maybe cut that back a little, too?  I just want to do what's best for him and not screw anything else up...getting off to such a rough start has me determined to get us back on track.

post #4 of 14

I went through this with my DD.  It WILL get better, and supplementing isn't necessarily the route to straight formula-feeding.  I was eventually able to exclusively breastfeed.


First thing - if you're able to pump a fair bit after he's finished nursing, then there may well be a latch problem.  Is he falling asleep during feeds? Do the feeds take a long time?  If so, try breast compressions during feeding, and make sure he's dressed in ONLY a diaper (the slight cold will keep him alert and more actively feeding).


Another thing to try is giving the supplement first - but not as much. This will increase the amount of time he can spend at the breast, and also slightly mitigate the slow-digesting properties of the formula. If he's gained as much as you think, he should be stronger now and more interested in nursing.  Start with an ounce and a half - give it at the start of the feed.  Then switch him to the breast and try to keep him actively nursing as much as possible. 


Weighing on different scales is a bad idea and will never give accurate results.  The better indicator of intake is output.  You can use a kitchen scale to weigh his diapers - he should be producing at least 6 diapers with more than 2 oz of fluid in each every day.  If he's not, then up the supplement OR try to feed him more frequently, if he'll cooperate.


As he gets bigger and stronger, cooperation during feeding will be less of an issue, and you can start dropping the amount you supplement.  He will wake up more readily due to hunger, nurse more often, and your supply will increase.  But the sheer amount of time he spends at the breast is important - which is why supplementing PRIOR to a feed is better, because you're less likely to pop him off to supplement before he's drained the breast as much as possible.


As for your nutrition - just eat as much as you can of nutrient-dense foods.  Don't let the words "low-fat" appear in your brain.  You need the fat, you need the calories.  Just make sure it's good fat from real food and not bags of doritos.  Eat as much meat and veg as you can cram in then go for whole-foods starches like sweet potatoes, white potatoes, whatever.  Have someone else bring you food while you're nursing.  Sleep lots. Keep your feet up.


Don't worry, you CAN do it.  It's work and it's not particularly fun (except maybe for the part where you're SUPPOSED to keep your butt parked in front of the TV for hours at a time) but it won't last forever.  Good luck!

post #5 of 14
Thread Starter 

He always gets sleepy about 10 minutes in but doesn't always fall asleep.  I can usually rouse him enough to go for a little longer.  This morning he nursed for about 15 minutes on each side and then I gave him 2 ounces of formula.  I will try stripping him down to his diaper and see if that helps.  When I pump after he nurses, I usually get less than an ounce from each side, sometimes it barely covers the bottom of the pumping bottle...I assumed this was good?  Will also try the supplementing first.  He's had 2 good sized poops in the last 24 hours...they were pretty brown but had a yellowish tinge-like the areas on the diaper where there wasn't much poop, it was yellowish-seedy, too.  I'm glad that he's pooping more, makes me think he's getting nutrition and digesting properly-but also concerns me as those were some pretty heavy diapers...I hope he didn't lose what he had gained!  He definitely has at least 6 soaked pee diapers a day, I'd say more like 8 or 10.  He seems more alert also, more awake times.  And overall, he seems healthy!  His hair is growing, his nails are growing, his skin is gorgeous, his eyes are bright.


Any advice on getting in to see a lactation consultant?  We have an appointment on Wednesday for another weight check and could possibly see one then-but do they take insurance?  If not, what does a consult generally cost?  I would really like to see one and see if we are doing anything wrong that can be fixed and help him out.

post #6 of 14

I have no idea about cost and insurance - I'm in Canada, many of our public health nurses have their IBCLC and I've never had to pay. 


It sounds like he's doing really well.  I would be entirely comfortable dropping your supplement by 1/2 oz (from 2 oz to 1 1/2) and definitely switch it to the beginning of the feed.  If, after a few days, his diaper output hasn't lessened, then drop the supplement another 1/2 oz and so on.  Your body is still adjusting your milk supply so you should be able to ramp up production fairly quickly.  Just keep a close eye on the diapers!  Don't worry too much about how many poops - a lot of babies stop pooping super-frequently around six weeks or so - just go by weight.  Eight to ten diapers that feel heavy in your hand is great.  Doesn't matter so much what's in them.  And big poops aren't anything to be concerned about, they're a cause for celebration :D  (However, if he does a huge poop just before he's weighed, then either weigh with the poop or take the measurement with a grain of salt - don't freak out if he hasn't gained quite as much as he should have.)

post #7 of 14
Thread Starter 

You have certainly eased my mind, thank you so much!  I found an IBCLC close to where his appointment is on Wednesday...don't know if we'll make it over there with this hurricane though.  They list their fees on their website and it's $75 for an hour or $125 for 2 hours...I really can't afford that!  I'm unemployed, lost my job at 3 months pregnant and make a whopping $198 a week.  I sent an email to see if they can help at all or if they can suggest someone else who maybe doesn't charge as much.  But maybe, if he's gained at his appointment, I can stop being so worried!

post #8 of 14

It sucks that it costs SO much to see someone to help you do something that your government theoretically really wants you to do :-(  But yes, I would say if he's gained well at his appointment, and you have a supplementation protocol that works and a clear plan for reducing the supplementation, you probably don't need to spend the money. 


Another thing I would suggest is dosing yourself heavily with 2 herbs - blessed thistle and fenugreek.  Blessed thistle works best if it's in tincture form, but fenugreek is fine in capsules.  You need to take a LOT. (Don't worry, neither is dangerous, although a heavy dose of fenugreek will make you smell a little funny - some people say like maple syrup.)  I found that two dropperfuls of blessed thistle and 3-4 capsules of fenugreek taken 3-4 times a day did boost my supply significantly.  The blessed thistle tastes disgusting - you do get used to it though.  Initially I took it in orange juice but after I while I was ok with it in water.  It's vile stuff but the aftertaste doesn't linger and it's well worth it.  They're not expensive herbs, fortunately.

post #9 of 14
Thread Starter 

I'm really not concerned about my supply...most of the time when I pump, I get around 2 ounces from each side-except for when I pump after nursing, of course.  I get 2 let-downs in about 20 minutes when nursing...he usually chokes and sputters and pulls off for a bit.  Something else that I forgot to mention, he won't stay latched on.  He pops on and off the whole time he's nursing but I never have an issue getting him to latch back on so, I think, he's still getting a good feed.

post #10 of 14

Ah, ok.  That sounds like a bit of overactive let-down, which is ok - as he gets bigger he won't be so sputtery.  But if you have no supply problem, there's no need to supplement.  I'm sorry, I completely misunderstood what was going on.  Hazards of internet help!


Popping on and off throughout the whole feed isn't great, is it really through the whole feed or just during your let-downs?  It may be something he will just grow out of, but it's a bit of a concern.  If he pulls off during your let-down,  do you spray milk everywhere?  If it's obviously milk flow bothering him, then you can pull him off when you feel your letdown start, let the big gushes go into a cloth or something, and put him back on when it subsides a bit.  But if he's popping off constantly, all throughout the feed, that isn't normal, and I'm afraid I *would* recommend spending the money to see a lactation consultant.


I don't understand why you're supplementing if you feel your supply is adequate?  If you have enough milk and his latch is okay, just feeding him more frequently ought to be enough to get his weight gain going satisfactorily, no need to use formula - or did I misunderstand that too and you're just supplementing with pumped milk?


Edit to add - I forgot to ask if you were intending to combination feed? 

post #11 of 14
Thread Starter 

It's through the whole feed.  Do you have any ideas of what that might indicate?  He isn't fussy when he pulls off and like I said, I can latch him right back on.  Would that maybe prevent me from producing enough hind milk?  I can tell as it gets longer into the feed that my milk gets whiter, it's more translucent at the beginning.  When he pulls off during let down, yes, milk is spraying and I let it slow down into a blanket.  I can't feel when I let down so I can't really catch it before it starts.  I'm supplementing with formula at the advice of his pediatrician-he has only shown a gain twice since he was born and has probably been weighed 8-10 times since birth-he was going in a lot for his jaundice and now, going a lot to check his weight.  At his appointment last Wednesday, he was 8 lbs 4 oz, 5 ounces away from his birth weight-and that was at almost 4 weeks-he turned 4 weeks yesterday.  Supplementing with my milk wasn't even suggested but I will definitely ask at his next appointment.

post #12 of 14

Ok so he DEFINITELY has shown a problem gaining, which means either he DOES have a latch or other feeding problem, or you are not producing enough milk.  It sounds like the former is far more likely, especially as he's constantly pulling off.  My guess - and it IS just a guess, you really, really need to see someone who knows about lactation and that sounds like definitely NOT your pediatrician - would be that he's having trouble synchronizing his sucking, breathing and swallowing.  Assuming you're using a newborn nipple on the bottle you're giving, it would be a slower rate of flow than from your breasts, and he may be being held more upright while being supplemented?  Or does he do the same thing while you're feeding him from a bottle?  Does he pull off every few sucks or is it more like every few minutes?  Can you hear him swallowing while nursing? or does he do that after he pulls off?


I can't tell you to go against what your pediatrician told you, but supplementing with your own milk is considered far preferable, for numerous reasons, than with formula.  Formula is harder on their little tummies and it also digests more slowly which can interfere with the "feed frequently" directives that really build a good nursing relationship and good, resilient supply.  If you CAN supplement with just your milk, it's a much better idea.  Unfortunately it involves some more pumping until you get his feeding problem sorted out - pump after every feed you can manage, and in between feeds (wait half an hour to 45 minutes after you finish pumping, then pump again), and give him what you get out of the previous pumping sessions at the next feeding (that way you don't have to worry about refrigerating it, breastmilk is fine at room temperature for a few hours).


In the meantime, try nursing him either upright, or lying on your back with his head facing down and toward your breast.  If he's getting put off by the flow of milk, simple gravity can slow it down a little.  Upright is probably going to be most comfortable for him and you - sit upright in a chair, hold him up supporting his head so his bum is resting on your leg and basically hold him so he can reach your nipple without having to tilt his head back at all. It's ok if his head drops forward onto the nipple a bit.  If upright doesn't work, try lying down with him on top of you so he's pulling milk UP out of your breast.  If he can manage either of those positions WITHOUT popping off constantly, try to go without supplementation for a bit and see how it works.  Feeding does require some energy so prolonging feeds with supplementation, while sometimes necessary, isn't ideal for baby.  The best outcome would be to have him nurse well in an alternate position, and be hungry more often. 


How often does he nurse now?  Like, what is the time from the start of one nursing session to the beginning of the next?  And how long does it take for him to get a good feed in, including the supplementation?

post #13 of 14

La Leche League Leaders will help you for free. You can call a local Leader or LLLI. You can find numbers on their web site. The web site kellymom.com has lots of great info.

post #14 of 14
Thread Starter 

I will definitely try that, thank you!

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