Slow weight gain in new baby--need fast advice

[Laurel]

I need some advice quickly. My dh and I are adopting a baby girl who was placed with us 2 weeks ago as a newborn. I had planned to induce lactation, but because we had such short notice for the adoption, I didn't even have time to pump or prepare in any way. I just started nursing her with the lact-aid. At that time, I had no plans to use any herbs or meds either.

She was 6 lb 2 oz at birth and 5 lb 11 oz when she left the hospital. She gained 7 oz the first week and was back to her birth weight. However, we took her for her 2 week checkup this past Friday and she had only gained 1 oz all week. The doctor is mildly concerned (but not freaking out or anything) and wants her weighed every week until she shows a steady pattern of gaining.

So, I posted about this to an adoptive bf'ing email group, and two people have expressed strong concern that I need to switch to the bottle immediately until she gains some weight, and only then try to re-introduce breastfeeding. I really don't know what to do, because my own doctor didn't seem to feel quite that urgent about things. His attitude was more a matter of "let's watch this and make sure everything's OK". But these other people are saying things more along the lines of "you need to get your baby gaining immediately because babies that small can become seriously ill and lose ground really fast". I would really like to get a variety of opinions so I can decide what we should do.

Sometimes dd nurses quickly and efficiently, but most of the time it seems like she either is sucking really hard but struggling to get much through that thin tube, or she is just sucking very lazily. I am just afraid that she is burning too much energy from the effort that it is taking her to get the supplement through the lact-aid tube. I have thought about getting a Medela SNS instead since it has wider tubing. That was my plan, until these others gave their opinions. Now I just don't know. I want to keep her at the breast, but I don't want to compromise her health in any way. I do plan to meet with a lactation consultant on Monday and get a professional opinion. Am I safe to keep nursing till Monday and ask the LC for her opinion, or should I really focus on getting as much formula into her as possible for now? Monday would also be the soonest I could get my hands on a SNS.

I am making no milk of my own, so she is getting nothing other than what is coming through that tube. Producing milk will have to be my other focus in all this.

[TurboClaudia]

if she is showing strong signs of hunger (being fussy at the breast, crying for long periods of time, etc.) you might consider getting more food into her somehow. i don't think you need to resort to bottles at this time, but you might try some finger feedings with the lact-aid tube or something similar. if you can latch her on well to your breast when using the lact-aid, she is stimulating your breast and beginning the process of relactation for you and you may be surprised that she actually is getting just a little bit of mama's milk from you in addition to the milk in the lact-aid.

i think you are safe waiting until tomorrow to meet with the lc to develop a plan for relactation and feeding your baby simultaneously.

any baby, newly born can lose energy from nursing so it's not just a concern with a baby that is a little smaller (like yours).

please know that i'm thinking of you...

~claudia

[tash11]

check to make sure the tube is positioned properly. its easy to get moved around. are you useing tape? if not you might want to try some. either hypoalergenic paper or the medical cloth tape. that helps keep the tube in the right spot. an sns will come with paper tape.

make sure the tube isnt blocked or cloged at all. if you hold the bag up with the tube down low it should very slowly drip. if it doesnt you might have a problem. I had two lact-aids and they both got clogged. (I also didnt strain the supplement since the stuff I had woudlnt go through the strainer).

if she seems likes shes struggling hold the bag up higher. its primarily a suction feed system, however it still does obey the laws of gravity.

[Laurel]

Thank you for the suggestions, Tash. I'm having to reposition the tube all the time to get it right. It's really driving me nuts. If she isn't sucking, I take the tube out and re-latch her. I am using tape, and the tube isn't clogged at all. It's definitely dripping when I pull it out of her mouth. Right now I'm using ready-to-feed formula so I don't have to strain it. I have been pulling the bag up as high as it will go.

It is so weird. Sometimes she is gulping the milk down. Other times she takes a few sucks, swallows, and then stops for awhile. I think she is definitely a leisurely nurser. And there are times, too, where I can tell she is straining to get the milk out of the tube. (I always re-latch her and re-position the tube at those times.)

I wasn't worried about any of this before our doctor appt last Friday. Since she had gained weight so well the first week (in spite of being incredibly sleepy), I figured this was just her style of nursing. She was 2 weeks early and is just a tiny little thing, and people kept telling me that smaller babies eat less, suck less hard, sleep more, etc. Even after visiting the doctor, I was only mildly concerned--I mostly just felt that we needed to be proactive about getting in a good place so the doctor wouldn't tell me to stop nursing. I wasn't terribly worried until I got these comments from other people who were so concerned.

But, she is getting more alert and staying awake longer every day. She is having ample wet and poopy dipes. She is not fussy. She's especially not fussy at the breast (my first ds was, so I know what that's like). TurboClaudia, I had felt earlier last week like I was seeing some breast and nipple changes, and I suspected that there was at least a tiny amount of milk, even though I couldn't even hand express any. But the past couple of days it seems like things are going backward. If anything, my breasts are getting softer and my nipples smaller. She has had a pretty good latch, and it's still pretty good most of the time, but I can tell it is slipping a little as my focus becomes more on her getting milk from the tube. I find myself putting up with more as long as I can hear her suck and swallow.

But, I am not as worried as I was last night. Like I said, she is acting very normal. Even my mom (who's first comment when I told her all this was, "Well, now you can't compromise her health just to breastfeed") feels like she is doing fine and is not showing obvious signs of lack of nourishment. We will defiitely be calling/visiting a LC tomorrow. I am also hoping to rent a hospital grade pump so I can get more on the ball with pumping. (I have been using a PIS, but I can tell it isn't doing much.) Before all this, I wasn't going to worry too much about milk supply, but now I feel like I need to put more effort into it.