Dear Dr. Palmer,
I am at my wits end what to do about nursing my baby boy. After struggling immensely to get breastfeeding going (flat nipples, really bad latches, Raynaud's syndrome making my nipples extremely painful in between feedings and a hx of sexual abuse leading to some triggers when breastfeeding), I was finally able to exclusively breastfeed my son by about week 8 with only mild pain during feedings. Before that I had been feeding both formula and breast to help me cope with all the pain of feeding him and still give him nourishment.
However, when he was at a checkup this week (week 13) he weight in at 10.6oz - the first percentile for weight by age. He was born a healthy 7.14oz at home, my second child. At our 6 week check, he had gained about 1.8 pounds and was deemed on track. Now he barely gained half a pound in the past 7 weeks, and what I thought was colic crying (he always cried in the evening for about 6 hours- despite me offering the breast) actually seems to by cries of hunger. After finding out his weight percentile I offered formula in addition to breast again and he has since been eating about 2 oz every hour, consistently eating every last drop offered. I am devastated thinking about not recognizing that my baby was basically starving.
I was breastfeeding him 5-6 times a day and pumping 2 times during work. During the past 3 days I have been breastfeeding at least every 1 hr 45 min (3 hrs at night) and pumping every 2 hrs at work for at least 10 feedings per day. I pump several min beyond when flow stops. I offer him the breast at every opportunity when we are together, and I let him use me as a pacifier when he wishes. Despite all this I still don't feel I have any more milk. I pump at most 2 oz at a time, and was previously pumping 3oz when going in 3 hr intervals. When he nurses, he empties both breasts in 10 min or less and wants more.
I am not on any medication, don't use any substances, eat healthy, drink at least 3/4 to 1 gallon of water a day, and don't have any health issues I am aware of. Menstruation has not returned and I am not using any hormonal birth control.
Do you have any insight about what might be going on and any other suggestions of what I could try? Thanks a lot.
Mom, you have gone far above and beyond the call of duty to feed your baby the best possible. Hugs to you. I don’t think you’ve “starved” your baby. Let’s take it fresh from here and see what we can learn. I have some questions before I can say much here.
You tell me about the recent formula feedings – you are saying he ate 2 oz of formula every hour. How much interest has he had in nursing now? Sounds as though this has been for about 4 or 5 days? Do you have access to get him weighed again now (in a few days)? Did the “colic” go away with the recent formula feedings?
Does he have any rashes? Has he had stool variations such as loose and watery, explosive, green, or constipated? Have you looked for or noticed any sensitivities to foods in your diet? Do you have any digestive complaints yourself? Is there any history on your first baby that might give us any clues? Have you been working with a lactation consultant at all (sounds as though you must have been)? Oh, and would you say that you and/or the father are smaller than average?
You say “he empties both breasts in 10 min or less and wants more.” I assume you continue to nurse beyond that point, as you say you let him use you “as a pacifier.” Your breasts do continue to make milk on demand while your child nurses, beyond that point where you feel that stored-up milk is depleted. I know that pediatricians sometimes mislead moms on that.
Please take a look at the suggested milestones for your baby’s age; found online or in some of your baby books. If your son was term, he should be right on with some milestones, maybe a little behind on a couple, and maybe a little ahead on a couple. If he was premature, subtract about 1.5 weeks from his age for every week of prematurity. How does he compare?
Linda F. Palmer, DC
"The Baby Bond"
Thanks for the reply. Let me try to give you all the info as best as I remember:
"You tell me about the recent formula feedings – you are saying he ate 2 oz of formula every hour. How much interest has he had in nursing now? "
The past three days he still had interest in nursing when supplementing with formula, although I supplemented less today. During the days when I was working long hours he appeared less enthusiastic about having to put in effort to nurse rather than bottle feed (despite using the slowest nipples available) In the past 12 hours he has nursed 12 times for about 20-30 min a time, but I have only had to feed about 4 oz formula total in 3 supplemental bottles today to keep him reasonably happy. He appeared discontent after the initial milk storage was depleted but kept suckling for the milk as it is made and after some time is then fine to detach for a bit.
I don't work on the weekends, so I hunkered down nursing all day. That's not practical during the week as I work full time however.
I also work somewhat irregular hours. I have been wondering whether that's messing with my supply, although I am able to pump mostly every 2.5 to 3 hrs, sometimes only every 3.5 -4 hours.
I could get him weighed on Tuesday, and see a lactation consultant then.
No more signs of "colic" since the supplementation.
He does not have any rashes, just a bit of craddle cap. He had only 1BM per week for about the first 8 weeks of life, now he has increased to maybe 2-3 per week. They have never looked like the typical breastfed baby stools - darker, smellier, and somewhat explosive. I tried an elimination diet once early on but didn't notice a difference in colicky behavior. I don't really have much digestive complaints any more - constipation after his delivery which has resolved now. Neither my husband or I nor extended family has any food allergies. My sister in law has Cron's disease.
I couldn't nurse my first baby at all because I could not tolerate the pain from nursing her on top of a very rough labor and very painful 18 month recovery. For this one, I was determined to nurse, and went to see lactation consultants as soon as I could get myself, baby and toddler into town (we live in a very rural area 1 hr away from the hospital with lactation consultants). They provided enough guidance and motivation to make it through painful feedings for 6 weeks, once that became better I thought we had gotten through the rough patch and stopped going. During feedings there he never transferred more than 2.5 oz at any one feeding. Both dad and I are smaller than average in height and stature, but baby is at 50th percentile for height, 1st for weight. Older sister always was around 30-55th percentile for weight during her 2 years, and 20-40th percentile for height.
I do try to nurse beyond when storages are depleted however baby gets very crabby very soon and will only do his "let down suckle" for 2-3 sec at a time when milk is not flowing pretty freely, then detach and fuss. That leads to me having to relatch him 10-20 times per side after the initial let down, which makes for more sore nipples and eventually makes me switch sides -maybe prematurely?
He was term and he is developmentally about on track, definitely not ahead though. He is almost able to hold up his head, coos, tries to grasp, follows objects and me across the room, etc.
I look forward to hearing your suggestions. Thanks alot.
You are doing a stellar job. His milestones sound just fine, which means he’s not “starving.” He’s been getting enough of what he needs. Maybe he could have taken in a little more, maybe not. I’m still a little fuzzy on the weight gains as the amounts in your first letter don’t add up – we might be missing a weighing/gaining in there? If he gained 1.8 pounds in his first 6 weeks, while receiving formula, that’s not too little but it’s no track record either. If that’s the case, he was already dropping in the curve, with formula, meaning lack of enough food isn’t the cause of his drop in curve now.
I’ve talked with others who work with moms and babies… it seems that babies are not all necessarily born large or small depending upon the genetic stature they are meant to reach. Other factors come in to play in terms of birth weight. Babies seem to gain or lose along the curve within that first year toward their destined size; weight before length often. On the growth charts, which are averages, these occurrences all average out and of course there are no compensations for genetic stature/build differences with the charts. One French study says that at 3 months, the length matches mom’s stature more and the weight, dad’s BMI, but that’s certainly no gospel. If mom and dad are both smaller in stature and BMI, you aren’t going to have a huge baby. Still, we can use the charts as a clue that we should look at things and make sure everything is going as it should be.
I don’t think it’s super important that you obtain another weight but if you do (I think I’d kindof want to), and if your baby has gained, say, over an ounce per day, then he was definitely having some catch-up growth, which means we do want to keep offering formula several times a day. Two weights a week apart are not entirely accurate enough to take entirely seriously. If you can recall how full or empty his bowels were at his last weighing, and how recently he was fed before weighing, or emptied his bladder, we’d want to take those factors into account for differences in weight. Of course you’d clothe or unclothe him the same as before.
It doesn’t sound like a case of food intolerance. Keep it in your mind as you make your observations, but I don’t think so, with what we know so far.
The chief idea/benefit of exclusive breastfeeding without any kind of supplements (except water) is to keep the virgin breastfed flora. This flora greatly reduces the baby’s risks of respiratory and diarrheal infections. From the early weeks of formula, your son’s flora is already mature and I’m not so sure it would revert to breastfed flora at this point, even if you were to nurse him exclusively for a few months. Maybe. And then at some point there you’d be starting solid foods anyway. The first couple of months are the most critical. There’s no concern now, that this has happened, because here he is, over 3 months and very healthy. Having a good amount of breastmilk will continue to bring him neurological and nutritional benefits, and some immune benefits as well. What I’m trying to say is that, at this point, trying to have him on exclusive breastmilk is not of so much importance, while any that he can get is a great advantage.
I know that you know that formula feeding can reduce the amount of milk you make, and that bottle feeding can reduce his desire to make effort at the breast. I think you’re on top of all that and doing the best possible with what you have been given. I think you may feel more comfortable with offering a little formula after some nursings, (or when you are away), if he seems unhappy/hungry, and there is no reason to feel bad or unsuccessful about it. It doesn’t sound as though you greatly need more lactation consulting at this point, but it can’t hurt. Many of them have their own scales…
Linda F. Palmer, DC
"The Baby Bond"