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Insufficient Weight Gain

1K views 23 replies 15 participants last post by  juliebird 
#1 ·
My baby just had his 4 month check-up today and he is not gaining well. He dropped off his own growth curve (which was 15th-25th) for weight. He is growing in length and head size perfectly.

He is exclusively breast fed. He will take 2-4 4oz bottles of expressed milk when he is at daycare (3 times per week) and eats whenever and wherever he wants at all other times. He does sleep 7-10 hours per night.

My pediatrician has him coming in again in 4 weeks instead of 8 for a weight check.

What can I do to help him gain? I already nurse him on demand. What are the risks from him not gaining? Does anyone know if this can slow his development or harm him in some way?
 
#2 ·
Have you put his numbers into the WHO growth charts? http://www.who.int/childgrowth/standards/en/ Their figures are based off breastfed babies, versus US Pediatric charts, which are mainly formula fed babies; you're not comparing apples to apples, if not.
If your baby is happy and healthy otherwise (meeting major milestones) chances are he's fine!
 
#3 ·
What is his weight? Even if he dropped off his own curve, he could be just getting to where his genetics are. For example, my first son was over 9 pounds at birth (two weeks early!), but that was because of gestational diabetes and IV fluid during labor. His weight gain tapered off and he ended up not doubling by 6 months or trippling by a year, yet was very obviously healthy (nice and roly-poly!)

It's important to look at mom and dad's height/weight, plus your son's overall development. Is he hitting milestones? Is he happy? Social? Does he cry a lot? Do you think there is a problem?

My second son, on the other hand, was also born large for gestational age, but his weight PLUMMETED. Seriously plummeted. From 90th% at birth to completely below the charts by 4 months old. And he's still WAY below the charts at 2 years old (only weighs 22 pounds). However, he has a genetic syndrome that there were immediate signs of at birth, serious medical issues that took a lot of time to get stabilized, and his height/weight is actually very typical for kids with his syndrome.

So, while weight gain COULD be an indicator of health, it's just ONE thing, you know? Look at your son, listen to your mama gut. If you think that he is hungry, then work on increasing your supply and his access to hind milk. If you think he's okay, then he probably is
 
#4 ·
Thank you for the quick posts. He is the happiest baby you will ever meet, smiles at everyone and loves to laugh. He's really laid back too, everyone always comments on how calm he is.

His weight was:

8lb 3 oz at birth
7 lb 2 oz a week later
10 lb 3 oz at 2 months
12 lb 3 oz at 3 1/2 months
12 lb 6 oz at 4 months

He is really low on the charts, wow - 3rd percentile. That's a big drop. I guess all I can do is keep nursing on demand. Both my husband and I are short and average weight.

I'll work on getting him to stay on the breast for longer. He usually finishes in about 7-8 minutes and is done, maybe that's just not long enough. But how can you make a baby to stay on the breast longer than that if he's the one who pulls off?
 
#5 ·
Dont worry too much about where he falls on the charts either..at 4months dd was 11lbs 8oz (less then your guy) at 19months she is 18lbs 15oz. She is little. Being little isnt necessarily bad.

Look at the parents. Look at diaper output. Then look at things like...did he recently start rolling over a lot? kicking a lot? Have you been going out more (I read a study where babies who spent more time outside and kept upright tend to be smaller because it helps with digestion..no idea if this was true..but you never know)?, have you changed your diet? exercise?

I wouldnt worry about the length of nursing. DD was an every hour for like 5 minute nurser. She liked to graze...as a toddler...she still grazes...
 
#6 ·
It is normal for a breastfed baby to drop in weight gain after about 4-6 months. My son has only gained a pound since his 6 mo check-up. As long as your baby is happy and eating well I would not worry. Does you baby show any sign of illness? Diarrhea?
 
#7 ·
It sounds like your baby is fine, but my ds was also right at that size so I understand that you still have a bit of anxiety. Have you tried switch nursing - i.e., switching him to the other breast as soon as his sucking slows down? (This happens every minute or two usually.) And/or nursing REALLY often - say, nursing for a few minutes at a time, every 20 minutes while he's awake?

But please note, I do agree with the other posters that, if all the other indicators are good, you probably shouldn't worry about his weight...
 
#9 ·
Quote:

Originally Posted by jmmom View Post
It sounds like your baby is fine, but my ds was also right at that size so I understand that you still have a bit of anxiety. Have you tried switch nursing - i.e., switching him to the other breast as soon as his sucking slows down? (This happens every minute or two usually.) And/or nursing REALLY often - say, nursing for a few minutes at a time, every 20 minutes while he's awake?

But please note, I do agree with the other posters that, if all the other indicators are good, you probably shouldn't worry about his weight...
I'm not sure if switch nursing would be a good idea - the baby would get mainly foremilk and not as much hindmilk where the calories are. You could try keeping him on one side for the entire feeding so that he gets the creamier hindmilk.

Also, making your boobs available (sleeping topless at night and cosleeping) at night would probably really help. DD was really distractible starting at that age and wouldn't eat much during the day but would make up for it at night.
 
#10 ·
I just want to thank you all for chiming in. My twins are also at the bottom end of things and my Ped told me and my husband that he wouldn't give them their vaccines unless they put on weight. He also scared us by telling us if they didn't put on more weight they would have brain damage! Other then changing Peds, which we are, it is crushing for me because I work so hard to breastfeed them. They are so active and the youngest kicks and rolls constantly.

Of course my husband freaked and since we are already giving them bottles on that days that I work, he began to give them "super bottles" with extra formula (i just can;t seem to get my breast on the pumping band wagon) and they porked on weight within a week. The down side is that my milk supply had dropped especially since they are also starting to eat solids.

It's nice to hear that others have skinny kids and they are still normal.
 
#12 ·
Mama of a tiny 3rd percenter here. We had a lot of trouble with slow weight gain, low milk supply etc at the beginning. Now she eats lots of solids and still breastfeeds a ton, she's still on the 3rd percentile!

Anyway, we saw a specialist ped for her, very early on (one of the best in this country), and he told us Head circumference is most important, height is a good indicator. Weight is simply easiest to check, but doesn't tell that much. As long as the head is growing, the brain is growing well, so no need to worry about development. And also, when I asked what if the head wasn't growing, the spec. ped. told us he has seen that a lot (in children adopted from orphanages overseas for example), and those children catch up very quickly as soon as they are well fed.
 
#13 ·
He's probably fine, but I would be a bit concerned about a 4-month old baby sleeping up to 10 hours at night - that's a long time to go without nursing. Can you wake him for a feed before you go to bed, and then maybe again 5-6 hours later? Actually you don't even need to wake him, most babies will nurse in their sleep if they're slightly aroused. I used to do that for my DD when she was little and my milk supply wasn't great.
 
#14 ·
Quote:

Originally Posted by spughy View Post
I would be a bit concerned about a 4-month old baby sleeping up to 10 hours at night - that's a long time to go without nursing.
I don't agree with that. My baby is 6 months old and has slept 8-10 hours/night since he was 1 month old. Though I don't nurse, I pump, and he gets 6-6 oz bottles everyday. He is healthy and happy as can be, he rarely wakes us up at night.

If your lo is healthy and happy then he is probably doing fine, just enjoy the sleep you get while you can. Sleeping habits can always change.
 
#15 ·
Quote:

Originally Posted by Quinn's Mama View Post
I don't agree with that. My baby is 6 months old and has slept 8-10 hours/night since he was 1 month old. Though I don't nurse, I pump, and he gets 6-6 oz bottles everyday. He is healthy and happy as can be, he rarely wakes us up at night.

If your lo is healthy and happy then he is probably doing fine, just enjoy the sleep you get while you can. Sleeping habits can always change.
Does your baby bedshare? I haven't heard of many babies that bedshare and don't wake up at least once and frankly I'm just curious! That being said, my 9.5 mo wakes up every 2 hours to eat still.
 
#16 ·
Quote:

Originally Posted by em123 View Post
Thank you for the quick posts. He is the happiest baby you will ever meet, smiles at everyone and loves to laugh. He's really laid back too, everyone always comments on how calm he is.

His weight was:

8lb 3 oz at birth
7 lb 2 oz a week later
10 lb 3 oz at 2 months
12 lb 3 oz at 3 1/2 months
12 lb 6 oz at 4 months

He is really low on the charts, wow - 3rd percentile. That's a big drop. I guess all I can do is keep nursing on demand. Both my husband and I are short and average weight.

I'll work on getting him to stay on the breast for longer. He usually finishes in about 7-8 minutes and is done, maybe that's just not long enough. But how can you make a baby to stay on the breast longer than that if he's the one who pulls off?
His weight doesn't look that bad, yes it's slower than most babies, and he certainly won't be doubling by 6 months, but that's okay. In the absence of any obvious medical issues, he's probably just going to be a small guy. His behavior suggests that he's perfectly okay.

One thing you might try, since he doesn't stay on the breast for very long...try pumping off some of your foremilk before nursing him, that way he'll get more hind milk with each feed, therefore getting more calories. Are you a good pumper? Do you have extra stored milk? When my younger son was having real weight gain issues, I would pump milk, set it in the fridge to separate, then scoop the separated fat off the top of one bottle and add it to another bottle. That way the fat content in one bottle was really high. Then I froze the bottle with lower fat (and labeled it) and saved it for when he started solids (or had pink eye, or had a diaper rash, or had a runny nose, etc etc...all those other wonderful uses for breastmilk!)

And definitely try cosleeping to see if he'll nurse once or twice at night. This will probably backfire and cause him to start waking regularly, which will mean a more tired mama, but it's much better than feeling the need to supplement!!! I'd rather give up some sleep than give formula. You can always work on getting him to sleep through the night at a later time
 
#17 ·
Quote:

Originally Posted by kalamos23 View Post
Does your baby bedshare? I haven't heard of many babies that bedshare and don't wake up at least once and frankly I'm just curious! That being said, my 9.5 mo wakes up every 2 hours to eat still.
No he doesn't bedshare. He has his own bed and room and seems very content that way. I have a few non hazard toys in with him so that if he does wake before mama he has something to do with himself. Sometimes he will wake about 6:30-7:00 and talk to himself and fall asleep again though. Either way he seems content to wait for his breakfast at ~8:30am. It is really nice to be able to sleep the night through. I think if he didn't let us sleep, we'd be going stir crazy by now.

Wow, how do you get enough sleep to function without being a grump all day?I don't think I could handle that little amount of sleep time.
 
#18 ·
To the OP:

I know sleep is golden, seriously I know, but the peak time for milk production is in the wee hours. A baby four months old that's gaining at a steady rate can be allowed to sleep through the night. But if I had a baby who was gaining slowly, I would aim for at least one nighttime feeding, if not two or three. It's very possible that your milk supply is suffering.

Other than that, I would look at the baby, not the scale. He hasn't lost weight. He is gaining, and it's possible this is just normal for him. My own DS gained very slowly between 2 and 4 months, and then hit a spurt and gained a lot the two months after that.

But I would seriously consider waking him for a nighttime feed, for a few weeks, and see if that helps.
 
#19 ·
Quote:

Originally Posted by Quinn's Mama View Post
No he doesn't bedshare. He has his own bed and room and seems very content that way. I have a few non hazard toys in with him so that if he does wake before mama he has something to do with himself. Sometimes he will wake about 6:30-7:00 and talk to himself and fall asleep again though. Either way he seems content to wait for his breakfast at ~8:30am. It is really nice to be able to sleep the night through. I think if he didn't let us sleep, we'd be going stir crazy by now.

Wow, how do you get enough sleep to function without being a grump all day?I don't think I could handle that little amount of sleep time.
She doesn't really wake me up and she doesn't wake up all the way either - half the time she finds the boob on her own and latches on, sometimes I have my shirt and sports bra down and she hits me and nuzzles until I pull it up. It sounds bad but really, I'm actually getting more sleep now than I was when I was pregnant since she goes to bed at 11-12 at night and sleeps until 11am. I'm a night owl by nature so it works for us.

The reason I asked if you bedshared was because I was wondering if maybe your baby is actually waking up in the middle of the night and you don't hear him because he is in the other room. It's not very typical to not wake up in the middle of the night, even for adults.
 
#20 ·
I know this thread is a month old but I wanted to come back here and say thank you to all the wonderful mamas who suggested cosleeping. We now get in one to two nighttime nursing sessions. He gained another pound this month and is doing wonderfully. We've moved the mattress to the floor and get extra snuggles in this way.

I never thought I'd be happy to have him wake me up but I really, really am. He doesn't even have to fully wake up, I can just roll over and nurse. Why wasn't I doing this from the beginning?
 
#24 ·
Oh good! So glad to hear that things are going well. I had issues with my EBF son when he was around 2 months (very slow weight gain) and we worked through it with switch nursing (he'd be attached for hours but he was falling asleep and not getting hindmilk)... He's 2.5 years now and still nursing at least 5x a day and healthy as can be
 
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