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Thread: late preterm, weak suck, not gaining

  1. #1

    Default late preterm, weak suck, not gaining

    Backstory: My son was born at 37w4d, 7lb 11oz. 15 days old today, has been at 7lb for 4 days. I have been bf him for 15 min, then pumping and bottle feeding the expressed milk. I am getting 20 - 30 ml each pump and it takes 30 plus minutes with dual electric pump. It just doesnt seem enough, my boy is still hungry and i am eager for him to eat more and start gaining. LC says my milk supply probably got behind because he wasnt demanding more due to the weak suck/sleepy baby. His suck has improved and he is more alert now but he is eating everything i pump and i cant seem to satiate him.

    Any advice or feedback on what i am doing or could be doing? I fear i may need to supp with formula to get his weight back up.

    Thanks in advance!

  2. #2
    Join Date
    May 2006
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    21,236

    Default Re: late preterm, weak suck, not gaining

    Welcome, Mama! And congrats on the new baby. Sorry nursing him has been tough so far, but what you describe sounds fixable.

    Here are a few things that may help:
    - If you're not using a hospital-grade rental pump with correctly-sized shields, now is the time to get one. Not all pumps are created equal, particularly when you're relying on the pump to maintain/increase supply.
    - Pump more frequently. You want to aim to pump around every 2 hours during the day and every 3 at night, or right after feedings, assuming your LO is nursing at least 8-10 times a day.
    - Pump for longer. If you're pumping 10 minutes per side, go to 15.
    - Herbs: fenugreek, blessed thistle and ordinary oatmeal are all good for increasing supply.
    - Drugs: as a last resort, Reglan and Domperidone are prescription drugs which can increase supply as a side-effect. Use of these drugs is considered "off-label"use and both have additional side-effects, so please discuss their use with your midwife, OB, GP, and/or LC before taking them.
    - Scale. By weighing your baby before and after feedings for a few days in a row, you will be able to gain a highly accurate picture of how much milk your baby gets at the breast, and that will help you know when you can stop the pumping and supplementing.
    - Supplemental nursing system (SNS): this can allow you to supplement at the breast, reducing the risk of bottle preference and potentially providing additional stimulation to your milk supply.
    Coolest thing my big girl said recently: "How can you tell the world is moving when you are standing on it?"
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  3. #3
    Join Date
    Dec 2011
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    183

    Default Re: late preterm, weak suck, not gaining

    The other benefit of mommal's suggestion to use a SNS... is that you LO will suckle while feeding, which will help to increase your milk production.

    And... if you can, nurse nurse nurse! When we had to get my LO's weight up, I let him stay at the breast for as long as he wanted. I would offer to nurse about every 2 hours, and would wake him up from sleeping around 3 hrs to nurse. There were a number of days where all we did was nurse . It worked though.

    Oh, and I drank a lot of Milkmaid Tea (Earth Mama Angel Baby). Steeped a whole pot, drank it hot, then made iced tea later
    3/2011 {EBF to 6mos, now BF and BLS, CD, EC'ing since 5mos - in underwear at 11mos, and babywearing}
    Babywearing International has chapters - see if there's one near you... most have lending libraries!

  4. #4
    Join Date
    Sep 2011
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    56

    Default Re: late preterm, weak suck, not gaining

    I would just offer this simple advice to what others said: Don't limit his time at the breast. Let him go for as long as he wants. Don't use pacifiers either. If he wants to suck, put him to the breast. I spent my first month with my daughter on one side for 30 minutes before she would come off for 30 minutes and then back on the other side for 30 minutes. It was really tiring but I just made myself comfortable in front of the TV with my laptop. You can also do skin to skin in between feedings. I loved taking naps with my daughter laying on my chest.

    Just stay with it momma. I didn't get relief from nonstop feedings till about 2 months but now we are still going strong at 6 months and I'm glad I didn't give in.

  5. #5
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    Default Re: late preterm, weak suck, not gaining

    It just doesn't seem enough, my boy is still hungry and i am eager for him to eat more and start gaining.
    Babies often "seem" hungry even when they are not. The problem is not his behavior, it is the weight gain-or lack thereof. I suggest you try to get in the habit of judging if baby is getting enough by his output (poops) and weight gain. It's not that baby's behavior means nothing, it does mean quite a bit! But it takes some time to learn to read it and it can be misleading especially when mom is (understandably) concerned about a poor weight gain.

    I agree with PP. -If he will nurse more (longer, more frequently) let him. Nurse nurse nurse, look at output, and pump when you can, just so you have that bit of extra to give him to get that weight up. If nursing is not comfortable for you, get help with that!
    I am curious if you have a lowest weight marker-was he ever at less than 7 pounds that you know of? In any case, it is important to look at weight gain from the lowest (known) weight, not from birth weight. Also make sure all weight checks are done in similar conditions on the same scale, if at all possible.

    Is it your doctor or you who are weighing him every day? Sometimes it stresses moms out too much to do such frequent weight checks. If baby is otherwise healthy, maybe you can go a bit longer-say, 3 days, before weighing again? idk, just a thought.

    Don't fear giving formula. If you have to, you have to. That is up to you and your pediatrician. Since baby is sucking better & more alert and you are under the care of an LC, you may see a turnaround soon. But this certainly would not be the first baby that got formula and then went on to breastfeed just fine.

  6. #6

    Default Re: late preterm, weak suck, not gaining

    Thank you for the advice and encocuragement. I did get a hold of a hospital pump so trying that. To clarify, the reason for limiting time at the boob was because he was using too much energy sucking weakly for an hour or hour and a half (or more) but not getting enough returm for his effort. My new criteria is not time but rather if he is sucking vigorously. I wish I had better access to a scale but am in rural Montana and dependent on my LC or doc visits to weigh him. He will be weighed again Monday, but so far has not climbed from his lowest weight of 7 lbs. Has stayed there for the past 5 days. And I am assuming that rooting or crying + rooting = hunger. Is that incorrect?
    Again, thanks!

  7. #7
    Join Date
    Dec 2011
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    Default Re: late preterm, weak suck, not gaining

    It may be hunger....but it also may be the need to comfort nurse

    I could tell which was the case based on how my LO nursed. If he quickly dropped off to fluttering ...comfort
    3/2011 {EBF to 6mos, now BF and BLS, CD, EC'ing since 5mos - in underwear at 11mos, and babywearing}
    Babywearing International has chapters - see if there's one near you... most have lending libraries!

  8. #8
    Join Date
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    Default Re: late preterm, weak suck, not gaining

    My new criteria is not time but rather if he is sucking vigorously.
    Just to clarify, This is criteria/instructions from your LC or pediatrician?

    When active sucking/swallowing slows, are you trying anything to get active sucking/swallowing started again (breast compressions, or stroking baby or rubbing his back or gently squeezing baby's foot or hand or stroking lips? (Basically, anything that works?) I used to gently jiggle my oldest's chin with my pinky to get him "started up" again.

    And I am assuming that rooting or crying + rooting = hunger. Is that incorrect?
    No, it's not incorrect. Yes, as pp says, it could indicate a need to 'comfort' nurse, but it also could be hunger-both are normal. It is normal for even a healthy, well gaining, two week old baby to want to nurse a long time per session or to want to nurse more, even very shortly after a nursing session. (not everytime, perhaps, but a good deal of the time at least.)

    What I was trying to suggest is not that your baby is not hungry, presumably he is, since he is not gaining & all 2 week old babies are hungry a lot of the time. But what I meant was, that the problem, in your case, is that baby is not gaining-not that baby is hungry. In fact, its very good that baby is showing signs of wanting to nurse more, what is really scary is when a baby is not gaining and NOT showing much interest in eating.

    Normally, during a feed, infants will will often slow down, or even take a break, and then want to nurse again very soon, often within a few minutes, (this happens even if milk supply is fine & baby is gaining fine, so it makes perfect sence it would also happen when a bb is not gaining well.) Infants have teeny tummies and normally take only a small amount at each feeding, so its normal for them to want to nurse again quickly even when all is well. Sometimes they want to top off before going to sleep, for example. So that is why I say 'hunger signs' are not the best indicator of whether or not baby is getting 'enough.' Weight gain and, at this age, output, (poops) are the most reliable indicators of that. This is also why it is often helpful if baby is allowed/encouraged to nurse as much as baby wants & as frequently as baby wants, as long as it is at least 10-12 times a day (at this age.)
    Is baby pooping at all? How much, and how 'big' and what do they look like? How has the poop pattern progessed or changed since birth?

    Has your LC done a before and after nursing session weight check? These are of limited helpfulness, but it may give you a better idea of what is going on, milk transfer wise, during a nursing session. Just remember it only 'takes a picture' of that one nursing session, its just more data to add to what you know. If after the weight check on Monday, baby has still not begun to gain, that might be something to look at?

    Be realistic about what weight gain you can expect. talk to your pediatrician and LC about what weight gain would be reasonable. I *think* average weight gain at this age is about 1 ounce a day? Any one have data on that? I mention this becasue I have seen lots of moms undermined because just when baby starts gaining someone tells them "they should be back up to birth weight by two weeks" or something like that and freaks mom out all over again. Your baby is not going to gain 11 ounces in just a few days, so don't expect that. If baby has begun to gain, after appariently just maintaining for so long, that will be great and certainly an indication things are going in the right direction.

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