6 weeks old (born at 35) but static weight gain

[@llli*frangipanni]

My DS was born at 35 weeks and spent a week on NICU on cpap and iv antibiotics. I was very blessed that he was able to bf asap and the staff were very encouraging of kangaroo care and bf. I have been solely feeding him since birth and he feeds 2 - 3 hourly on demand for approximately 20-30 minutes each time but this last week, he has not gained weight

He is now 6 weeks old and weighs 6lb 10oz but was only 5lb 14oz at birth. Our HV advised me this week that his weight gain should be more than what he is currently doing and advised topping up with formula which i rejected. I feel that my milk supply is plenty and i have a good let down, he appears to feel well (swallowing heard, plenty of wet & dirty nappies) but he is soo tiny and scrawney... is this normal?? I've had people say their bf babies gained a 1lb a week!!!

After he has finished feeding, he is content and sleeping but generally he is a bit grumpy but i put that down to personality? I feel like ive lost some confidence at the moment and hoping that someone is able to suggest ways of helping him thrive
thank you x

[@llli*mommal]

Welcome to the forum and congratulations on the new baby!

Some breastfed babies gain a pound a week, but that is very much on the higher side of normal weight gain. More typical weight gain is around 5-7 oz per week (see this reference: http://kellymom.com/bf/normal/weight-gain/).

When your baby was weighed this past week, was it on the same scale as always, in the nude? At this age, differences in calibration between scales or the few oz difference between a clothed and nude baby can make a huge difference in weight gain that appears normal and weight gain that doesn't.

If there really has been a pause in growth this week, that is a little worrisome, particularly with such a young and small baby. It may be normal- generally people do not weigh babies every week because if you zoom in too closely on the data you can mistake normal fluctuations in growth for problems. And growth does fluctuate over time- sometimes a baby's weight or height will pause for a bit, and then spurt up the following week. So long as the overall trend is in the right direction, those variations don't matter.

What color are your baby's poops? Yellow like curry is a good sign, and if they look like thin curried cottage cheese or curried yogurt () that is ideal. If they are greenish, brownish, and watery, that would be potentially of concern.

That being said, because your baby is so young I would do the following:
- See your pediatrician and make sure your baby isn't sick. Ear infections or other infections can lead to slowed growth. Also, you may want to discuss the possibility of acid reflux. Babies with reflux can gain slowly because they learn that using their digestive system leads to discomfort, and medication can help with that. The fact that your baby is "grumpy" after feedings could be a sign of reflux.
- See a lactation consultant, preferably an IBCLC, for hands-on help.
- Get yourself a professional grade baby scale and do some data collection. (You can probably rent one from your LC.) By weighing baby before and after feedings, you can get a highly accurate picture of baby's intake during a feeding session, and if you do several days worth of data collection you can get an accurate picture of his overall intake. If there's a problem with milk intake, let us know and we'll come back with strategies that have helped those of us who have had similar issues.

[@llli*lllmamamia]

The weight gain can be misleading if your preemie got off to a rough/slow start! It might be helpful to start looking at weight gain from today on, instead of in the past.

You are noticing lots of good signs of a good nurser! Lots of gulping, wet/messy diapers, etc. Good job!

My preemies (twins, born at 35 weeks) stayed scrawny for a long time. Thankfully I had an older child who had followed the same pattern, so the pediatrician and I were more confident that it may be my kids' genetics to be smaller during infancy.

Other signs that baby is getting enough milk:
- 3 messy diapers per day
- Nurses as often as he wants for as long as he wants, 10-12 times per 24 hours (possibly more)
- Generally content after nursing

Personally, I would feel more comfortable if I consulted with a bf-friendly pediatrician, a lactation consultant, and a LLL leader before giving my baby formula.

[@llli*mommal]

After 6 weeks pooping can slow down to as little as once per week for an exclusively breastfed baby. IDK how well that rule applies to premature babies, though.

[@llli*aphimama]

With pp. Mommal's advice in her first post was great, and covers everything I would advise. Instead I'll give you a supportive nudge and say to follow your instincts. My DD1 was a 35 weeker and she gained VERY slowly, but hit her stride. The way the lactation consultant explained it to me was that it was harder for her to actually gain, because it took more energy to transfer the milk so it would be a slower process. Once her growth spurts spread out instead of being every couple of weeks, she started plumping up a bit more rapidly. Almost a pound in the first month isn't bad at all. My pediatrician always said things like "I'd like it to be more" but I started to notice that he WASN'T saying "I'm really worried that she's not thriving" because in medical terms, there seems to be a difference.

FWIW, DD1 started at 5 lb 7 oz, and by 6 weeks was at 6 lbs. 9 oz. then at 12 weeks was 8 lbs. 4 oz. (I went back and checked my calendar of Dr visits). You don't want much less than .5 oz/day so a baby scale is a good idea. I stopped in at the peds office once a week and they let me do it free of charge and w/o an appt so that I didn't have to purchase one. But .5 oz/day is about a lb/month. I'd just watch it and make sure he's having a good number of wets/dirties and trust your own instincts. Having a preemie as a first time nursing mom is no easy task, and you're likely to second guess yourself A LOT. It's ok however you go about this, but you do have options if you'd rather get a second opinion.

[@llli*frangipanni]

Thank you for your replies. We saw the paed at the hospital on thursday who was not concerned at this stage and felt that one weigh was not sufficient enough to determine if there is a problem but suggested weighing in a week and another review in two weeks with a plan to continue as we are. So, there is me all happy and making my friend a birthday cake when i asked DH if he would feed DS with some frozen milk (has over 1litre in reserves in the freezer from when we were in NICU) and i would pump afterwards so I could finish the icing, no problems.. Then i pumped and only got out 1 oz in 30 mins!! so the chances are that i have not been producing enough and my 'grumpy' baby is simply hungry! I felt awful my poor babe!. I have now been putting DS to the breast for a feed and topping up with 2oz of frozen EBM from the freezer and when he has finished his feed im pumping for 15 minutes to restimulate the supply.. 24 hours on and my DS is smiling - yes smiling!! fingers crossed that soon my supply will be good enough again to not have to top up..

Does anyone know if having a reduction in milk is quite common??

[@llli*mommal]

Don't panic. Pump output can vary a lot, based on time of day, when you last nursed, your experience with the pump, the type of pump you are using, and your overall response to pumping. So that 1 oz you got does not necessarily indicate low suppy. That being said, when you have a small, young baby who has paused in weight gain, baby seems unhappy after nursing, and lower pump output, that is a better indication of supply problems. At this point, I would suggest seeing a lactation consultant, preferably an IBCLC, for hands-on help. I would also look into renting a professional scale, one that is accurate to the 1/10 of an oz. By weighing your baby before and after feedings, you can gain a very accurate picture of milk intake over the course of a feeding and over the course of the day. You'll know when you need to supplement and when you don't. Don't rely on a single weigh-feed-weigh test at the LC's office, since milk intake is highly variable over time and you want to have enough data to create a good average before making your conclusions about milk supply and milk transfer.

Reduction in milk supply and pump output over time is common. Most moms start out making more milk than their babies need, so that the babies can be fed easily and abundantly as they master the art of breastfeeding. Eventually milk supply declines to match demand more precisely. Many moms mistake this mpnatural adjustment to supply for inadequate supply, which is why I recommend that you get the scale mentioned above.

[@llli*auderey]

agree with PP. don't panic!

[@llli*frangipanni]

went to the health visitors today for our weekly weigh in (cant afford to purchase baby scales just yet and hubby worries i may become obsessed over this ) and babe has gained 7.5 oz in a week **yay! me dancing round the table** I have spoken to an infant feeding co-ordinator/lactation consultant and im hoping to see her on thursday, fingers crossed.. but what do i do now? strange question, i know - sorry.. but, ive been bf on demand, then pumping afterwards for 15 mins and only topping up with ebm if baby is not content.. Do i continue to pump and top up? or soley bf and see what happens at the next weigh in?? im feeling so confused but also worried that i no longer have any reserves in the freezer .. im sorry, so many questions! I just want to be able to do whats best for him as i gave up bf my older two boys within a few weeks and im determined not to this time

[@llli*auderey]

congrats! that's awesome news.

so, you've used up all the milk you pumped?

in that case i might try to wean off the supplementing slowly - try to replace top-offs with extra nursing, maybe start 1 feeding a day or something?