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Thread: Green poop and slow growth when we reduce supplemental EBM

  1. #1
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    Default Green poop and slow growth when we reduce supplemental EBM

    My baby is 7 weeks today. We left the hospital BFing on demand and thought everything was going fine. She nursed about 90% of the time she was awake, and fell asleep on the breast. She was nursing about every 2 hours around the clock. At her 2 week appointment, she had not yet gained her weight back, but was growing ...just slowly. The doctor checked her again at 3 weeks, and she had only gained about 2 ounces over the week. He told us to stop feeding at the breast and start pumping exclusively. He also told us to put one scoop of formula in every 2 oz of EBM. We gave her 3 bottles following that protocol, and I knew it was not right for my baby. She was choking on reflux all night that night.

    The following day, we found a new pediatrician. She recommended breastfeeding, and then offering a 1.5oz bottle of EBM. We did this for 1 week, and she gained 15oz in a week. So she told me I could start offering the bottle only every other feeding.

    Now we are BFing at the breast, and I pump about 3-4 times per day. I have stored about 60 oz of EBM, and I am still offering 4-5 oz EBM throughout each day.

    The baby seems content most of the time. I am having to nurse, then nurse again about 45 minutes later. If she is not satisfied, I give her an oz of freshly pumped EBM. Then she will stay satisfied for a couple of hours. She spends about 3-4 hours per day awake and alert, and doesn't cry unless she is hungry or wet. She poops 4-5 times per day, and it is a significant amount. However, it has become more green lately. She usually has a good wet diaper after every other feed, and she is feeding 7-8 times per day.

    My questions:
    1. Why is her poop green? Is she not getting enough hindmilk? It was staying more yellow when she was getting more EBM by bottle.

    2. I have an initial let-down while pumping that I don't feel, but if I have a second let-down, it hurts a little. I never feel that when she is nursing. Is that ok?

    3. She falls asleep at the breast ALMOST every nursing session, sometimes after only 3-5 minutes. I am just not convinced she is getting enough, but I can't get her to wake on the breast. We have tried compressions, messing with her, cold wash cloth. The only thing that helps is detaching and changing her clothes, but she goes back to sleep within a couple minutes on the breast. Is that ok?

    4. She is still not growing well. She is 7 weeks old, and has only gained about 1lb, 4oz since birth. Is that normal for breastfed babies?

    5. Is it normal to be able to pump 1.5oz immediately after nursing when the baby comes off the breast unsatisfied? (This happens about twice per day.)

    Thanks for any help you can provide.
    Last edited by @llli*hpuckett; June 19th, 2012 at 02:21 PM.

  2. #2
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    Default Re: Green poop and slow growth when we reduce supplemental E

    Sorry the post is so long. I am really afraid I might be starving my baby because I am able to pump so much after feedings. And she was born 7lb 5oz, and is now only 8lb 9oz after 7 weeks.

  3. #3
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    Default Re: Green poop and slow growth when we reduce supplemental E

    1. Why is her poop green? Is she not getting enough hindmilk? It was staying more yellow when she was getting more EBM by bottle.
    Green poop can be:
    A) a normal variation
    B) an indication of allergy
    C) an indication of milk oversupply
    D) an indication of insufficient milk intake

    2. I have an initial let-down while pumping that I don't feel, but if I have a second let-down, it hurts a little. I never feel that when she is nursing. Is that ok?
    That's all normal. Some moms feel letdowns, some don't. I've successfully nursed 2 kids and never felt a letdown- I have to judge what's going on by the baby's behavior. When I hear lots of rapid swallowing, that's a letdown.

    3. She falls asleep at the breast ALMOST every nursing session, sometimes after only 3-5 minutes. I am just not convinced she is getting enough, but I can't get her to wake on the breast. We have tried compressions, messing with her, cold wash cloth. The only thing that helps is detaching and changing her clothes, but she goes back to sleep within a couple minutes on the breast. Is that ok?
    Sleepiness at the breast is a problem when baby is not gaining sufficient weight. Tips on coping with a sleepy baby:
    - Keep her cool- a cool baby is often more alert. Strip her down to a diaper or onesie when it's time to nurse, and keep a fan blowing in the room.
    - Annoy her- Tickle her, use the washrag, etc.
    - Do breast compressions to speed milk flow to the baby.
    - Switch nursing- when baby starts to fall asleep, remove her from the breast, change her diaper, burp her, and switch her to the other side. When she starts to doze again, repeat the process and keep repeating it until she will no longer wake.

    4. She is still not growing well. She is 7 weeks old, and has only gained about 1lb, 4oz since birth. Is that normal for breastfed babies?
    Can you post a complete weight history? (Birth weight, lowest weight, weight at each checkup.) This sounds rather low but it would be helpful to see if there is a general pattern here.

    5. Is it normal to be able to pump 1.5oz immediately after nursing when the baby comes off the breast unsatisfied? (This happens about twice per day.)
    This can be very normal. Being able to pump milk after the baby nurses is normal, though the amount varies widely from mom to mom. The thing that concerns me here is that you feel the baby is "unsatisfied". Can you tell us exactly what you're observing?
    Coolest thing my big girl said recently: "How can you tell the world is moving when you are standing on it?"
    Coolest thing my little girl sang recently: "I love dat one-two pupples!"

  4. #4

    Default Re: Green poop and slow growth when we reduce supplemental E

    I am interested in your answers to mommals excellent questions. I have no idea what is going on or why your baby cannot gain well at the breast when you seem to make not just enough milk but possibly more than enough. 15 ounce weight gain in one week is twice the norm!

  5. #5
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    Default Re: Green poop and slow growth when we reduce supplemental E

    Quote Originally Posted by @llli*mommal View Post
    Can you post a complete weight history? (Birth weight, lowest weight, weight at each checkup.) This sounds rather low but it would be helpful to see if there is a general pattern here.
    birth: 7lb 5oz
    discharge (day 2): 6lb 7oz
    Day 6: 6lb 9oz
    2 wks: 6lb 15oz
    2 wks, 3 days: 7lb 2oz
    3wks: 7lb 3oz
    3 wks, 1 day: 7lb 5oz (new scale/ new doctor, and after one night of formula + EBM bottles)
    4 wks: 8lb 4oz
    5 wks: 8lb 6oz (from home with a cheap baby scale)
    6 wks: 8lb 7.5oz (")
    7 wks: 8lb 9oz (")

    Even if my home scale is not accurate, it's still showing her only gaining 1.5 oz/wk for the past two weeks. She continues to have lots of wet and dirty diapers though, so it's really confusing.



    Quote Originally Posted by @llli*mommal View Post
    This can be very normal. Being able to pump milk after the baby nurses is normal, though the amount varies widely from mom to mom. The thing that concerns me here is that you feel the baby is "unsatisfied". Can you tell us exactly what you're observing?
    Sometimes she nurses and either sleeps or is alert and content afterward. Other times, she nurses and falls asleep on the breast, only to wake up 10 minutes later acting hungry (stuffing her hands in her mouth and crying). I used to pump after every feeding, and I would feed her 1oz EBM by bottle after I pumped.

    Each time I could pump about .5-2oz after she had fed depending on the time of day. The only feeding that I didn't supplement with EBM was the middle of the night feeding. Then 1 weeks ago, I decided that her poop was the right color (bright yellow and curdy) and frequent enough as well as her pees and everything was going better, so I started decreasing the amount of supplement. Yesterday, her poop started turning darker green and mucousy, and now today, she is extremely gassy. So now I am just really confused.

    I am 99% sure I am producing about 25-30 oz of milk per day that I can pump off. I just don't think she is getting that from me, and now I am concerned that if I don't start pumping every feed again, my supply will suffer.

    I really need to figure out how to get her to move milk better because it is in there. I am confused as whether she is getting enough, and if so, is she not getting the fatty stuff. I don't want to just pump all of the fatty hindmilk off and freeze it if she is only getting foremilk.

    Im kind of panicking at this point.

  6. #6

    Default Re: Green poop and slow growth when we reduce supplemental E

    Number one, do not panic! There is an explanation, there is always an explanation.

    I just saw in your op she is nursing for very short amount of time-and I see you are having a hard time getting her to nurse longer. OK-but I also see she is only nursing 7-8 times a day?

    That is likely just not enough. Up until 6-8 weeks of age, and often for much longer, a breastfed baby typically must nurse a minimum of 10-12 times a day. That would be a minimum of 3-5 times more than your baby is currently nursing- so you can see, that could make a big difference. Are there any barriers to simply nursing her more often? Would you have to wake her in order to nurse more frequently? Does nursing hurt you or is latching difficult? Does she cue, frequently? and/or do you offer, frequently? Are you in any way scheduling or holding off on feedings-maybe, for example, because some one told you to nurse every such and such hours or something? Do you use a pacifier?
    Meanwhile-
    Take a breath and look at what is good. You are pretty darn sure your body can make enough milk for your baby, even if some of it is by pumping right now. And despite possibly needing bottles, your baby is also still nursing at the breast. Those are really good things that will pave the way for a successful transition to ebf once you figure out what is going on.

    Number one, I think you want to keep trying to increase nursing sessions-frequency for sure and maybe length as well. I also think it is important to figure out once and for all what baby is really gaining/not gaining. Since you are getting one story from your home scale and another from output, and previous weight checks were on a few different scales I assume, I would think this means doing regular weight checks-maybe twice a week (?) done correctly and double checked, on a doctor's or lactation consultant's scale, the SAME scale, with baby in only a dry diaper, or naked, very time.

    At the same time-Have you seen a Lactation consultant? If not, can you? Make sure it is someone who is practiced in slow weight gain and milk transfer issues in babies this age-as the issue seems to obviously not be one of supply. I think someone who understands what they are looking for needs to watch baby nurse, plus do some before and after weight checks to see what is going on milk transfer wise at each feeding. I suggest at least 3 before and after weight checks over a couple of days to see if there is a pattern-one just does not tell you enough, one can be falsely alarming or falsely reassuring, in my opinion.

    I understand wanting baby to have fattier milk, it makes sense, but the fact is, all milk has fat, and typically, with oversupply and forceful letdown, where a baby is getting more "foremilk" and less "hindmilk"- usually results in very rapid weight gain. So I doubt that is the main problem, at least as far as the weight gain goes. You may very well have forceful letdown and that is causing the gassiness and green poops, but those can have many causes and again ffld would not, imo, fully explain the very slow weight gain. (Also btw, less frequent nursing sessions or too much time between nursing sessions makes ffld worse-jsut going to more frequent nursing sessions often tames ffld issues.) Again, I think at least part of the problem is your baby is probably not nursing long enough or frequently enough, plus there may be
    milk transfer issues or else those weight checks are way off.
    Last edited by @llli*lllmeg; June 20th, 2012 at 01:35 AM.

  7. #7
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    Default Re: Green poop and slow growth when we reduce supplemental E

    with all LLLMeg's terrific advice. In particular, a trip to see the lactation consultant sounds like a very good idea. I'd want to make sure someone with a lot of experience checks baby for tongue-tie, as well. Sometimes poor tongue mobility can impact a baby's ability to transfer milk.

    Since you're having such tough time right now, how about renting a scale for home use and doing a couple days' worth of before and after feeding measurements? One weigh-feed-weigh test at the LC's office won't tell you much, since intake at the breast can vary a lot. You want a day or two's worth of data before coming up with an average intake amount. Another reason a scale can be useful is that it can tell you when your baby has had a decent feeding and does not require a supplement, and when she probably does need a top-up.

    But definitely start by trying to get little Miss Sleepyhead to nurse a few extra times per day.
    Coolest thing my big girl said recently: "How can you tell the world is moving when you are standing on it?"
    Coolest thing my little girl sang recently: "I love dat one-two pupples!"

  8. #8
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    Default Re: Green poop and slow growth when we reduce supplemental E

    My sister-in-law had a "slow to gain" infant too.
    what helped her baby finally fill out and gain weight was
    1. Nursing 10-12 times a day, especially at night
    2. Doing a marathon session at least once a day.. she kept the baby at the breast for an hour or more..in a relaxed comfortable chair
    3. she did not let more than 2-3 hours pass before nursing again.

    My nephew was always lean, he still is, but his weight gain normalized.
    DD#1 July 1986 VB
    DD#2 April 1988 c/sec
    DS#3 April 1990 VBAC
    DS#4 June 1993 VB
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    DD#5 April 2001 c/sec
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  9. #9
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    Default Re: Green poop and slow growth when we reduce supplemental E

    Quote Originally Posted by @llli*lllmeg View Post
    Are there any barriers to simply nursing her more often?
    The main reason I am not nursing more frequently is because each feeding takes about 60-90 minutes. For example, this morning, baby woke me at 5:15 to feed. I started by nursing her. She sucked well for about 5 minutes on the first breast, fell asleep on the breast, and didn't want to wake up for the second. So I changed her diaper, tickled her feet, and started the second breast. She nursed for about 2 minutes and fell asleep, so I let her continue to sleep suck for about 20 minutes. I swaddled her and put her in the bassinet so I could pump. While I pumped, she had gas and pooped and peed and was crying by the time I finished. I changed her and put her back in the bassinet, and she started acting hungry. So I nursed her back to sleep. By the time we were finished it was 6:40. I got breakfast and dressed and read to my 2yo before baby woke up hungry again just a few minutes ago(8am). This time she nursed on the first breast for about 3 minutes before falling asleep, pulling off and sleeping against my breast while I typed. I put her in the swing to get her to wake up again for breast 2.

    on my home baby scale, it appears that she is getting 1-2.5 oz from me per feeding, but it is only accurate to .5oz with an error of .5 either direction. So I don't trust those numbers.

    I feel like I have to pump every feeding to maintain my supply because she isnt getting it all out. My older child was born prematurely, and I had to fight for every drop of milk, so I really don't want to lose what I have.

    Quote Originally Posted by @llli*lllmeg View Post
    Would you have to wake her in order to nurse more frequently?
    Right now, she nurses at about 10pm, 3am and 5 or 6am. Then she feeds usually 5 more times during the day, usually around 8, 11, 1, 3 and then from 5-7 or 8 pretty much straight through. She has skipped that 5am feeding a couple of times. That middle night feeding is the largest of the day. Per my scale, she gets 2.5-3.5oz.

    I have tried waking her at night for an extra feeding, but it is pointless because she wont make an effort to eat.

    Quote Originally Posted by @llli*lllmeg View Post
    Does nursing hurt you or is latching difficult?
    Nursing doesn't hurt at all, and per the LC at the hospital, our latch looked perfect on both sides.

    Quote Originally Posted by @llli*lllmeg View Post
    Does she cue, frequently? and/or do you offer, frequently?
    She sticks her hands in and around her mouth or roots but not more frequently than I feed her. If she does that within 15 minutes of finishing nursing, I give her a supplemental oz of EBM.

    Quote Originally Posted by @llli*lllmeg View Post
    Are you in any way scheduling or holding off on feedings-maybe, for example, because some one told you to nurse every such and such hours or something?
    Maybe ...not for the purpose of waiting a certain amount of time, but when we go to the drugstore and grocery shopping in a few minutes, I know she will stay asleep in the carseat because of the motion, which means she probably won't eat again until we have been home for about 15 minutes. We are on the go a lot, and I do feed her in public anytime we stop long enough to. For example, my 2yo and I had a mommy and me gymnastics class yesterday, so I went an hour early, and nursed her before the class. Then I gave her a supplemental bottle of EBM just to make sure she would stay content through the class. I wore her for the class, and she slept until we got home 2+ hours later. She definitely goes longer between feedings after I giver her a bottle.

    Her 1st pediatrician told me to only feed her for 10 minutes each side every 3 hours, but we changed pediatricians because I could tell that he was not the best doctor for someone who planned to EBF.

    Quote Originally Posted by @llli*lllmeg View Post
    Do you use a pacifier?
    We do.

    Quote Originally Posted by @llli*mommal View Post
    Since you're having such tough time right now, how about renting a scale for home use and doing a couple days' worth of before and after feeding measurements?
    Where can you rent a scale from? I am in a smaller town, and I am not sure where to go for something like that.

    ** Forgot to mention - I have spoken to the LC we talked with at the hospital, and she based on our conversations, she initially had me get on Domperidone to boost supply in an effort to make transfer easier for baby. That was also based on the one 24-hr period I pumped when I had just started pumping as a result of the 1st pediatrician giving us a failure to thrive diagnosis. I only pumped 17oz that day, but I know my supply has about doubled based on the amount I am pumping after feeds and the few times I have had to pump instead of feeding. I use a hospital grade pump.

    THe LC doesn't want me to come in for a consultation because she doesn't think she can help me. She thinks the baby is just not moving milk like she should. I am also planning to go to my first LLL meeting tomorrow morning.
    Last edited by @llli*hpuckett; June 20th, 2012 at 08:12 AM.

  10. #10
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    Default Re: Green poop and slow growth when we reduce supplemental E

    You can usually rent a scale from a LC- so call up the one who didn't think she could help you and ask if she has one.

    Based on what you describe, this really sounds like a sleepy baby problem. You're not taking any medications that could be making her sleepy, by any chance? Pain meds in particular spring to mind... But if she's "just" sleepy, how about spending a couple days just really focusing on nursing- no errands, have someone else take charge of your toddler. Just nurse.
    Coolest thing my big girl said recently: "How can you tell the world is moving when you are standing on it?"
    Coolest thing my little girl sang recently: "I love dat one-two pupples!"

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