Feeling confused about slowdown in weight gain

[@llli*3kidsmama]

I feel like I've heard conflicting opinions about oversupply/too much foremilk possibly causing slow weight gain. Some say that no, oversupply wouldn't be the cause of slowdown in weight gain because foremilk still has plenty of fat to allow good growth. But I met with an IBCLC recently who said yes, too much foremilk could cause slow weight gain.

I'm feel confused about where I am, supply-wise, and what could be the reason for my daughter's slowdown in weight gain. I know I had oversupply earlier and block nursed to help with that. Now I'm back to her taking one breast per feeding in the mornings (switching from nursing to nursing - no longer blocking) and then sometimes offering both breasts as needed in the late afternoons. However, she often can't even finish one breast in the mornings. Does that mean I still have "oversupply"? If she's having yellow diapers and doesn't seem pained or uncomfortable (beyond pulling off at let down, etc) should we just carry on as we are and not go back to blocking?

Her weight gain had been consistently averaging 1oz per day. However, the past two weeks it has slowed way down (2.5 ounces per week). She's 10 weeks old today. Good wet diapers and usually multiple poopy diapers per day, mostly yellow with occasional greenish ones.

I'm confused why this would be? I obviously have enough milk and she was able to transfer efficiently at the IBCLC's office (48 gram gain from nursing one side). Is she just not taking in enough (thoigh her diapers are good?) since lots of her nursings are just one side? She nurses a bunch - over 12 times per 24 hours. Some are very fast feedings where I know she doesnt take much. However, I'm offering a lot of those without feeding cues, so I really don't think it would help to offer more often. I think I'm maxing her out as it is.

She was 6lbs, 13oz at birth and was 11lbs, 3oz today.

Thanks for any thoughts!

[@llli*joe.s.mom]

I'm no expert on this, but oversupply is usually associated with fast weight gain, even where there is a foremilk/hindmilk imbalance. For excess foremilk to cause slow weight gain, I would expect to see a baby with a real tummy ache? Like, explosive poops/diarrhea, gas, etc.?

If your baby has yellow poops and is not uncomfortable, and you are not painfully engorged, I would say you don't have oversupply anymore. You definitely don't have a foremilk imbalance. I would continue to offer the breast as needed, following your baby's cues, rather than on a block feeding schedule. If you are concerned about weight gain, switch breasts more often (but it's really normal for the baby to take one side at a time in the morning, and both sides later, so if that's working and baby is happy, keep it up). Watch the baby, not the clock.

Growth doesn't always happen on a steady curve, so my guess is your baby has just slowed down a bit and then will jump up again. Especially if she's gained really fast earlier, it's probably no big deal. But 2.5 oz a week is a bit on the low side, so if that keeps up for more than a week or two, I'd probably start switching sides more to try to increase your supply again. It is possible to block feed too much and reduce your supply too much, so you may have overdone it a bit.

Basically, I think everything is fine! I definitely wouldn't worry about oversupply at this point, as it sounds like you have that under control. Just nurse that baby as much as she wants, and she'll grow at her own speed, you know?

[@llli*3kidsmama]

Thanks for your reply! She definitely has explosive poops (we can often hear her poop from the other room!) and is very gassy, however, neither seem to bother her. And she doesn't have diarrhea-looking poops. Most are pretty standard breastmilk poop looking...occasionally a little slimy looking, but then back to normal next time.

The thing is, I don't think my supply is too low...? Even in the afternoons (when switch nursing is sometimes necessary to satiate her) the opposite side leaks at letdown. And then, like I mentioned, she usually doesn't even drain one breast completely (I know they're never fully empty) at a feeding in the mornings.....????

I worry that she just doesn't have enough of a hunger drive?

(I should add that I have major feeding trauma from my son who was a 26 week preemie and was diagnosed with failure to thrive and ended up with a feeding tube. So, know that my concerns are partially based on my lack of a "normal" baby growth experience...)

[@llli*3kidsmama]

I should add that many feedings end with her pulling off and not wanting more, even with obvious milk still available. There will be milk all over my nipple (not flowing like letdown) and I can easily hand express more to the point that it's spraying. This is after letdown and after she's definitely finished eating. Even past those engorged early morning feedings...

[@llli*3kidsmama]

So, is the 48 gram gain (from nursing one side) adequate? I'm not sure the LC remembered that she usually only nurses one side per feeding. At 12-14 feedings per day, I wonder if that's enough? Of course, that was just a snapshot and every feeding is likely different, so who knows...

[@llli*joe.s.mom]

I'm not sure about the 48 gram gain from one feeding, because I'm not sure how much a baby is supposed to take in in one feeding (I'm more familiar with how much they are supposed to gain per week). What did the LC say? Did she say that was a good amount? If it was low, I would try not to read too much into it, because as you say, it was just a snapshot and every feeding is different.

12-14 feedings per day is GREAT, and her diaper output sounds spot on. I think she's eating just the right amount!

Big poop explosions are normal, actually. When I say "explosive poops" I'm thinking more like diarrhea (actually watery and thin) or green and frothy. And actually, some of those are okay (well, very thin diarrhea would make me think my baby had a bug), but if it's every time ... you know, maybe look into it. What you're talking about doesn't concern me. With my eldest I had oversupply, and he continued to have green stools occasionally for months, but he was happy and my breasts were no longer painfully engorged, so I didn't worry about it. If it's every single dirty diaper and your baby seems distressed, that's when you should worry.

I have a 8 week old myself, and sometimes she pulls off when I still have plenty of milk. I am pumping (just once a day - don't want to create oversupply) after she feeds now and then, and I always still have lots of milk in the breast she just nursed. But it's not so much milk it's causing me PAIN, and her poops are yellow, therefore, it's not oversupply, and she's not getting way too much foremilk. Again, oversupply and OALD are only problems if they are causing problems, you know?

My sense is that everything is FINE and your daughter is getting plenty! As mentioned, 2.5 ounces in a week is a bit low, but she's probably going to have a massive growth spurt next week and make it all up. The key here is to watch your baby - if she's happy and healthy and hitting milestones and making lots of wet and dirty diapers and nursing frequently, everything is probably fine!! I hear you on the feeding trauma - something like that can really undermine your confidence! - but I really think everything is going great right now! Give it a week or two, nurse her every time you think she's hungry (and if it makes you feel better, offer her the breast sometimes when she's not acting hungry and see if she'll take it), get her weighed again, and I bet she'll have put on a bunch of weight.

[@llli*3kidsmama]

The past few days have been pretty rough, as far as her nursing. While it seemed to start with her not finishing a breast in the mornings, it's really become more like she's rarely getting a good feeding in at all. Constantly pulling off, etc. She'll suck to get let down, then pop off, come back on, pop off, look around, etc. She sounds exactly like the articles on distractible babies. (Though she seems a little young at 10 weeks?). She doesn't seem in pain - it's as though she just simply doesn't want to eat? I'm going to try more nursing while moving and see if that helps her focus. In the meantime, it seems like her wet diapers haven't been as good the past couple days. Should I express a little milk and syringe feed after breastfeedings to keep her hydrated? Is there any specific trick to that? I assume it should come after a breastfeeding?

[@llli*joe.s.mom]

When you say diapers aren't as good, how many are you talking about?

Fussiness at the breast is pretty common at this age. This link is helpful for troubleshooting. I would keep working on getting her on the breast (unless the diaper output is very bad and then supplementation might be a good idea). At 10 weeks, she may be able to get more milk, more quickly, than in the past. Babies get more efficient at nursing as they get older, and by the time they're a few months old, nursing is often a quick five minute affair. Nursing in a dark quiet area, in the side lying position, helps some babies stay on longer.

Could she have thrush? Do you see any white patches in her mouth? Sometimes that makes babies really unhappy about nursing (because their mouth hurts).

It wouldn't hurt to syringe feed her after a feeding but it's probably not necessary unless you're seeing less than 6 diapers a day. Otherwise, I'd just work on breastfeeding more.

[@llli*3kidsmama]

Yesterday she only had 4 wet diapers. But so far today she has had 3 good wets and 3 ok wets. Both days have had multiple poopy diapers (but at 10 weeks, that's no longer a good indicator of milk intake, is it?)

So it's looking like she'll probably have enough wet diapers today...I'm glad to have a few ounces of expressed milk in case we need it, though.

I don't think she has thrush. She definitely has a white tongue, but I'm pretty sure it's just milk tongue. No white patches elsewhere in her mouth.

I've paid super close attention today and it always seems the popping off is after letdown (not just right after, but even into a few minutes after). It's as though she just wants to comfort suck all day and isn't ever hungry. I don't think my letdown seems super strong (it doesn't spray when she pops off...just drips) today. I feel like my breast fullness is very different from even yesterday, when they were very full in the early morning. It seems they are very responsive - and yesterday she nursed like today....not very thoroughly.

[@llli*rakoonz]

If you're seeing a lot of poopy diapers, it's always an indicator of getting milk in otherwise how would it be coming out the other end, ya know . (The reason dirty diaper counts don't always give an accurate picture in older babies is that sometimes, though not always, ebf babies will start to poop a lot less frequently after about 6 weeks, since breastmilk is so completely digestable. So not seeing a lot of poops is not necessarily a sign of inadequate intake, depending on other factors.) Wets can also be disguised within the dirties, esp. if you use disposables, since they're so absorbent.