Please help an anxious mom be okay with slow weight gain?

[@llli*maddieb]

It's only true if your baby is nursing so long because baby cannot transfer milk effectively. Since your baby is not nursing with normal frequency, the milk transfer may be fine and baby simply needs to nurse more often.
Whether or not to give formula to your baby is a medical decision you should make with your doctor, formula is a medicine for treating specific issues and nurses should not be pressuring you to do anything.
I strongly suggest, start nursing
more often and see an ibclc to have latch and milk transfer assessed. If a baby is not gaining as they should by breast feeding alone, that means baby is not getting enough breastmilk for some reason. The question is why. Supplementing only treats the symptom, usually while causing other issues. Sometimes it is needed, of course. But far more often it is given unnecessarily. Even if it is needed, the cause of the problem still needs to be identified and fixed.

[@llli*k9companions]

I have a 5 week old baby that is slow weight gain also. I'm also high anxiety so I understand your concerns. My baby has only been gaining 2 oz. a week, but it's consistent, 2 oz. every week. His doctor is fine with his weight gain. He's gaining length and head circumference he's just not gaining much weight. It keeps stressing me out, and I've found almost nothing that says it's ok for him to gain so little but I'm trusting his doctor and my instincts that he's happy, alert, hitting his milestones quickly and generally seems like a very healthy baby. Good luck and I hope you can find some peace and reassurance!

[@llli*maddieb]

Sorry I was on my phone before which I have a hard time communicating on. Just to clarify:

I have not read anything about the length of nursing sessions being too long. Wouldn't that mean that cluster feeding would be bad for a baby?

There is lots of confusion about this, and lots of times moms are unfortunately and almost always incorrectly told to limit time at the breast, or to schedule feedings, (so, not cluster feed) or that long sessions mean something is wrong. No, as long as baby is gaining fine, length of nursing sessions can be long and that is fine. In fact they normally are pretty long in the early weeks when baby is learning to nurse and mom’s milk production is building. After that, they can still be long because baby’s nurse for comfort as well as milk and this is normal and needed for breastfeeding.

IF, however, a baby is not getting milk when nursing, or is getting very little milk, that baby would possibly be sucking and sucking trying to get more when they can't. The problem then is that the baby cannot get enough milk no matter how much baby nurses. It could mean that baby is not sucking effectively due to poor latch and/or ineffective sucking, or it could mean low milk production. Or both. That is what you would see an IBCLC to help you ascertain and fix, if needed.
But the idea that an otherwise healthy 6 week old is 'using too much energy' by long nursing sessions is simply wrong, in my opinion. If the baby is getting milk for their effort, that will more than make up for the energy spent nursing. Plus it is normal for the baby to hang out and suckle just for comfort. I think sometimes people forget breastfeeding is just-normal. It is not fraught with all this peril.

[@llli*mrssqueegy]

Thank you again for all the replies! Sorry for having so many questions.

As far as I can tell by searching the ILCA website, there are no IBCLCs in my city (Winnipeg, MB, Canada). I have been seeing local public health nurses who have some training in lactation, but I find that a lot of the information I have received either isn't true or is outdated. As far as I can tell, I can get a good latch, with pain only in the first 10-15 seconds. How can I tell if the milk transfer is good? My pedi did rule out a tongue tie at birth.

I have a hard time telling when he is getting milk. Generally at the beginning of a session there is a lot of active sucking, gulping and swallowing. Then he slows down but seems to be actively sucking, with some swallowing. Eventually, he comfort sucks where he is barely sucking at all. I do breast compressions, although after I read the link posted I realized that I was taught wrong. I was taught to do them when he stopped sucking to get him to suck again, but the link said to compress when he is sucking but not swallowing. I have started to do them this way now.

Sometimes the second stage of sucking that I mentioned can go on for a long time. Sometimes I don't think that I hear him swallowing at all. Is he just sucking to try and get more milk but isn't getting any because my supply is low? If I was to wait until he pulled off himself, we would be there for days. If I unlatch him, sometimes he freaks out, roots around and I switch sides. Sometimes when I unlatch him, he seems content or falls asleep. I take this to mean that he is full.

How do you know if a baby is full?

[@llli*mrssqueegy]

Well, after a week of waking DS to eat every 2 hours during the day to make sure he gets at least 8-10 feeds, he has gained a whopping 3.2 oz.

I also did a weighed feed at our BF group and he got 2.1 oz.

I'm so defeated. I guess it's time to start the domperidone.

[@llli*joshuas.mommy]

Sorry that he didn't gain more just with feeding more often. It sounds like you need to figure out whether the problem is poor milk transfer, or low milk supply. You address those things differently so you really need to know which one it is. If the problem is that baby can't transfer milk effectively, then domperidone is not necessarily going to help. If the baby can transfer milk effectively but you have low supply, then domperidone is one way to address it, but not the only way. 1)Has baby been checked out by a pediatrician or lactation consultant for a tongue tie or lip tie? This can often get in the way of good milk transfer. 2)Do you ever pump? If so, do you pump instead of a feeding or after a feeding? How much milk are you able to get when you pump? This might help us figure out if you have a supply problem. Pumping is not really a great indicator of what baby is getting at the breast, but if you ARE able to pump a good amount, that indicates supply isn't the problem. If you CAN'T pump a good amount, then supply may be the problem, or it could just be that you don't respond well to the pump (not all women do).

Also, can you weigh him again before and after a feeding? It's best to do several pre-and-post feeding weights, since what a baby takes in at one particular session may or may not represent what they usually get.

[@llli*mrssqueegy]

My pedi says he doesn't have a tongue tie, but when I mentioned a posterior tongue tie, he had no idea what I was talking about so who knows if he really knows how to diagnose one.

I do pump occasionally, always after a feed, never to replace one. In the mornings I can usually pump 1-2oz, later in the day usually 0.5-1oz (total for both breasts).

I might see if I can rent a scale to do more weighed feeds.

We saw the pedi yesterday and he wants us to start supplementing. I have frozen breast milk to use and we have a SNS. I'm planning to offer 1 oz supplements 4 times a day. I'm not sure what else to do. I really don't want to leave my son at 3 oz. a week for any longer.

[@llli*mrssqueegy]

I spoke to a local LLL leader today and she is concerned about posterior tongue tie. I looked at Dr. Kotlow's website and it does seem to fit. I still get a lot of latching pain, especially when he is sleepy. His tongue doesn't raise up when he cries. She thinks my supply is good if I am able to pump what I do. She also thinks it could be contributing to his long nursing sessions.

Luckily she referred me to a local dentist who is very experienced and treats all types of tongue ties. I am very excited and hopeful that this might be our issue. I am really struggling with this and this is just the boost I needed today.

[@llli*joshuas.mommy]

I agree with your LLL leader that if you are able to pump 1-2 oz after a morning feed, your supply is just fine. It sounds like you're on the right track with the posterior tongue tie. Good luck with getting it fixed, I'm glad you got a referral to someone who can do that for you Good luck and let us know what happens!

[@llli*maddieb]

sorry i missed your 11-8 post and sorry no lc's near you ! glad you found some direction fom your local lll. i hope the tt treatment helps!