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Thread: Questionable Pedi advice and no weight gain...

  1. #1

    Exclamation Questionable Pedi advice and no weight gain...

    Some background info... DS born 7.15 at birth, 8.1 at 2 week, 11.11 at 2 month and 11.12 at 4 month. He is exclusively breastfed and I was pumping some morning to build up a small supply. I would pump one breast, get about 2-3 oz. I wasn't concerned about building a huge supply because I'm still looking for a job.

    At the 2 month appt, DS spit up and had a green diaper. Doc asked how often he spit up and I told her about twice an hour after every feeding. I wasn't terribly concerned because it never pair with crying or distress. She suggested that instead of feeding 16 minutes on each side, I tried 14 minutes on each side. Then she asked how often I fed. At the time, it was about every 2.5-3 hours per request of DS. I never really set a schedule. She said my milk wasn't coming in and I should only be feeding every 3-4 hours. I never really attempted that because DS would be crying. I did cut him off after 14 minutes each side and the spitting up stopped.

    About a month later, DS was really fussing and pulling away from my right side after about 8 minutes. I thought he was just becoming a more efficient nurser. The left side he would stay longer. The whole month of November, he was pretty fussy.

    Fast forward to his 4 month appointment and he's gained only an ounce. I would refer to forums and so much advice is "it's in your head, don't worry about it." Now I know he's not getting enough. I've started pumping after two nursing sessions during the day to boost my supply. I feed him 2 ounces of formula after morning feeding and expressed BM after two other feedings per request of an different pedi. Throughout this whole period, he produces 8-10 wet and 4-6 dirty diapers a day.

    Problem: He's growing more unhappy at the breast and I'm afraid my right side is drying up. I just don't hear the let down like I do the left side. How can I get my supply up? I drink plenty of water, eat oatmeal and drink Mother's Milk. Any suggestions?? I don't want to give up but he's so happy after the bottle!

  2. #2

    Default Re: Questionable Pedi advice and no weight gain...

    I forgot to add that DS eats about 5-6 times a day. He's been sleeping through the night since since birth... about 11:30 pm to 6:30 am, give or take a few hours.

  3. #3
    Join Date
    Feb 2007
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    1,710

    Default Re: Questionable Pedi advice and no weight gain...

    Hmm. That is a pretty big change in weight gain from 2 months to 4 months. I'd be inclined to suspect different scale/different amount of clothes, etc. But 5-6 times a day is on the low end for number of nursing sessions. Is that counting your supplementing session?

    The advice to go from 16 minutes to 14 minutes is a bit bizarre to me, the 3-4 hours between nursing sessions is bad advice (especially if you're worried about weight gain!). The bit about your milk not coming at 2 months in is just BUNK - no-one's milk takes that long to come in, and if your baby is nursing at that point, you have milk...

    Have you seen the stuff on Kellymom about low supply? It might help you assess your situation

    http://kellymom.com/bf/got-milk/supp...es/low-supply/

  4. #4
    Join Date
    May 2006
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    21,119

    Default Re: Questionable Pedi advice and no weight gain...

    The pediatrician's advice wasn't questionable. It was just plain AWFUL. Like so awful that I would never go to that pediatrician again, and would warn my friends against going to that particular practice. Here's why:
    - Spit-up that is produced without evidence of pain or poor weight gain is a laundry problem, not a health problem.
    - Green poop is simply part of the normal color spectrum of breastfed baby poop. Green poop is only a problem if it is consistently green and accompanied by allergy symptoms or poor weight gain.
    - Breastfed babies can be trusted to set their own time at the breast. Some babies will take 5 minutes to nurse, some will take an hour.
    - Breastfed babies can be trusted to take in only as much milk as they need.
    - Breastfed babies should be fed on demand, and not scheduled to some artificial interval UNLESS the baby is not demanding enough, in which case mom should offer to feed more often than the baby demands.
    - There is no reason to think that your milk was "not coming in enough" because your baby fed more than every 3-4 hours. It is entirely normal for babies to feed every 1-2 hours or even more often, regardless of the state of mom's supply.

    I think the most likely cause of your baby's low weight gain is his extremely low feeding frequency. Most exclusively breastfed babies nurse a minimum of 8 times a day, with many breastfed babies nursing more like 10-12 times per day- and night. The first thing I would do in order to try to remedy this issue is to offer the breast every 2 hours during the day and every 3-4 at night- and I know that this means giving up on sleep! The more your baby nurses, the more your supply will increase, because milk supply is created and maintained by demand. Give your body more demand, and you will have more supply.
    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!"

  5. #5
    Join Date
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    Default Re: Questionable Pedi advice and no weight gain...

    PP I too thought 5-6 times a day is quite low. My DD nurses 3 + times just in the night time Ditch the pedi, that "go 3-4 hours" advice is ancient. Your supply will increase if you increase the frequency of nursing, so like mommal said, I would go every 2 during the day and then stick a couple in at night - that will definitely help!! Good luck mama!

  6. #6

    Default Re: Questionable Pedi advice and no weight gain...

    Unfortunately, the same scale was used for both weigh-ins and he was completely naked.

    The pedi was referring to foremilk, something about DS only getting a salad instead of a meal. I didn't listen to that part (feeding every 3-4 hours) but I think cutting him off a minute or two early decreased my supply. Honestly, I don't understand how to increase the feedings. I struggle to sneak in the sixth feeding. He sleeps through the night and always has (started at four hours and progressively got longer), at four and a half months, I don't want to wake him. I feed on demand and he naps (often only 20 min) between every feeding which can prolong the feeding longer.

    I understand how five times a day isn't enough but certainly not every BF baby eats ten times a day?

    Thanks for the support and responses. I'm trying so hard but when my DH fed baby... it was glorious. Please help me stick with it!!

  7. #7
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    Default Re: Questionable Pedi advice and no weight gain...

    Well, if he's only demanding every 2.5 or 3, just offer it at every 2, regardless if he is asking or not. If he doesn't want milk, he will let you know!! But it would be a good way to try to get some more into him during the day. BTW getting a little fussy at the breast is pretty normal for this age - I think it happened to many of us mama's when our babies were that age!

    I understand that you don't want to wake him - will he dream feed? That is, can you pick him up and feed him while he remains sleeping? Some babies are very good at that, and it might help. Honestly, if the weight gain is really bothering you, then it might be worth waking him to eat just for a little while to get him back on track. But it's up to you!

  8. #8
    Join Date
    May 2006
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    Default Re: Questionable Pedi advice and no weight gain...

    Man, where did you find this pediatrician? It's a very common misconception that the so-called "foremilk" is not enough for a baby (i.e. it's a salad and not a "meal"), and that you have to reach some artificially determined length of time at the breast in order to reach the so-called "hindmilk"- but pediatricians should know better!!! Babies will grow fine on "foremilk" alone, provided they get enough of it. When it comes to infant growth, the QUANTITY of milk the baby gets is much more important than the QUALITY of milk.

    Cutting feedings even a minute or two short can reduce supply. Usually not immediately, but over the long term all that missed demand starts to add up!

    It sounds like your baby is not particularly demanding, and that can definitely be a challenge for a mom. If I had to choose between a non-demanding baby and a nonstop-demanding baby, I'd choose the nonstop-demander because that kind of baby will FIGHT to get fed. It's the too-polite-to-eat babies who are the more difficult ones, IMO, because you can't just sit back and be confident that they will get their needs met. 4-5 months is often a very distractible age, and a lot of babies who are frequent nursers will suddenly forget to nurse because they are so interested in the world around them. It may help to take your LO into a low distraction environment- like a darkened bedroom- when it's time to nurse.

    It's true that not every breastfed baby eats 10 times a day at 4 months. According to the American Academy of Pediatrics, after 6 weeks the average minimum number of feedings is 8, with increases in feeding frequency to be expected during growth spurts and when increases in milk volume are desired. There are MANY babies who eat far more often than 8 times a day, and a few who eat less. But what really matters is not what other babies do, but what your baby is doing. At this point, he's not gaining the way he should be, and that means he's probably not eating frequently enough. Again, quantity of milk is the important factor in weight gain, and since breastfed babies typically take small amounts at the breast, the more feedings you cram into the day the better.

    I totally get not wanting to wake the baby at night. It's really, really hard to be up a whole bunch to feed the baby. And I hate to beat a dead horse... But when you have a concern about weight gain, you want to cram as many feedings as possible into each 24 hours. Does the baby sleep in a crib, in his own room, or does he sleep in a crib or co-sleeper in your room, or does he share a bed with you? Either of the latter 2 arrangements make for easier night-nursing because you don't have to really get all the way up. You can nurse and still be half-asleep. One way to get a nursing session in without having to wake up in the wee hours is to nurse the baby right before you go to bed. He may be half-asleep, but many babies nurse surprisingly well in that state!

    If you can't bring yourself to wake the baby, I would make sure to get up at least 1-2x per night to pump. That should help your supply quite a bit.

    Please don't give up! I know you're trying SO hard and it's really not fair when a mom who is doing everything she can isn't getting rewarded with a plumped-up baby... But your situation sounds like the sort that can be turned around, and you're never going to look back on this time in your life and say "I wish I'd done less".

    Just a quick check- are you possibly pregnant, or are you taking any form of hormonal contraception? Either of those things can cause milk supply to tank.
    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!"

  9. #9

    Default Re: Questionable Pedi advice and no weight gain...

    Thank you for the response... makes so much sense. I was told to cut back at the end of September. October he was happy, been more fussy in November because he's hungry! He sleeps in his own crib. DEFINITELY not pregnant and I'm not on any hormones.

    For the past few days, I've been giving him an extra 8 ounces a day between formula and EBM. I'll try to nurse and pump the day away and see how it goes! Would anyone recommend fenugreek?

  10. #10
    Join Date
    Feb 2012
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    Default Re: Questionable Pedi advice and no weight gain...

    fenugreek can be helpful but nothing will produce more milk if you're not removing more milk from the breast - ie nursing and pumping - i totally agree with PPs that you can turn this around!!
    DS1 6/7/11
    DS2 10/29/13

    Nursing, pumping, cloth-diapering, babywearing, working professor mama with the awesomest SAHD ever.

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