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Thread: Baby not gained enough weight and doctor has got me freaked

  1. #1

    Default Baby not gained enough weight and doctor has got me freaked

    Hi everyone, I'm new, looking for some help with my six week old daughter.

    We had our six week check today and it didn't go so well...

    The Health Visitor weighed the baby. She'd only gained 2.5 ounces in a week and HV plotted this on her graph in the red book and started saying baby's growth has "plateaued" and she would prefer her to gain 4-5oz per week (the previous weigh-in last week she had only gained .5oz so that's only 3oz in 2 weeks, although it has been a different set of scales each time. HV suggested I attend a Milk Mates group locally, although I haven't been aware of any issues with the feeding and I am pretty clued up in that area I thought. HV then surprised me massively by suggesting I ought to start expressing my milk and giving it in a bottle every other feed so I can tell how much I am giving her. This is something I had been under the impression was not ideal as it could cause her to go off the breast. Anyway, I was a bit freaked to hear HV say baby might not be doing well so I just nodded along and then she said doctor would check the baby as standard and I should ask him about the weight.

    So off I go to see the doctor, head spinning thinking I had no idea there was a problem, is it even a problem etc. It all got worse from there. The doctor checked her over and said all reflexes etc good but when he looked at her red book and list of weights he said he was concerned she is underweight and not gaining properly and announced he "suspects I am not making enough milk", without asking me any questions about the actual feeding mind. This has really upset me to be honest and I've spent most of the rest of the day in tears. She was 6lb15oz at brith, went down to 6lb8oz and is now 7lb11oz at 6 weeks five days. The HV and the doctor both kept telling me about the previous baby at the clinic today who was born ten pounds and is now 15 pounds at 6 weeks and I just kept thinking but how can you compare two such different babies?

    I've been talking myself down all night and have pretty much decided it's too soon to start messing with bottles. I am concerned that bottles could be a hygiene risk even with breastmilk in them (or certainly that risk would be another thing for me to worry about even if it's not that big a thing) and I am really worried it would put her off the boob which I don't want. I'm going back next week to have her weighed again but I don't want to get over-obsessed with where she is on a graph, I keep telling myself that she is happy and alert and generally seems fine, she feeds regularly and wets lots of nappies and all this counts for much more than whether she has gained 2.5oz or 4. So I am trying my very best to stay cool and not spin out about this.

    Except now every time I feed her I am worrying I'm doing it wrong and every time she cries I'm frightened she might be trying to tell me she is starving slowly I thought low milk supply was very rare, but what if I am the one in a thousand and my baby is suffering because I am too militant about breastfeeding?

  2. #2
    Join Date
    Jun 2009
    Posts
    5,254

    Default Re: Baby not gained enough weight and doctor has got me frea

    How frustrating! I know it's scary but you are going to be ok. Let’s say it turns out supplementing is a good idea. There are many ways to do that in a breastfeeding supportive way, so please don’t think supplementing means the end of nursing. It absolutely does not. If it is done carefully, with precautions, and for the right reasons, supplementing can help breastfeeding because it helps baby get big and strong enough to extract milk more efficiently.

    Also, low milk production is one reason a baby might not be growing as expected. It is not the only reason. Some babies have difficulty extracting milk when they nurse. Some babies are not nursing often enough. Sometimes it’s a combination of factors. Rarely, there is an underlying medical issue and the slow weight gain is not really about feeding at all.

    Let’s look at a few things. First, assuming the scales are correct, a 3 ounce gain in 2 weeks does indicate a very slow weight gain. Does it mean you are starving your baby? It does not sound like it. But a newborn needs enough milk not only to maintain but to grow normally. Of course, there is a very wide range of healthy and normal. But it's important to know what is typical, and a typical breastfed baby gains about on ounce a day, some a little less, some a lot more, starting around a week old (before that baby typically loses or maintains or gains slowly)

    So here is what I am wondering-

    When was the 6lb 8 oz check done and was there any weight check done in between the and the 7lb 11 ounce checks? Have any two weights ever been done on the same scale?

    How much does baby POOP. Not pee. Poop. Poops are a much better indicator of appropriate input. So, how often, how 'big' (estimate-size of a penny? Size of a 50 cent piece?) and color/consistency.

    How many times in 24 hours does baby nurse. How many times total in 24 hours.

    How are nursing sessions? (Any pain, typical length, does baby take one or both sides typically, etc.)

  3. #3

    Default Re: Baby not gained enough weight and doctor has got me frea

    She did go Thursday to Tuesday without doing a poo, now seems to be doing one smallish one a day. Feeding sessions had been going well, I thought, but I going to be more midful and make sure she's not sucking without drinking. Have spoken to heal visitor today who made noises about a drug to increase my supply, we have settled on waiting until next Weds when she will weigh her again and then we will decide.

  4. #4
    Join Date
    May 2006
    Posts
    20,788

    Default Re: Baby not gained enough weight and doctor has got me frea

    I'd really like to see baby weighed on the same scale for a while. It sounds like the doc didn't weigh baby himself, but just looked at the HV's book, correct? Poor data collection can make trouble where none exists. You might want to consider renting your own professional quality baby scale, and do some home measurements. I'd especially love for you to do some weigh-feed-weigh measurements on the baby. One or two measurements typically tell you very little, because any given feeding may be better or worse than average. But several days' worth of data will give you a good picture of the baby's average intake.

    LLLMeg asked some really good questions about pain and nursing frequency. Those two aspects of your nursing experience can really impact the baby's weight gain.
    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

    Default Re: Baby not gained enough weight and doctor has got me frea

    No pain at all and she feeds about every two hours and three to four times at night. She does make a clicking sound when nursing though and always has, when she was gaining adequately I wasn't too worried about this and thought it was just her thing, now I am trying to work on the latch but even when she is clearly sucking and swallowing well the clicking is still there. I do have very small breasts for feeding (less than an A cup even now) so struggle with compression which is one suggestion I have had from a breastfeeding expert. We usually do cradle hold, sometimes rugby hold and occasionally I sit her astride my leg facing me to feed but the clicking continues whatever I do, even I if I relatch 20 times. She may do a couple of sucks without clicking but it always starts up. My other breast will usually leak and when I try expressing it's forceful

  6. #6
    Join Date
    May 2006
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    20,788

    Default Re: Baby not gained enough weight and doctor has got me frea

    Clicking is usually a sign that baby is breaking suction for some reason. Sometimes it's baby's way of coping with a forceful letdown. When you express, how much milk can you get? Oversupply often makes letdowns more extreme.

    Another reason some babies click is a tongue-tie, which can impact weight gain. Has baby been carefully checked for that?
    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!"

  7. #7

    Default Re: Baby not gained enough weight and doctor has got me frea

    i have tried expressing once and only managed 1.5 oz in about an hour and a half. She hasn't really been checked for tongue tie and that's something 'i will query at next appt if the gain hasn't improved. I feel as if they're very quick to go straight to suggesting formula and I am keen to be my own advocate to avoid such action unless all other avenues have been explored, but sadly I don't really feel the doctor I'm seeing is massively supportive so I may be looking at changing if needs be. Obviously I don't want my daughter to be suffering at all and that's what really upset me was the thought that she could be hungry and unhappy, but having had some time to think things through and do some research I now feel that since she is developmentally doing well and generally happy in herself, it's unlikely I need to rush to take drastic action. I have spoken with my midwife who is more supportive and she says we may look at increasing my supply with a drug if needs be but my first course of action is just to work on the feeding. When the weight gain was good I was disregarding the possible latch problem but now I am working more at it and I find the clicking noise is less if I hold baby more firmly to my breast. I am also going to consider hiring a set of scales if things aren't better next Weds when we go back to the doctor. This same doctor who told me offhandedly he thought my supply was probably not good has also prescribed me Cerazette as a contraceptive which I now think is a bad idea after doing some researcjh which suggests it could negatively impact supply - I'm going to hold off taking it though.

  8. #8
    Join Date
    May 2006
    Posts
    20,788

    Default Re: Baby not gained enough weight and doctor has got me frea

    If your supply needs to be increased, and the baby is having trouble doing the job, there is something you can do aside from using drugs, and that is pumping. Frequent pumping with a high-quality pump (hospital-grade rental is preferable) and correctly sized shields can do wonders for supply.

    I think you are absolutely right to hold off on using the Cerazette. It's a progestin-only pill and that is much less likely to negatively impact your supply than a combination estrogen-progestin contraceptive, there seems to be good anecdotal evidence that even progestin-only contraceptives can decrease supply for some women. If you're already worried about supply, it makes sense to not take a chance!
    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: Baby not gained enough weight and doctor has got me frea

    I feel like I am getting better/longer feeds now using breast compression to keep her sucking longer, fingers crossed for her next weigh-in! The compression is very difficult to master with small breasts as it is easy to interfere with the latch though.

  10. #10

    Default Re: Baby not gained enough weight and doctor has got me frea

    Argh, doctor still not happy after another weigh in! He is now insisting that I need to express milk and give it to her either in a bottle or a cup. To be honest I am really unsure about either of these, especially the bottle. He says I must be doing something wrong as she is not heavy enough, but to me it looks as though she is back on that stupid line-on-chart they are so obsessed with. Over 6 days she went from 3.48kg to 3.58, which is a 3.5oz gain, and the doctor agrees with me she seems healthy and happy, but wants me back next week and says I need to at least express more milk and give it to her if I won't give her formula. I am feeding her at the breast at least every two hours for at least twenty minutes, and when expressing it takes me a looong time to get even an ounce and a half, so it seems not even particularly feasible for me to be able to express between breastfeeds and give her the expressed milk in a cup, I really don't know what to do for the best. I am so reluctant to give in and give her powdered milk just to keep a doctor happy, but I am scared he will think I am ignoring him

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