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Thread: 4.5 months old not gaining weight

  1. #1

    Default 4.5 months old not gaining weight

    First of all, thanks to everyone contributing to this website. Where I live, it's almost impossible to find a decent lactation consultant and LLL has been a life saver.

    Now to my problem. My daughter was born weighing 3.5 kg on the 50th centile. She's exclusively breastfed and was gaining well for 2.5 months, always on the 50th centile.

    At the age of 2.5 months she suffered from diarrhea and since then has been having problems gaining weight.

    At 3 months she weighed only 5.4 kg. After 1 month she gained only 100 grams and she's on the 9th centile now. She's latching well and swallowing. She poops 2-3 times a day and wets her diaper 6-7 times.

    When she's awake, she laughs and plays, but gets frequently fussy and only naps very occasionaly for 30 minutes or so. At night, she wakes up every 2-3 hours to feed (before, she used to sleep for 4-5 hours straight)

    Her pediatrician was very concerned at her 4 month check up (5.5 kg) and strongly suggested I supplement with formula. We agreed to give it 2 more weeks of exclusive breasfeeding if I pump frequently during the day and bottle feed her the hind milk at night. I've been pumping 3-4 times a day and getting 1-2 oz each pumping session so it's not like I have a supply problem.

    it's only been a week since her 4 month check up but she hasn't gained any weight. I feel guilty insisting on breasfeeding her exclusively because I don't know if it's harming her as she's not gaining weight. Her length is still between the 25th and 50th percentile so I'm hoping she's just naturally thin. But my pediatrician insists she needs supplementation or her development will suffer and I'm at a loss. Her appointment is in a week and if she doesn't gain any weight by then then I think I'll have to start supplementing with formula.

    Anyone had a similar experience? Did you end up supplementing? Any help would be appreciated
    Last edited by @llli*lulua89; February 7th, 2016 at 07:46 AM.

  2. #2
    Join Date
    Jun 2009

    Default Re: 4.5 months old not gaining weight

    Did baby lose weight ever, or only dropped percentiles while baby was still gaining? Have all weight checks been on the same infant digital scale? Done carefully, with same type of units, baby in a dry diaper or naked, etc.

    Which growth charts are being used?

    A 4 month old being frequently fussy, nursing more at night than they did before, and sleeping in short stretches is all entirely normal. In other words, less sleep does not equal not enough food into baby. A baby pooping 2-3 times a day would indicate baby is getting enough to eat. Exactly how many times in 24 hours does baby typically nurse? Has this increased or decreased since you started bottles?

    A couple things to know is that 1) Weight gain is not the only indication of normal growth. Length growth is normal I take it. How are the other measurements- head circ, developmental milestones?
    Scales matter. Scale error is real and causes these problems.
    Babies do not gain steadily. They gain in fits and starts. In other words no gain for a week at 4 months is entirely normal.
    Weight gain rate normally slows starting at 3-4 months.
    Average normal gain varies.
    Unless there is a medical issue impacting gain, the only reason a baby would not gain normally would be baby not getting enough milk overall. Formula in proper amount does not make a baby gain faster.

    I am of two minds with the idea a baby might benefit from more "hind milk." On the one hand, if giving baby double crème milk or whatever you are attempting there helps you avoid bottles of formula, so it is an either/or situation, fine. No harm done. On the other hand, I know of no research that this is needed to help a baby this age gain. If a mom has normal milk production and a baby nurses with normal frequency and effectiveness there would never be any reason to supplement with your milk, whether it is a special hind milk bottle or just normal from the tap, or formula. Since pumping and bottles can interfere with normal breastfeeding patterns (plus is exhausting for mom) I think this is not an entirely benign intervention and should only be done if baby really needs more milk overall and cannot get it by nursing more. And in that case where baby really needed more milk, I think you could just pump and give your baby what you pump and not worry about whether or not it is hindmilk.

    I am not sure you would "have" to start supplementing with formula. I do not know the legalities of the situation are, and I suppose if the doctor wanted to make trouble for you he or she could, by calling child services. But formula is a medical intervention, and a drop down in percentiles seems like very little cause for such an intervention in an otherwise healthy baby.

    I am curious what the doctor said exactly about formula. Exact words. Did he/she specify how much? How long? Why? etc.

    Stop feeling guilty about "insisting" on breastfeeding exclusively. Unfortunately a medical profession that refuses to recognize the importance of breastfeeding and the potential harm of unneeded supplements is to blame here, because we know formula is regularly "strongly suggested" when it is entirely unnecessary. And we know that if formula is given unnecessarily, it is likely to harm the breastfeeding relationship. So of course mothers have lost trust in doctors.

    Here are some thoughts: If giving your baby pumped milk in bottles over and above normal nursing frequency has not resulted in better gain, why would formula given the same way do so?
    Has doctor suggested any tests? Baby gained perfectly fine on your milk for months, and then your baby was quite ill with diarrhea it sounds like and gain has not "recovered" so to speak. So, Maybe baby is low on some nutrient as a result of the illness that is causing continued slow gain?
    Can you seek a different medical opinion?

    I also strongly suggest the book My Child Won't Eat. Read the section on charting and the section called 'crises at 3 months' BEFORE you see the doctor again. http://www.amazon.com/My-Child-Wont-.../dp/1780660057
    Last edited by @llli*maddieb; February 7th, 2016 at 10:08 AM.

  3. #3
    Join Date
    May 2006

    Default Re: 4.5 months old not gaining weight

    Can you post a weight history for the baby? It might help us see whether what is happening was a period of slow gain followed by normal gain, as one would expect when a baby is sick and then gets well, or has this baby really been gaining slowly on a consistent basis. KWIM?

    Can you see a different pediatrician? If you feel like your child's doctor has already decided that her weight gain is abnormal and supplements are required, it can really help to have someone with fresh eyes take a look at the baby.

    Did you ever figure out what was making the baby sick?

  4. #4

    Default Re: 4.5 months old not gaining weight

    Thank you for your replies.

    Birth weight 3.5 kg
    1 month 4 kg
    2 months 4.8 kg
    3 months 5.4 kg
    4 months 5.5 kg

    She never lost weight. All the checks were on the same scale with a dry diaper and my doctor uses the WHO charts.

    Normally she feeds about 10 times per day. For the last few days she's been nursing 15-20 times per day so I'm hoping she's having a growth spurt (fingers crossed)

    Length and head circumference are increasingly steadily and she's hitting all the developmental milestones. It's worth mentioning that I'm petite (155 cm, hubby 162 cm)

    The doctor said to supplement with formula until the age of 5 months, then I should start her on solids. He believes (despite my protestations) that I'm not producing enough milk. I saw another pediatrician and he suggested the same thing. I think I'll try to find another pediatrician who is more supportive regarding breasfeeding.

    We have another appointment tomorrow to monitor her weight and I'm hopeful she's gained some weight after nursing like crazy for the last few days. Thank you for your reassurance. I know my baby is doing well as she's happy and active. She just happens to be petite like mommy. I just really regret spending so much time and effort worrying about what a scale says instead of trusting my instincts.

  5. #5
    Join Date
    Jul 2010
    New York

    Default Re: 4.5 months old not gaining weight

    At the age of 2.5 months she suffered from diarrhea and since then has been having problems gaining weight.

    Perhaps the diarrhea is a symptom of an underlying problem completely unrelated to breastfeeding. It is not common for an exclusively breastfed baby to get diarrhea. So I am wondering if your pediatricians had an alternative explanation. I can understand if you do offer your baby supplemental feeds and she still does not gain suffiicent weight. Then you will know you are dealing with an metabolic issue not a lack of breastmilk issue.
    Started my family in 1986
    Finally done in 2001

  6. #6
    Join Date
    Jun 2009

    Default Re: 4.5 months old not gaining weight

    Sorry I cannot think in metric. I will leave it to someone else to figure out what those weights might mean.
    It is typical for rate of gain to slow after 3 or 4 months.
    Simply dropping down percentiles is not necessarily any cause for alarm.
    What evidence aside from slow gain is the doctor using to diagnose low milk production specifically?
    Pediatricians (or any other kind of doctor) receive no training in assessing and solving lactation issues of any kind, unless they seek such education for themselves. A different medical opinion might help, but you may get more of the same.
    If the doctor is not being clear about how much formula to give baby each day, and what they expect from the formula, and is not going to be closely monitoring gain after putting baby on formula, and is suggesting solids at 5 months as a matter of course rather than looking at this specific baby and figuring out if that might be appropriate, that is red flag in my opinion.
    I would suggest seeing a board certified lactation consultant (IBCLC) and discuss with her how to best ascertain if there is any breastfeeding-related issue and what it might be.
    Professionally, an IBCLC will not be able to override a physician's directive to supplement with formula. But you could use her findings to discuss options with your baby's pediatrician.
    I agree with esthervegan that that the possibility exists that some underlying illness is going on that is being overlooked in the rush to blame your milk production. Unfortunately, this does happen sometimes.
    It may be possible your baby has some nutritional deficit. Sometimes formula helps in that case because vitamins and minerals have been added to formula. But that does not mean formula is the only way to get those into baby. Another option is that Baby could be given vitamin supplements that target that deficit.
    I again suggest reading the book My Child Won't Eat.
    If your baby does need formula supplements, it is important to protect your milk production by pumping or hand expressing as often as baby is given supplements, or, if that is not possible, as often as you can. Of course anything you pump can be given to baby.

  7. #7
    Join Date
    May 2006

    Default Re: 4.5 months old not gaining weight

    Non-metric mamas, I did the conversions and this baby has been gaining about 1 lb per month, up until the 3-4 month window during which baby gained about 3 oz.

    OP, from 0-4 months most babies gain an average of 5-7 oz per week, or about 0.14-0.2 kg per week, or about 0.56-0.8 kg per month. So it seems to me that something happened in the last month that took your baby from normal gain to very low. Given that her nursing frequency and diaper output are normal, I would be looking into 2 possibilities. The first is measurement error. The second is that the baby isn't well- is she perhaps still suffering from some sort of illness that is causing her to have trouble gaining weight? The fact that your doctor doesn't seem to want to investigate the latter possibility makes me think it would be a very good idea to get a second opinion.

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