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Thread: 4 month old not gaining weight

  1. #1
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    Default 4 month old not gaining weight

    Hi everyone - this is my first posting here. I'm exclusively breastfeeding my 3rd child who just turned 4 months. At checkup last week he was 75% for height (same as previous) but 10% for weight (previously 25%). Ped said I need to supplement, with pumped milk or formula, and that she sees this a lot in this age range. One thing to note - about 6 weeks ago I stopped consuming dairy due to a milk protein intolerance. I probably haven't been doing a great job replacing the protein and fat I was getting from dairy (I ate a lot of it, which is easy with toddlers who like it too).
    Now I am freaked out. He hasn't been getting bottles lately although he had them once in a while early on. He won't take a bottle, especially from me. I have been pumping extra milk when needed and freezing it, but I've tried to give him fresh milk in a bottle the last couple days and it doesn't work.
    Before this checkup I thought he was doing fine although had started waking up at night to feed (which I was responding to). He has always been a "banana" baby so he's not chubby.
    Birth weight 6 lbs 11 oz. lowest weight was about 6 lbs 1 oz. 4 days ago at the doctor he weighed 12 lbs 13 oz.
    What should I do? Thanks in advance. PS- I am a worrier, so this has been troubling me a lot! I don't want to starve him!

  2. #2
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    Default Re: 4 month old not gaining weight

    Welcome to the forum!

    If your baby is being fed on demand or at least 8-10 times in a 24 hour period, and is producing sufficient wet/poopy diapers, I don't think I see a problem. Yes, he's a lean baby but he has always been on the small side, and there's nothing wrong with being on the lower end of the weight-for-age charts. The charts aren't a test, where all the babies below the 50th percentile fail- there are healthy babies in all shapes and sizes, and statistically speaking there are just as many babies in the 10th percentile as there are in the 90th.

    Your consumption/non-consumption of dairy won't make a difference to the quality/quantity of your milk. Women's bodies evolved to produce plenty of good milk even during food shortages. That's why most women gain weight during pregnancy- so they have energy reserves to fall back on just in case there's a famine. Your diet isn't going to do anything to your milk supply unless you are LITERALLY at the point where you are starving.

    It's very normal for breastfed babies to drop percentiles as they get into the middle of their first year. Highly active babies often "lean out" somewhat earlier than their more sedentary peers. My kids both dropped percentiles between 2 and 4 months, going from around the 95-100th percentiles to around the 85-90th. Of course, no-one ever frets about the fat babies! It makes me a little... suspicious, I guess, when you say that your doc says she "sees this a lot in this age range". Does that mean that she's unaware of the normal changes in the rate of weight gain exhibited by breastfed babies, and is more comfortable with the escalating rate of weight gain seen in formula-fed babies?

    Basically, I think that if your baby is happy, healthy, and continuing to gain weight at his own pace, there's no need to worry. You might want to find a different pediatrician, though.
    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!"

  3. #3
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    Default Re: 4 month old not gaining weight

    Thanks!! That makes me feel lots better. What my pediatrician said was basically "we see this a lot with 2nd or 3rd children, the moms are stressed and about this point (4 months) the milk quality or quantity starts to be a problem." My other issue here, one that I need to solve regardless, is that baby isn't willing to take a bottle. I need to get that worked out somehow for the longer term.
    This baby is active, alert and happy, and maybe his increased activity has impacted his weight gain in the last month.
    Do you feel there is a link between napping well and eating well at this stage? He just transitioned out of the swaddle and it has made naps difficult. I'm trying to get him onto somewhat of a (non-rigid) schedule so he can take better naps. He seems to eat more when he's getting better sleep. Do you agree?
    I do like our pediatrician and she's been really good with my other kids. She's fairly pro-formula though and I knew that from before...and maybe she was just having a bad day. We'll see.

  4. #4
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    Default Re: 4 month old not gaining weight

    Quote Originally Posted by @llli*123babies View Post
    "we see this a lot with 2nd or 3rd children, the moms are stressed and about this point (4 months) the milk quality or quantity starts to be a problem."
    Oh gosh, this statement is so full of BS that I don't know where to start shoveling!

    First, does your pediatrician see this "a lot"? I think she sees what she EXPECTS to see. She expects that 2nd, 3rd, etc., children will have trouble gaining weight, and therefore mistakes normal slowdowns in infant growth for inadequate growth. Even though pediatricians are supposed to know that breastfeeding is the gold standard for fostering normal growth, many of them still expect breastfed babies to grow like formula-fed ones.

    Second, does stress affect milk quality/quantity? Not particularly. This is why women can breastfeed through war and famine, and why the human species has survived for millennia. If stress impacted a mother's ability to feed her baby as easily as people assume, humans would have never made it through the Middle Ages.

    Third, milk quality- how important is that for healthy growth/development and how likely is it to vary based on stress level or number of children? Not very and not very. When it comes to infant growth, what matters is not milk quality but milk quantity. A baby can thrive on nothing but relatively low-calorie "foremilk" provided he gets enough of it, because ALL milk contains ALL the components needed to support normal growth. This link goes into more depth: http://kellymom.com/nutrition/milk/change-milkfat/

    Now, the one area where your pediatrician and I would probably agree is that moms of more than one child cannot focus all their attention on the new baby, and if that division of attention leads to a mom feeding the new baby less than she should, that can cause issues for the new baby's weight gain. So, what do you do if the new baby is having trouble gaining weight? Add formula? NO! Your first step should be to try to nurse the baby more. Breastfed babies generally eat small amounts when compared to formula-fed babies, but they make up for the small size of the average feeding by feeding much more frequently than formula-fed babies. If you happen to have a particularly non-demanding baby, one who is nursing on the low end of the frequency spectrum, start offering the breast more often, take away the pacifier if you are using one (pacis can cause babies to nurse less often, since they get all their sucking needs met by silicone, instead of by mom), and stop nighttime swaddling (swaddling can lead to longer sleep stretches and less night feeding). Your baby has already outgrown the swaddle, and that's great. The mom should also review her contraception choices- if she is using hormonal contraception of any kind, including the supposedly "safe for breastfeeding" methods like the mini-pill and Mirena IUD, that could be putting a dent in her supply. And if she's unexpectedly pregnant, that will probably kill her supply and formula will have to be part of her breastfeeding journey.

    Napping and weight gain are not, AFAIK, connected. Babies are all over the spectrum when it comes to naps. There are babies who have long, extremely predictable sleep stretches, and on the other end of the spectrum are babies who get their nap needs met in brief 20-30 minute stretches that occur throughout the day. But if you feel that your LO eats more, and eats better, when he has a good nap, then that's all that matters! Now, when you say you want a "non-rigid schedule", what does that mean exactly and how are you going about getting there?

  5. #5
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    Default Re: 4 month old not gaining weight

    Thanks so much!! You ladies are helping me gain back some of the confidence I lost at the pediatrician on Friday. I've come to realize that breastfeeding is so dependent on the confidence of the mother...to keep going and to trust. I lost some trust in myself because of the doctor's input and advice. That was quite a blow!
    As far as "schedule" what I mean is doing a better job of getting him a nap routine during the day and getting him to bed in the evening. Of course, if he wakes or is hungry I will feed him, always. And the "non-rigid" part also has to do with the other kids in the house - we need to be able to work around them, too. But that hasn't stopped me from devoting time to BFing him on demand so far.
    I have started watching how long he is actively nursing, so I have an idea of how "big" a meal he is eating. When he isn't serious, he loves to nap at the breast and that leads to longer and less active eating sessions. That is why I am hoping that with more good naps, he will be able to eat more productively each time. I'm also seeing if he will eat every couple of hours (give or take) during the day, vs slightly longer. The last two nights he's woken once to eat, ate well, and then slept well. I wish I could stop worrying about his weight but it is a battle for me!!
    Oh, and by the way...
    -he doesn't take a pacifier, he prefers his own hands/fingers
    -I am not on any hormonal BC
    I do so appreciate your input and advice, it means a lot! My pediatrician probably had a bad day...i don't know. She did say I should try supplementing with my own milk. I am still a little puzzled as to how important that is. If the baby won't take more from me, why would he want a bottle? And not to mention, he hates the bottle! So do I just keep going with this 2-hour routine and not worry about bottles? Or should I just keep trying? If he isn't hungry, or just angry about the bottle, I'm just wasting pumped milk, and that's no good.

  6. #6
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    Default Re: 4 month old not gaining weight

    Your schedule sounds more like a routine, which is great. When I hear the word schedule, I worry that a mom is trying to space out feedings and nap times to some predetermined interval that she read about in a book, or heard about from a friend... And those things tend to make everyone miserable and have the potential to derail breastfeeding, which is why that word makes my ears perk up!

    Sleepy babies often respond well to something called switch nursing. When baby starts to doze off at the breast, transitioning from active suckling to sleepy, shallow, fluttery sucking, you take him off the breast, burp him or change his diaper, and switch him to the other side. If he dozes off on the second breast, you repeat the process: remove, burp/diaper, relatch. You keep repeating until baby will no longer latch or wake. Hopefully this teaches baby that when he's on the breast he had better be nursing actively, or you're going to annoy him by taking him off the breast and messing with him. Switch nursing is also really good for weight gain.

    How often does your baby nurse, in a 24 hour period? Ever feel like your baby is skipping nursing sessions because he's so satisfied sucking on his little hands?

    I'm not surprised your doc recommended bottles. The amount of education pediatricians get on breastfeeding and breastfeeding management is pretty minimal! A bottle is sometimes the only tool the pediatrician can think to reach for. Metaphorically speaking.
    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
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    Default Re: 4 month old not gaining weight

    Yes - I didn't use the right word... it needs to be a routine, not a schedule! And every day is slightly different, either because of his needs, or whatever else is going on in our house. I probably haven't given him enough quiet time for daytime naps as much as I should, and I'm trying to be better about that.
    He eats about 8-10 times a day, some are "snacks" (short sessions) and in the afternoon he likes to nap on me while nursing. The switch nursing idea is great (yay!) and I plan to try that right away. I think that will really help with his afternoon feedings.
    I also think you're right about the pediatrician and bottles. I do think he needs to be able to take a bottle, so that I can feel comfortable going out without him, and in the past he's taken small bottles of pumped milk when it was given by dad or grandma. But I don't really want to start replacing a nursing session with a bottle if I don't have to right now - I never have pumped as much milk as think he gets directly and so I don't want my supply to go down b/c of that.

  8. #8
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    Default Re: 4 month old not gaining weight

    Let us know how things progress! It sounds like you're doing really well.
    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
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    Default Re: 4 month old not gaining weight

    I definitely will! I cannot tell you how much i appreciate this input and support. it has been a game changer for me in the last week!! thanks. One last thing (for now): what is your opinion on how important it is to introduce a bottle at this age? Again it would just be for the rare times when I'm out without him and he needs to eat.

  10. #10
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    Default Re: 4 month old not gaining weight

    Introducing a bottle at this age... It's a very personal choice! Some moms really feel like they need their LOs to take a bottle so that the moms can get out for some baby-free time. Others are quite content to be 100% attached to their babies until the baby naturally transitions to being able to rely on solids and sippy cups when mom isn't around. Put me in the latter group- I've taken my babies everywhere I go. That has meant some sacrifices, I guess- like the weddings I didn't go to because they were "adults only" and I wasn't schlepping my kid to an event just to leave her with a babysitter. And also some rather weird moments, like nursing my LO at the doctor's office while getting blood drawn, etc. All worth the price of not messing with bottles, for me, anyway!
    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!"

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