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Thread: 6 month old with low weight gain- did I get bad advice?

  1. #1
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    Feb 2013
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    Default 6 month old with low weight gain- did I get bad advice?

    My six month old baby boy had his check up today and had what the pediatrician called "poor weight gain". I left feeling worried, alarmed, and kinda worried about my milk supply. Apparently he is now below the 5% weight range and this is alarming because he has plummeted down the growth curve rapidly, and he is also very tall so he weighs very little for his height. And, we are using the WHO charts.

    Here is a quick history of the weight/height situation:

    born: 8 lbs 6 oz, 21"
    2 months: 11 lbs 14 oz, 25"
    4 months 13 lbs 8 oz, 27"
    6 months: 14 lbs 3 oz, 28.5"

    So he only gained 11 oz in 2 months. I will admit I am constantly worried about my milk supply. I went back to work part time when he was 3 months and full time just last month, and I am a horrible pumper. I can only ever pump 1-2 oz at a time, so I have to pump 5x a day to have enough for him. He nurses a lot in the evenings and then again 3-5x overnight (we co-sleep so I can't keep track really). During the work days, I am gone exactly 8.5 hours and he drinks 2 3.5 oz bottles and then also I run home to nurse him at lunch for a mid day feeding. I admit I am super proud of myself for making to 6 months with him exclusively having breastmilk, given how hard it has been to provide for him. It does feel like he empties both breasts each time he nurses. If there was more he would surely drink it. He never is pulling off on his own.

    He seems to have plenty of wet diapers a day but he only poops every 3 days or so. It has been this way since he was 4 weeks old.

    Today the pediatrician told me he was alarmed because my baby "wasn't growing". My heart dropped. He told me my milk wasn't enough for him and to start solids immediately. I was delaying solids because my little guy just didn't seem ready yet- he's not sitting up unassisted. I also planned to do baby led weaning. The pedi told me to start avocado since its high in fat and calories, and also sweet potatoes. He told me to give as many solids as he would eat. I am supposed to return in a month for a weight check and if he's fallen further off the growth chart, I need to start supplementing with formula.

    I'm hoping someone can help me evaluate this advice. I live in a small town in a rural area and there is only one pediatrician to choose from. I am feeling guilty for not making enough milk to help my baby grow. I tried giving him some avocado today and got him to take a bite, but he looked horrified and confused, and it did not seem like he enjoyed it. I couldn't get him to take any more bites after that one. I want to go super slow with solids, and I doubt he will eat enough avocado at this rate to make a difference in a month's time.

    Any opinions or experiences anyone can share with me would be most appreciated! Thanks!

  2. #2
    Join Date
    Aug 2012
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    Default Re: 6 month old with low weight gain- did I get bad advice?

    I don't have expert advice for you, so I'm hoping someone else will answer as well. But I am a little confused... your baby's pedi said your baby isn't growing, but he gained 11 oz in 2 months? And it looks like 1.5 inches? That might not have been the rate of growth the pedi was looking for, but he is definitely growing.

    Please don't feel guilty about not making enough milk. I know that is what we mothers do best, but you are working really hard for him, and that's something to be proud of. You might need to make adjustments based on whatever expert advice you can accumulate (this is not my area) but there is no place for guilt here, OK?!

    Just some ideas: When you say he's never pulling off on his own, do you meant that he would keep breastfeeding if you let him? Or do you feel like your breasts are empty so you pull him off? I would let him always pull off on his own. Even if he stops swallowing for a few minutes, the more nursing you can do, even if you think he isn't getting any more milk, is good! Let him suck as long as he will, and then encourage him to keep going!!

    As for your pumping, way to go with pumping so much to provide breast milk for your baby. It takes dedication and you are really doing a great job. I wonder if you could pump a larger volume with some adjustments to your setup. For example, what model of pump are you using? Is it a brand new pump? Have you ever seen a lactation consultant to make sure the flanges are fitting properly?

    About the solids--there are many schools of thought here and I don't question your judgement about delaying or doing BLS, etc. Your intuition about going slowly and not pushing him seems sound to me. I did just want to add though that I think it's normal and totally to be expected for a baby to look confused and tentative about taking their first bites of solids. It's a completely new world, after all! You can keep offering him little bits of foods here and there and keep gauging his interest and when he's ready, he will dig in.

    Finally, as someone who has had issues with my milk supply in the past, I want to tell you that when my baby did finally start eating significant amounts of solids, at around 9 months, I felt a huge weight lifted off my shoulders. She's not quite 12 months yet, so I know she still needs my milk, but for me it has been a wonderful feeling (though at times bittersweet) to know that she doesn't rely on me 100% for her nutritional needs and it's given me a somewhat different and more positive view of our breastfeeding relationship (not that it was ever negative, it was just more challenging). So I don't want to encourage you to start offering solids before you feel your baby is ready, but I also think that you might be only a few months away from seeing the light at the end of this tunnel where breastfeeding becomes more relaxed. At least that has been my experience! You're almost there!

  3. #3
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    Default Re: 6 month old with low weight gain- did I get bad advice?

    First, hugs to you. I know how devastating it can feel to have the pediatrician say your child isn't growing (fast enough). But he's so tall! Is his head circumference on track? i saw a post through this forum about how, if baby is developing well otherwise and growing in length and head is growing (indicates brain growth), it is ok. My LO is 75% for height and about 10% for weight at 5 months so I understand what it's like to have a lean baby. He dropped to 10% weight percentile at our 4 month checkup and I was told I could start solids and supplement. I did neither. He is happy and hitting his milestones for now so that is what I am going on. Is your baby happy? Satisfied after feedings? Poor kid, I feel for you both about the avocado experiment. Don't force him - you are right to trust yourself there.
    I got some good advice and support from this forum when I posted about this similar thing last m

  4. #4
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    Default Re: 6 month old with low weight gain- did I get bad advice?

    Sorry...dang iPhone! Last month so I hope others will reply. I wish you could get a second opinion from another doctor.
    Hugs again, and I stand with you!! Sending support.

  5. #5
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    Default Re: 6 month old with low weight gain- did I get bad advice?

    I can't really evaluate this specific advice. That would be too close to giving medical advice. I guess I can talk generally about it.

    So, I would suggest getting a second medical opinion if you are unhappy with the advice you have been given. I get it there is one pediatrician in town, but what would you do if your baby needed to see a specialst, for example? sometimes ya gatta do what ya gotta do.

    Generally speaking, 6 months is old enough for the introduction of solids. The main problem with 'pushing solids' from a breastfeeding standpoint, is it may reduce how much breastmilk baby takes in, which would defeat the purpose if the goal is increasing calories into baby. of course, I agree that starting solids very gradually is usually best for many reasons and, if your baby is not interested, he is not interested. But your doctor did not know what your baby's reaction would be when he suggested the solids. Kellymom has a list of typical baby appropriate foods and their calorie count fyi.

    Has your baby really 'stopped growing' in any sense? Yes the weight gain is slow. But baby is gaining, right? what about height? What about head circ?

    You could also think about this-if you had to choose one, would you choose to supplement with formula-perhaps while you are at work and baby is getting bottles anyway- or 'push' solids?

    he's not sitting up unassisted.
    if you sit him on his bottom can he stay up? That is sitting unassisted, at least how I understand it, feel free to correct me-step by step baby development is not my strong suit. But in my experience, baby putting themselves from a lying postion into a sitting position comes later. My 8 month old does not even do that yet, but we started solids a month ago, and we are doing baby-led.

    Your baby's output and nursing frequency sound normal for this age. That pumping scedule sounds exhausting though.
    Are you using the best pump you can get? is it new? have you troubleshooted it lately, changed the membranes? have you considered trying to increase your milk production with herbs, medication?

  6. #6
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    Default Re: 6 month old with low weight gain- did I get bad advice?

    Hi everyone, thank you so much for the replies and support! I know I don't need to feel guilty, but it's just such an emotional subject, isn't it. And yes, we moms seem to do guilty well sometimes! sprocket, I am so looking forward to the stage you describe when my baby finally gets nutrients from another source besides me! Sounds dreamy to me right now. Good to hear it is normal for them to look so confused the first few times! I am going to keep trying a few bites here and there over the next few days, and try mashing up the avocado with a little BM. (oh, the precious breastmilk, how I hate to "waste" it that way, but it might help!)

    In answer to all the questions:

    -Yes, he is definitely growing, just not as fast as the pedi would like to see. He just said to me, "well he looks fine otherwise, besides the fact that he isn't growing", and of course being a nervous FTM that stuck in my head.

    -his head circumference is on track as well, I was sure to ask about that.

    -yes, he would keep breastfeeding if I let him... forever. Although mostly he's suckling and snoozing after getting a let down or two on each side, but he likes to stay latched on for as long as I will let him. So yeah, I'm usually the one ending the experience. On the evenings and weekends I will let him stay on for 45 minutes or so, and sometimes he spends most of the night latched on since we cosleep, but during the work days obviously I am on more of a schedule so our nursing sessions end after he gets a let down or two (10-20 min), from each side.

    -mostly he seems satisfied after feedings but there are definitely times he doesn't seem satisfied. In the past I've chalked this up to normal baby "fussiness" but now I am wondering if he's getting enough.

    -as far as the pumping goes, I've tried seeing a LC about it and tried "everything". I do have a new pump, the Medela PIS. I've been fitted for flanges, changed membranes/valves, etc. I pump for 20 minutes a shot. I've tried the herbs (fenugreek, mother's milk tea, more milk plus), but they don't seem to do much for me. I haven't tried the medication yet.

    -lllmeg, that is a good question about formula vs. 'pushing' the solids. I don't really know the answer to that, I am not sure which is the healthier option for my baby.

    -re: the sitting, I suppose I meant to say that he isn't sitting up unsupported yet. Meaning, if I put him in a sitting position he just topples over slowly. He has good head and neck control though.

    -I could potentially get a second opinion, there is a bigger town 1.5 hours away from here, which is where I would go if we needed a specialist. Not ideal when the pedi is currently located 2 miles from my house, but it is doable.

    On a side note, my mom told me he pooped an enormous poop today and it was entirely green! Just from that one bite of avocado?!? Crazy. So, some of the bite did make it down there. Sorry for the TMI. I'm sure you are all so interested in my baby's poop color. :|

  7. #7
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    Default Re: 6 month old with low weight gain- did I get bad advice?

    Hi mama, your story sounds similar to mine in many ways. My son had slow weight gain for the first six months. His was partially due to an upper lip tie and a posterior tongue tie which went undiagnosed until 5.5 mo of age, but I think a large part of it was also supply. I tweaked our routine constantly, and something would work for a while and then inevitably his weight gain would slow again. At one point we added an extra feeding and he gained something like 11oz in a few weeks, and then only gained 5oz the following month. I whole heartedly understand the worry. I did choose to start him on solids at 5.5 months to assist with his weight gain as was recommended by an IBCLC. From what Ive been told, there is no reason for a breastfed baby 6mo or older to need formula since they can make up calories by eating solids. As you know, its not to replace breastmilk, but merely compliment it. That was the advice given to me. Perhaps you want to contact someone who can give you info specific to your situation. I was told that mashed avocados and sweet potatoes are perfect foods to compliment breastmilk with for weight gain, as your doc said. I was even told that many women boost the calories in the sweet potatoes by adding a little bit of coconut oil. My sons weight gain has improved substantially, and as a previous poster said, it does take some weight off of your shoulders. For the record, both of my kids took about a month to get used to solids. As someone else said, when they get it, they get it, and there's no going back .

    As far as the pumping goes, I'm wondering if you're pumping long enough. How long and often are you pumping? Are you able to pump more often or for a longer period of time? I started off pumping 20 min every 2 hours and 20 minutes, but now pump 30-35 min ever 2hours. I can usually get another 1.5oz or so with the added 10-15 minutes on my pump time.

    I wish I could help you understand why your son isn't gaining. I know that was, and still is, a very sore subject for me. I dont know how you feel, but it makes me feel inadequate. And stressed... Always thinking about if he's nursing often enough, from both sides, is he emptying me... Blah blah blah. Its very scary to think that your baby might not be growing enough. The only thing I can think of that gives me comfort, regardless of its accuracy, is that my son, who was HUGE at birth (a healthy 10lb 11oz), requires a quantity of milk on the higher side of average (36oz), and I make a mid-average quantity (27-28oz). So, it isn't that I'm abnormal, but perhaps being in the big side makes him want high-average or slightly more than average quantities. Anyway, I therefore added solids to help.

    Have posterior tongue tie and/or upper lip tie been ruled out? One symptom of them (they typically present together) is constant nursing because babies that have them are inefficient at emptying the breast. They also tend to fall asleep at the breast. You saying he never comes off by himself makes me think that.

    Good luck, mama. Keep us posted.
    Last edited by @llli*alilwest; April 11th, 2013 at 12:22 PM.

  8. #8
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    Default Re: 6 month old with low weight gain- did I get bad advice?

    If you can manage it, I HIGHLY recommend you try out a hospital-grade pump such as the Medela Symphony. This is one of the best investments I ever made in my milk supply--a huge pain to lug around and not cheap (I think I paid about $60/month) but looking back, it was SO SO worth it for the peace of mind it gave me because it really helped my supply. If it does help you get more milk when you're pumping, the benefits are really 2-fold: 1. you get more milk to feed your baby from bottles while you're away and 2. you increase your supply so you get more milk to feed your baby while you're nursing. I rented one for 2 months when my baby was about 5-6 months old and noticed a significant difference and returned it thinking I could always rent it again if I needed another boost, and I haven't needed it more than that. So it wasn't even a long-term expense. I would use it to pump during the day and then also pump for a while (maybe 45 minutes) while watching TV after my baby went to bed many nights. It helped a lot.

  9. #9
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    Default Re: 6 month old with low weight gain- did I get bad advice?

    Quote Originally Posted by @llli*rainykatie View Post
    -lllmeg, that is a good question about formula vs. 'pushing' the solids. I don't really know the answer to that, I am not sure which is the healthier option for my baby.
    IMO, if you must supplement our baby's diet, formula is the healthier choice until around a year of age. It's not breastmilk, but it's closer to breastmilk than any solid you can offer.
    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!"

  10. #10
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    Default Re: 6 month old with low weight gain- did I get bad advice?

    I have a suggestion. How about letting your baby nurse for as long as baby wants whenever you are together for a week, or two, and see if that helps baby gain any faster? Long nursing sessions are just how some babies roll. I just nursed my 8 month old and she must have been on there well over an hour, nursing in her sleep, sometimes nursing vigorously and sometimes not, and I felt multiple letdowns over that time. Also if nursing sessions always take a long time, have you tried breast compressions?
    When you took the herbs, did you take a dose recommended on the container? That is not enough for many moms esp. with fenugreek is my understanding.

    Of course, the very best choice if baby cannot get enough milk from mom is donated breastmilk, but that is certainly not possible or practical for everyone. Many moms want to stay away from formula due to it being processed and the multiple allergens in the ingredients. I totally get that. But formula IS formulated (sorry) to get babies growing and to have a similar calorie and fat content as breastmilk. So if the issue is baby is not getting enough breastmilk, then I agree with mommal that formula is kind of a closer fit in some ways. Also, purely from a calories into baby standpoint, I think it can be argued that formula will do that with less total consumption and less stress than ‘solid foods.’ Another benefit is that you could then not feel pressured about the solids and go back to having fun introducing your baby to those in the gradual way you think best, which I think it can be argued, will help give your baby healthier eating habits for life.

    You have done amazing to exclusively nurse (or provide your milk) for your child for this long. It has given him a wonderful start in life, and it sounds like your doctor, while concerned about the weight gain, is otherwise seeing a happy healthy baby. Even if you do ultimately think it is best to supplement, that does not in any way erase what you have done or prevent your baby from continuing to get the benefits of your milk and of nursing at the breast. For many moms it is really very hard to maintain good production after returning to work.

    OH, if you do decide to get a second opinion, I suggest you first contact the LLL or any other breastfeeding support group in that area, or an IBCLC, or something, to get some names of breastfeeding friendly and knowledgeable doctors. Not that your doctor is not these things, actually his advice was not anti-breastfeeding at all.

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