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Thread: Please help with 4.5 month old not gaining

  1. #1

    Question Please help with 4.5 month old not gaining

    Hello! I'm looking for some help and advice to help my son start gaining weight again. He dropped to the 0.6% at his 4 month appointment, and I still can't get him to gain. Doctor suggested giving him an extra oz or so after each feeding, which we have been doing for the last week and it just seems to make him spit up more (spitting up the extra oz from bottle in addition to breastmilk). He hasn't gained and has maybe lost a few ounces in the last week (morning weight fluctuated between 11# 3.5oz and 10# 15.5oz the last 7 days).

    The info:
    DOB 12/31/13 (due date 1/5/14)
    Birth weight - 6# 14.8oz, 20"
    3-Days - 6# 5.5oz
    2-months - 9# 9oz, 22"
    4-months - 11# 2.5oz, 23"

    Those are weights from the doctor, but we have a decent scale at home and I noticed he didn't gain any weight at all the whole month of April (I weigh occasionally and write it down in his daily tracker but he had given me no cause to worry about his weight so I had not been looking back at his weights and only weighed him twice in April so there could have been fluctuations, but his weight was the exact same March 27 and April 27).

    He also has bad eczema and I cut out dairy May 1 and have noticed a huge improvement in his skin (and cradle cap). I've been trying to be very careful about still eating well for BFing, lots of broccoli and spinach and just started adding lots of oatmeal and Mothers Milk tea in hopes it will increase my supply. Anyways that wouldn't have affected his lack of April weight gain anyways, but hope it doesn't hurt my supply. I don't eat many carbs so I thought increasing oatmeal would be beneficial.

    When I pump I only get 2-3oz, unless it's late at night or in the middle of the night and then I get 5 or so. I've been trying to pump to increase my supply, pumping after every feeding for 15-20 minutes in addition to my before bed pump. I typically get 1-1.5oz when pumping after a feeding (but it takes forever). I've gotten up in the night to pump maybe twice in the last few weeks and will do it if it will make a difference but I'd obviously really rather not!

    Baby just transitioned from 4 naps to 3, and is nursing 5x a day. Has been sleeping 11-12 hours at night for months. I really really do not like the idea of waking my baby during the night, but understand that that may be people's suggestion. The last 4-5 days he's started waking at 5:15 instead of his normal 6:00 which has led to me falling back asleep nursing him and him nursing for 40 minutes or so, though I can't be totally sure if he's nursing very actively the whole time I was asleep.

    Baby is happy, active, alert. Super smiley and giggly. Has started fussing at breast last few weeks, but seems satisfied with the food he is getting in a day. I think his fussing is more about being distracted, I almost always have to nurse him side lying in a dark room now, but often he will pop off and squeal after 4 minutes or so. When this happens I just keep switching back and forth.

    We have a weight check with doctor in 2 more weeks and if he hasn't gained will talk about supplementing but I really really do not want to.

    So that's just a whole bunch of not too organized info about me and my kiddo!
    Thank you in advance for any advice!!

    Kris Z.

  2. #2
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    Default Re: Please help with 4.5 month old not gaining

    Instead of trying to push more into him at each feeding, try to feed him more often.

    Is he swaddled or using a pacifier at night? That can sometimes cause them to sleep too long when they really should be waking to eat.
    Feeding a baby at night doesn't necessarily mean waking them very much. Mine dream feeds all the time. And the whole thing about not waking sleeping babies only applies if the baby is gaining well, if not then wake them to feed.

    2-3 ounces at a pumping session isn't bad really, remember that babies are better at extracting milk unless they are having a problem (mine had tongue and lip tie.) How is nursing, comfortable or does it hurt?

    If you are worried about how much he is getting you can do some before and after feeding weight checks.

  3. #3
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    Default Re: Please help with 4.5 month old not gaining

    How many total feeding sessions is baby having a day at this point? 8-12 per day is the average minimum amount for a 4 month old, but I'm guessing you are likely not hitting that target with all of that sleeping your baby is doing!

    Honestly, I know you said you don't want to wake your baby at night, but I'm sure you know that going an 11-12 hour stretch with no feedings is highly, highly unusual for a 4 month old. And since you are experiencing significant issues with weight gain, this really is the place to focus, in my opinion. Some babies really are not very demanding or proactive about getting their milk needs met on their own, and I think this is for sure one of those cases where it makes sense to help baby out by offering to nurse much more frequently. There is nothing wrong with feeding baby at night, no matter what anyone tells you. And this won't be forever!

    Pumping in the middle of the night is exhausting, and I can see why you don't want to do that--but I would DEFINITELY try to nurse in the middle of the night. Baby may potentially dream feed anyway, just like the PP mentioned. Good luck, mama!
    Apologies for the short responses! I'm usually responding one-handed on my smartphone!

  4. #4
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    Default Re: Please help with 4.5 month old not gaining

    Welcome to the forum!

    The one thing that really jumps out at me from your post is that your baby is nursing just 5X per day and is sleeping very long stretches at night. I can understand why you may not want to change these 2 things- especially the long sleep stretch, because what mom wants to be up all night nursing?- but when there is a concern about weight gain the first things to do are to nurse more often and to not allow the baby to sleep through without eating.

    Most exclusively breastfed babies need to eat at least 8 times a day in order to remain well-nourished, and many, maybe even most, nurse far more often than that. So if this were my baby, I would make it my goal to cram at least 8 and preferably 10 nursing sessions into my day. I would want to make sure that some of those feedings took place at night, and if the baby is sleeping swaddled or with a pacifier, I would take those 2 sleep-extending tools away.

    Has the doc discussed the possibility of reflux and/or allergies with you? When I see a baby who is nursing very infrequently, I have to wonder WHY that baby isn't nursing more, and the two possibilities that immediately spring to mind are reflux (hurting babies often don't want to eat) and allergies. You've cut out dairy and that's terrific, especially if there's a reflux angle here, as a dairy allergy can make reflux worse.

    Are you giving your baby a daily mulitvitamin? Sometimes low iron or other micronutrient deficiencies can cause issues with slow gain. But in this case you probably don't need to look any farther than the extremely low feeding frequency to explain why the baby isn't growing faster. Not yet, anyway!
    Coolest thing my big girl said recently: "How can you tell the world is moving when you are standing on it?"
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  5. #5

    Default Re: Please help with 4.5 month old not gaining

    Thanks for your response! Recently stopped swaddling and he doesn't have a paci at night (occasionally one to get to sleep but then we take it away). Would I add a dream feed in at 10pm before I go to bed? It doesn't disturb them to wake them I read that they get their deepest sleep the first half of the night.

    Nursing is comfortable, though all the pumping has been making me sore.

    Did a before/after weight check this morning, he took 5.0oz in his morning feed.

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    Default Re: Please help with 4.5 month old not gaining

    How are his diapers? Does he poop normally? And did the eczema improve when you eliminated dairy? Can you describe the eczema- are there open wet areas or is it dry and flaky?
    “We are not put on earth for ourselves, but are placed here for each other. If you are there always for others, then in time of need, someone will be there for you.”
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  7. #7

    Default Re: Please help with 4.5 month old not gaining

    Definitely not hitting 8-12... We did when he was a newborn though. We do the "eat wake sleep" cycle so I try never to feed him before sleeping, and our typical day is wake up, nurse, playtime for 1-1.5 hours, nap 1-2 (sometimes 3) hours. To get in more daytime feeds I would have to feed him before a nap and I didn't want nursing to become a sleep association...?

    Thanks!

  8. #8

    Default Re: Please help with 4.5 month old not gaining

    Quote Originally Posted by @llli*still.here View Post
    How are his diapers? Does he poop normally? And did the eczema improve when you eliminated dairy? Can you describe the eczema- are there open wet areas or is it dry and flaky?
    Eczema was dry and flaky, ALL over tummy with patches on back, legs, arms, and cheeks. We put lanolin on them and it always helped and we continue to do that, but his skin has become like baby skin again on his cheeks in the last 14 days and his tummy is getting much better. He did previously have some patches that were shinier but never got to the point of weepy.

    Oh I forgot to mention diapers! 8-9 wet diapers and 1-3 poo per day. Wet diapers aren't as sopping wet as they used to be (use cotton so easy to tell) but he's wet every time we change him. The last few weeks (since elim dairy) his poo have often been very smelly and pudding like, but still mustard colored. They're sticky and take lots of wipes (it's gross).

  9. #9

    Default Re: Please help with 4.5 month old not gaining

    Quote Originally Posted by @llli*mommal View Post
    Welcome to the forum!

    The one thing that really jumps out at me from your post is that your baby is nursing just 5X per day and is sleeping very long stretches at night. I can understand why you may not want to change these 2 things- especially the long sleep stretch, because what mom wants to be up all night nursing?- but when there is a concern about weight gain the first things to do are to nurse more often and to not allow the baby to sleep through without eating.

    Most exclusively breastfed babies need to eat at least 8 times a day in order to remain well-nourished, and many, maybe even most, nurse far more often than that. So if this were my baby, I would make it my goal to cram at least 8 and preferably 10 nursing sessions into my day. I would want to make sure that some of those feedings took place at night, and if the baby is sleeping swaddled or with a pacifier, I would take those 2 sleep-extending tools away.

    Has the doc discussed the possibility of reflux and/or allergies with you? When I see a baby who is nursing very infrequently, I have to wonder WHY that baby isn't nursing more, and the two possibilities that immediately spring to mind are reflux (hurting babies often don't want to eat) and allergies. You've cut out dairy and that's terrific, especially if there's a reflux angle here, as a dairy allergy can make reflux worse.

    Are you giving your baby a daily mulitvitamin? Sometimes low iron or other micronutrient deficiencies can cause issues with slow gain. But in this case you probably don't need to look any farther than the extremely low feeding frequency to explain why the baby isn't growing faster. Not yet, anyway!
    Thank you!
    Well when I look at our schedule (3 hour eat wake sleep) I find it hard to visualize when we fit in extra feedings. Back when he took shorter naps we did this, but our schedule has evolved as he started taking more regular naps. When he wakes up he is happy. He's ready to eat and will cry lightly, but his face lights up and he gives me huge smiles when I get him from a nap. He latches on hungrily but doesn't appear to be underfed (except of course the lack of weight gain!)

    Doc didn't think that 5x a day was unusual, and wanted us to add to the feeds we were doing rather than wake or add additional feeds. I think I will call their office as this hasn't worked the last week. I don't think he has reflux (though he spits up a bunch, always has, doc said it was normal) or allergies. He just appears so healthy and happy.

    Baby D drops are the only vit he gets.

  10. #10
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    Default Re: Please help with 4.5 month old not gaining

    It sounds like the dairy elimination helped a lot with the eczema, so I don't think your baby's slow gain is related to the allergy issue.

    I'm going to be completely honest with you. I think you need to let go of the schedule. Your baby is not gaining well because he's not eating enough. Routines are great. Schedules are not. And even routines should be flexible for a baby that young. His needs are constantly changing-going through growth spurts, hitting developmental milestones, all kinds of factors. And all of that is going to alter when and how much he needs to eat on any given day. His tummy can only hold so much at a time and (for now) his body knows how to recognize when it's full vs when it is over-full. Let him learn to listen to those cues and eat when he's hungry (and stop when he's not).

    Your baby is happy and healthy- that is great news. But he's also not gaining the way he should and that is a red flag. The clear solution is to feed him more often.
    Last edited by @llli*still.here; May 14th, 2014 at 09:17 AM.
    “We are not put on earth for ourselves, but are placed here for each other. If you are there always for others, then in time of need, someone will be there for you.”
    --Anonymous

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