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Thread: Failure to thrive - thoughts?

  1. #1
    Join Date
    Aug 2011
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    Default Failure to thrive - thoughts?

    Background: My DS is 6 months as of yesterday. He's a happy little dude - smiling, laughing, "talking" all the time, awake for 2 hrs at a time between naps, and active as can be (doesn't sit unassisted but is already up on all fours ready to crawl).

    We dabbled with some solids at the instruction of the pediatrician starting at 5 months - basically we made it through all the stage 1 baby foods, but not on a consistent basis, maybe once every 2-3 days we'd give him some solids.

    Other than the infrequent solids, he's exclusively breastfed. He generally eats every 2-3 hours, with a 4 hr stretch when he has his longer nap in the afternoon. Sometimes he wakes up between 3-4am to eat, but most nights he goes 12hrs straight (7pm-7am). I always let him nurse as long as he wants on both sides, and let him decide when he's done. Sometimes he finishes both sides and cries, but refuses to take the breast again, and then calms down within a minute and is happy for the next couple hours.

    At his appointment yesterday, we discovered he hasn't gained any weight since 3 months. Dr called it FTT. He had a sick visit where he was up 4 oz from his 3 month visit, but he's back to the same weight he was at that 3 month visit now. He HAS doubled his birth weight, but that was at his 3 month visit (he's 6oz over). He also grew 2 inches from 4-6 months and his head gained an inch as well.

    Dr instructed me to start giving him solids at least 2x a day (as much as he wants in a sitting) and try to get at least 4oz of formula in him daily to up his calorie intake. What could I be doing wrong that he needs so much extra, but seems so content?? When I've been away for a day and pumped, I got 30+oz and he only took about 28oz total.

    I guess at this point if we're adding food it's not all that big of a deal to add 4oz of formula (instead of water, since he was supposed to be starting with 4-6oz of water at this age?), but I just kind of feel like there's got to be something wrong with my milk that he just isn't growing, even though it seems like he's getting enough??

    Thoughts/advice/opinions/etc - please :-)

  2. #2
    Join Date
    Jun 2009
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    Default Re: Failure to thrive - thoughts?

    hi kemiles. Sorry you are going through this it must be scary!

    FTT is a serious diagnosis. So it is important your doctor knows you are taking his concerns seriously. But that may not mean that you have to do something you are not comfortable with. I also think that your doctor is suggesting a responsible, commonsense approach that need not harm breastfeeding. 4 ounces of formula a day is not all that much, although (if it were me) I would ask my doctor if this supplement could be my own expressed milk instead, or if I could instead increase nursing sessions by 2-4 additional sessions a 24 hour day, to see if that helped.

    "Offering" solid foods twice a day is not going to hurt anything either, as long as you try to nurse prior to meals and keep it to offering solids, not pushing. Where things get dicey from a scientific standpoint is when moms are told to LIMIT nursing sessions, or stop breastfeeding and switch to formula, or push solid foods over breastmilk.

    At this point, if you do not want to implement the diet changes your doctor has suggested, what you can do is 1) discuss your concerns about this plan with your doctor and ask if any alternative plan would be acceptable and/or 2) get a second opinion.

    Would your doctor be ok with you supplementing the amount he suggests of formula with your own pumped milk? Nursing more? Or, What if you pumped your milk , let it settle in the fridge, and skimmed the "cream" off the top as a supplement?

    As far as why your baby has not gained in three months, I of course cannot answer that, except to say that it is almost impossible that this has anything to do with the quality of your breastmilk! IF the slow/no gain is due to what baby is eating, it is due to baby not getting enough breastmilk.

    Your pump output for that one day-30 ounces, suggests your milk production is normal. Baby taking 28 ounces is normal, as breastfed babies typically take about 30 ounces per day at the breast, but of course this varies up and down.

    The red flag for me is the sleep. Babies under 6 months do not typically take sleep stretches of the length your baby does. You don’t say how long your baby has been sleeping 12 hours, but that long sleep stretch is the first place I would look for answers. Babies typically need to take in nutrition around the clock, because each feeding is relatively small. And even at 6 months a single sleep stretch of only 5 hours is considered sleeping through the night.

    Why would baby be content? Maybe baby is getting enough, and something else is going on. But also, some babies seem content even when they are not getting enough. Also there are things parents are encouraged to do that may lead to baby seeming content when baby is not. Pacifier use, especially at night, has been shown to lead to poor weight gain. Swaddling baby at night might do the same. Baby not sleeping in the same room as mom might lead to baby not waking as much or mom missing subtle feeding cues. It sounds like you are cue feeding so that is not the problem, because not allowing baby to comfort nurse, nurse to sleep, timing or scheduling feedings, all may lead to baby not getting enough breastmilk overall.


    (instead of water, since he was supposed to be starting with 4-6oz of water at this age?)
    have you been giving your baby this amount of water? Who said this is how much water a baby "should" be getting?" This is an awful lot of water for a breastfed baby. Little sips of water WITH solid ‘meals’ are all a baby might need, if that, assuming baby is getting plenty of breastmilk. It is important that baby not get filled up with anything like water or juice that is not nutritious. Breastmilk is of course hydrating AND nutritious.

  3. #3
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    Aug 2011
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    Default Re: Failure to thrive - thoughts?

    He's been sleeping 10-12hrs straight since right around 3 months, which I guess is where he leveled out with the weight gain.

    He's not been getting water other than one really hot day he got a couple sips about an hour after he ate because we were outside and not able to go inside for awhile. The literature the clinic sent me home with says 4-6oz for a 6 month old.

    He doesn't use a pacifier, but he does suck on his fingers.

    He sleeps in my closet - so kind of in the room, but he's in there because it's dark and keeps one more wall between him and his loud sisters :-)

    I would say he currently nurses at least 6x a day, sometimes more. All sessions are minimum 15 minutes, sometimes (early morning) they're as long as 30 minutes. He's swallowing (almost gulping) throughout the sessions, and his diapers are plenty wet.

    I'm not super concerned about offering more solids - I wasn't sure about the amounts they're suggesting but if he's hungry and wants it I'm ok with it. I always nurse him when he wakes up, and then when he does get solids it's about an hour after a feeding, maybe 1.5 hrs.

    Dr was concerned, but not really, if that makes sense? She said because he's gained in height and his head is getting bigger, that he must be getting at least "adequate" intake, or he wouldn't grow height-wise. She just did not like that the weight gain hasn't increase, and is now completely off the charts (the computer said 0.00%).

  4. #4
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    May 2006
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    Default Re: Failure to thrive - thoughts?

    Can you give us a full weight history for the baby?
    Also, any chance that baby has been weighed improperly- using different scales at different visits, weighing baby in the nude versus weighing baby clothed?

    The literature from the clinic about water is incorrect. Breastfed babies typically need either no or little water until closer to a year; as long as they are nursed on demand breastmilk alone meets their fluid requirements.

    Nursing just 6x per day is on the low side for a 6 month old baby. Most babies require at least 8 nursing sessions in order to get their calorie needs met. I think the simplest, perhaps easiest way to get more calories into your baby is to nurse more, and nighttime would be the perfect time to cram in some more sessions. How about starting by adding a dream-feed right before you go to bed?

    Would you consider putting baby in bed with you, or in a co-sleeper crib right next to your bed? Babies who co-sleep often wake a little more often, because mom and her milk are both right there. It's like how I can't pass an open box of cookies without taking one... Also, if baby is right there, you might catch some very early, very subtle cues, indicating that the baby is transitioning into a lighter stage of sleep and is perhaps a little hungry.
    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
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    Aug 2011
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    Default Re: Failure to thrive - thoughts?

    He can't be in my bed because he's a tummy sleeper and we have a pillow top mattress. I don't have a cosleeper, not sure DH would be willing to pick one up because DS is likely our last baby.

    Weight history:
    Birth: 6lb 11oz
    Home: 6lb 2oz
    Regained birthweight by 8 days old
    2 months: 11lbs 10oz
    3 months: 13lbs 11oz
    4 months: 13lbs 14oz
    6 months: 13lbs 14oz

    I brought up the slowed gain at his 4 month appt but the ped was a fill-in for our regular who was on maternity leave. She didn't see an issue with it, and assumed based on his chart he'd be around 15.5lbs by his 6 month :-( The scales have all been different, but the same type of scale, if that makes sense? We've been in different rooms for the checkups but all the rooms have the same digital scales.

    I have a video monitor on him all night, and really the most stirring he does is to turn his head from one side to the other, he's a very sound sleeper.

    They told me back at his 4 month appointment that 5-7 nursing sessions a day from that point on would be considered normal, that the 8-10 is only the newborn phase?

    I have been trying today to feed him when he wakes up and again before going down for a nap, but he isn't interested before his nap then. The only thing it's accomplished so far is that his naps are shorter, which I guess in the long run will have me feeding him more frequently, but he'll also end up with 4-5 naps a day and too much awake time :-(

  6. #6
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    Default Re: Failure to thrive - thoughts?

    Ok, so as far as we know, your baby's slow gain started at 3 months. And the long sleep started at 3 months. I would strongly suggest nursing your baby more often. No matter if it cuts into his naps-I really think the last thing to worry about at this point is that your baby needs more sleep....Short naps and waking a few times at night are normal and needed so baby can get anough to eat. There is no harm to baby to wake him up at night and nurse. Nursing 6 times a day might be often enough for some 6 month olds. But even at 6 months, nursing 8-10 times a day or even more would be entirely normal.

    They told me back at his 4 month appointment that 5-7 nursing sessions a day from that point on would be considered normal, that the 8-10 is only the newborn phase?
    this is nonsense. Every baby is different of course but no, nursing 5-7 times a day is not enough for most 4 month olds or even many 6 month olds. This is a schedule that might be ok for a formula fed baby who is given large bottles at a time, but not the typical breastfed baby. My 11 month old nurses 10 times a day.

  7. #7
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    May 2006
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    Default Re: Failure to thrive - thoughts?

    Quote Originally Posted by @llli*kemiles View Post
    He can't be in my bed because he's a tummy sleeper and we have a pillow top mattress. I don't have a cosleeper, not sure DH would be willing to pick one up because DS is likely our last baby.
    Do you have a firmer mattress, maybe a spare futon you can put on the floor? That way you and baby could sleep apart from the pillow top, at least for now, while you're trying to get baby back on track.


    They told me back at his 4 month appointment that 5-7 nursing sessions a day from that point on would be considered normal, that the 8-10 is only the newborn phase?
    I honestly have no idea why they would tell you this. It is completely false, and there is no credible medical data to back it up. Whille there are a few babies who can thrive on less than 8 feedings a day, MOST babies require a minimum of 8, and many require significantly more. And the proof is in the pudding: if a babyis feeding 6 times a day and gaining weight at a normal pace, then that baby probably doesn't need 8 feedings a day. But if a baby is feeding 6 times a day and not gaining weight... Then 6 feedings isn't enough for that baby.

    I have been trying today to feed him when he wakes up and again before going down for a nap, but he isn't interested before his nap then. The only thing it's accomplished so far is that his naps are shorter, which I guess in the long run will have me feeding him more frequently, but he'll also end up with 4-5 naps a day and too much awake time :-(
    Please don't worry about short naps. As long as a baby gets enough sleep overall, it doesn't matter if it comes in a few long stretches or many short ones.
    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!"

  8. #8
    Join Date
    Feb 2012
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    Default Re: Failure to thrive - thoughts?

    I agree with PP that the place to start is by increasing the number of feedings per day. My son nursed or took a bottle 8-10 times per day until he was close to a year, if I remember correctly. Such a long sleep stretch is very unusual for such a young, breastfed baby. While I'm sure you're happy he sleeps through the night, it would be good to add a feed or two overnight. You could start by adding in a dreamfeed before your own bedtime.

    If increasing the number of feedings doesn't quickly result in an increase in weight, you may need to look into medical reasons why he is failing to gain. If he is taking around 28 ounces per day, that should probably be enough, so if he isn't gaining on that, there could be an underlying medical issue. Of course, that 28 ounces was just on one day--you can't be sure it is representative of how much he usually eats, especially since he usually nurses directly and that was a day you were away and he was being bottle fed. Babies often take more from a bottle than by nursing, just because it takes very little effort on their part to drink from a bottle, so he may not be getting that much from you on a daily basis. Although the fact that you could pump 30 ounces is encouraging.

    Anyway, try adding at least 1 or 2 additional feedings and recheck his weight in a week or two. If he hasn't gained at least a few ounces, you'll know there could be a medical problem that needs investigating.
    First-time mama to Joshua, 10/29/11. 29 months and going strong! for 14 months; now finished with pump weaning!

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