How To Tell If Low Supply???

[@llli*milkmaid28]

My son (child #2) just had his 4 month check up today. At birth, he was in the 80 something percentile (don't remember the exact #) for weight. At his two month checkup, he was in the 65th percentile for weight. Today, at his four month, he is down to the 33rd percentile. I was really surprised because I hadn't noticed anything that would lead me to be concerned about his intake or weight gain. This is my second child. With my first, I'm pretty sure I had oversupply issues and she never had any issue gaining weight.

The pediatrician thought the issue could be low supply or it could be something else like acid reflux (he still spits up a good deal, but has never been on meds and never seems to be upset by the spit up).

Before I go crazy trying to increase my supply, I first want to know if that is really the issue. Is there a way that I can "measure" my supply? My pediatrician recommended that I pump first thing in the morning and that if I got less than 3-4 oz, that would show I had low supply. However, I'm wary of any pediatrician's lactation advice because it often seems to contradict what I find on La Leche League forums. Any better way to tell if low supply is my problem? Like I said, I'm really surprised by the lack of weight gain because I thought oversupply was my problem, not low supply.

A few details... my son feeds every 2 hours or so during the day, usually only one breast per feeding. Sometimes spits up a fair amount soon after eating. He seems content after eating. He was sleeping a 4-5 hr stretch at night but about two weeks ago, he started waking every 1-3 hours again. I feed him almost every time he wakes (unless the paci puts him back to sleep right away). I've always fed on demand and breastfeed exclusively. Early on, he was a very fussy nurser and commenters on this forum thought that he might also be experiencing oversupply issues but that all seemed to resolve itself around 2.5 months.

[@llli*zaynethepain]

Weight gain is the best indicator of supply. Can you give us all your baby's weights so far? Was baby weighed naked, on the same scale every time and is your doctor using the WHO charts for breastfed babies. Second at this age is wet diapers. How many wet diapers does he have a day? A better way to check how much he's getting is a before/after feed weigh. Actually several of them is best as babies take different amounts depending on time of day, distractabilty at the office, ect. Some breastfeeding groups will have a scale there, or an LC's office, or you could rent a very precise scale from your doc's office or hospital and do a couple at home where baby is likely to be most comfortable and nurse best.

[@llli*sonogirl]

Also, your ability to pump milk is definitely not an indicator of your supply. Some moms just do not respond well to the pump, so the ability to pump a set amount in the morning does not mean anything!

[@llli*mommy2lilah]

How many wet and dirty diapers does he have? Pumping is not an indicator of supply!

Is your baby happy/content and alert? Did you have a lot of fluids during labor? That can inflate the baby's weight.

[@llli*milkmaid28]

Thank you so much for your replies. Here are his weights so far:

At Birth: 8 lbs 6 oz
At lowest: 8 lbs 0 oz (leaving the hospital)
At 2 months: 12 lbs 9 oz
At 4 months: 14 lbs 13 oz

He was at the doctor at one week old too but I don't have the exact number on that one. I know he hadn't reached his birth weight at that point.

I haven't counted his wet/dirty diapers exactly but I'd estimate conservatively that he has 7-8 wet diapers a day and 2-3 poops. If this seems low, I can keep track over the next few days to make sure that is an accurate guess.

I had an IV with fluids during labor. It was an all natural birth so I'm not sure how much they gave me, but they did have me on an IV.

As far as the charts the doctor is using... I don't know if they are specific to breastfeeding babies. I don't think so. They have never mentioned anything about that. They do know that I'm exclusively breastfeeding so maybe they take that into account? Not sure on that.

He is over all a happy baby, although fussier than his sister was. It's hard to know what to attribute to being hungry, wanting to be held, having gas, etc. I haven't felt that anything is wrong with him based on his fussiness. I just assumed that he is a little more "needy" than his sister was. He can be soothed fairly easily. He is very alert and interactive and full of smiles for those he loves.

He does spit up a significant amount and I wonder if maybe not enough is staying in his stomach. Based on earlier reading of these forums, I didn't think the amount of spit up was anything to be alarmed about.

[@llli*mommal]

Is he a very active baby? What's he doing, physically? Reaching, rolling, kicking?

[@llli*milkmaid28]

Mommal, he is active but not exceptionally active. He has rolled occasionally (both ways) but he doesn't regularly roll in either direction. He reaches for things, grabs things, puts things in his mouth. When laid on his back, he often "spins" himself in various directions or scoots himself along the floor by propelling with his legs. He loves to be held in a sitting position (on his own he can sort of sit if he leans waaayyy forward). He also loves to be held in a standing position where he can bear some weight on his legs. He loves to kick in the bathtub and kicks a lot in his bouncy seat. To my knowledge, he is developmentally appropriate for his age but not especially advanced.

In reply to zaynethepain's earlier question, he has always been weighed naked. The first two weights given were on the hospital's scale and the second two were on the pediatrician's scale.

[@llli*milkmaid28]

Just a quick update... I kept track of his diapers and he had 10 wet diapers and 2 poopy diapers in a 24 hour period. I'm looking forward to hearing your thoughts on his weight gain and output.

[@llli*lllmeg]

Baby’s birth percentile is almost irrelevant. Because almost all breastfed babies who are born in hospitals lose weight in the first several days. And the weight gain of 3.5 pounds in the first two months sounds good. Assuming baby started "really" gaining at about 1 week of age, (typical) and that the 2 month checkup happened 7 or 8 weeks later, that indicates average weight gain of at least 7 or 8 ounces a week. If my math is right, (an iffy prospect) that is good weight gain.

The gain from 2 months to 4 months was 2 lbs 5 ounces. Assuming those checks were 8 or 9 weeks apart, that indicates an average gain of 4 to 4.5 ounces a week between 2 and 4 months. Much slower than before.

Before doing ANYTHING else, I would suggest getting baby weighed AGAIN. To rule out human or scale error. Make sure it is the same scale as the 2 month appt and baby is weighed correctly (naked, on a digital infant scale, stand right there and note the number)

Output seems normal. What do the poops look like and about how much was it?

I don't think there is another way to measure your supply, but what about seeing a lactation consultant to have breastfeeding assessed? She can see if there is anything going on with latch or sucking that seems concerning, do a before and after nursing weight check, etc. It will give you more info to add to what you know about weight gain. Sometimes slow gain means there is a breastfeeding issue, and that issue MIGHT be low production, but sometimes it is anotehr breastfeeding issue, or it can indicates a medical issue, sometimes it is just who that baby is.

Any reason for there to be low supply after 2 months? Start birth control?

Do you think baby has reflux? Does baby have pain? Dr. Sears www.askdrsears.com has a good article on reflux.

Any sign of food allergy? (rash, blood in poop, excessive fussiness)

How is other measured growth? (length, head circ?)

[@llli*milkmaid28]

Update... I took lilmeg's advice and went back to the pediatrician today to have him weighed again on the same scale. Our original 4 month appt was Tuesday am and he weighed 14 lb 13 oz. Today (Thursday am), he weighed 15 lb 0 oz on the same scale. This second time, he had not nursed well in the hours before the weighing because we were out and about and he was distracted and fussy. Both times, he was weighed naked (no diaper).

Does this new weight change anything? I've never worried about him getting enough because I just trusted my body to provide what he needed but since this appointment, I have been really worried about him and thinking that he might waste away to nothing. I have been offering the breast more, just to encourage him to eat as much as possible and to boost my supply.

To answer the other questions...

My mom's intuition tells me that reflux is not his problem. But I'm no doctor, so I could be wrong.

No signs of a food allergy, except he is fussier than many babies, but he's also happy a lot too.

His length and head circ are good... they have continued to grow in roughly the same percentiles throughout his life.

I'm not on any hormonal birth control. The only factor that I think might be lowering my supply is stress. My husband is working a crazy schedule this summer which leaves me on my own with two kids a lot (and I'm sleep deprived). It's been hard but I feel like I've been handling it pretty well over all.