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Thread: Dr. visit results - not a good weight gain

  1. #1
    Join Date
    Jul 2013
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    Default Dr. visit results - not a good weight gain

    I posted recently about my breastfeeding situation, and breastfeeding after reduction. I had met with an IBCLC and she thought that I would probably be okay to cut out supplements completely. I was very excited about this, especially since my little one's diaper counts stayed good.

    However, we went back to the doctor today for a re-check on his weight. Ten days ago, at three weeks old, he weighed 7lbs 10oz. Today, at four-and-a-half weeks old, he weighed 7lbs 12oz. So he only gained 2 ounces in ten days...not at all what he should have gained. He is now in the 2nd percentile for weight. I know that's not all there is to it, but when he has steadily dropped from the 50th percentile at birth to the 2nd percentile now, this does worry me.

    So I have decided that I need to supplement again, and do it regularly.

    What I want to know is what the best way is to supplement while still maintaining the supply I do have. I need to state now that I do not think that the SNS is for me. I will be supplementing with expressed milk and with formula when I don't have expressed milk.

    Should I nurse for fifteen minutes and then offer supplement? Should I pump while someone else gives him a bottle? How much should I offer at a time? How can I bottle feed but not over feed?

    Also, what can I do to increase the amount I pump? I already do breast compression, and I am starting to do relaxation techniques. I also use hand expression after pumping. I use a Medela Symphony, so all I can control is the suction level and also switching between let down mode and regular mode.

    Thank you in advance for any advice you may have!
    Last edited by @llli*mrsredhead; July 29th, 2013 at 06:27 PM.

  2. #2
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    May 2006
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    Default Re: Dr. visit results - not a good weight gain

    Same scale, baby weighed in the nude both times, right? (The reason I ask is that sometimes the problem isn't the baby, but rather differences between scales or weights being taken with baby clothed one time but not the next.)

    I think the first thing to figure out is whether or not the baby is getting enough when nursing, and is just constitutionally small. Can you possibly rent a professional scale, and do several days' worth of before and after nursing weights? This would be the best way to figure out how much milk the baby takes in when nursing. If he's getting in the range of 20-30 oz per day, then maybe he's just a small baby and not a baby who isn't getting enough milk.

    Is your baby one who will stay on the breast forever, or does he ever come off on his own? If he comes off on his own, I think the way to supplement would be to nurse him for as long as he wants, then supplement via bottle, and then put him back on the breast for a little more comfort sucking. Anding the feeding with the breast means that he'll associate the breast with the feeling of being relaxed, satiated, and comforted- and those positive associations are great for maintaining the nursing relationship.

    If your baby never comes off by himself, then I would offer both breasts for at least 10-15 minutes, then supplement, and then put the baby back on the breast.

    The scale would be really useful when deciding how much to offer as a supplement. If the baby has had 2 oz of breastmilk at the breast, you know you don't need to offer more than 2-3 oz of formula.

    Obviously, whenever you can fit in a pumping session, do it. Nothing is better for supply than emptying the breast frequently and completely. But if you want to try the herbal route, fenugreek, blessed thistle, and ordinary oatmeal are all useful for some moms. And there are prescription drugs that can increase supply- Reglan and Domperidone. Talk to your doc before using either one, of course!
    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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    Jul 2013
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    Default Re: Dr. visit results - not a good weight gain

    Thank you for the response, mommal!

    Yeah, it was the same scale both times - I asked specifically to use the same one - and he was weighed completely naked.

    I do have a professional scale rented already, the Medela BabyWeigh. I have just been using it once a day, and so I knew his weight wasn't going up as expected. I haven't been doing it before and after feedings, but I will start.

    He is the type who will never come off by himself, so I'll time the feedings, supplement, and then put him back on, because I really do enjoy nursing him and I want him to have all of the positive associations.

    Should I aim for around four or five ounces in total each feeding? So if baby gets one ounce at the breast, offer three or four ounces, and as you said, if baby gets two ounces at the breast, offer two or three ounces?

    As far as galactagogues, I've been doing them all! Fenugreek, blessed thistle, Domperidone, mothers milk tea, and now More Milk Plus. I'll stick with those and try to pump as much as I can without stressing too much about it.

  4. #4
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    Default Re: Dr. visit results - not a good weight gain

    I would talk to the doc about appropriate supplement amounts. If your LO got 2 oz from the breast, that would actually be a pretty normal feeding. As long as he nursed 10-12 times a day, 2 oz feedings would likely be sufficient, with no need to supplement. A breastfed baby typically eats around 20-30 oz of milk per day, but I honestly have no idea how you're supposed to figure out how much formula a baby needs, or how you would accurately make up a shortfall in breastmilk with formula. So, yeah. Call the doc.

    My gut says keep the supplements to 2 oz, and see what happens.
    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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    Default Re: Dr. visit results - not a good weight gain

    Has there ever been any discussion wiht your doctor about other possible causes of slow weight gain? Medical causes (Heart issues, allergies, some nutritional deficiency? If I understand your history correctly, gain has never been good whether you were supplementing or not. Plus hasn’t your baby always pooped several times a day? So where is that poop coming from? This is just not adding up to be entirely about the amount of food into baby to me.

    For milk production going forward, it would be important to continue to nurse or pump frequently. Generally, I would think that feedings should mimic the size and frequency of normal feedings at the breast, which would be 3 ounces at most at this age, baby eating at least 10 times a day. If your doctor is suggesting baby get 5 ounces at a time, get clarity on how often he is thinking baby needs such a large feeding. My guess is its something like 6 times a day-far to infrequently for a breastfed baby typically. A baby getting 5 ounces 10 times a day would be getting 50 ounces a day! Much too much.

    As far as how to supplement each time, I think there are a lot of benefits to supplementing BEFORE nursing, and letting baby finish at the breast. But this does not have to be every feeding.

    Did your IBCLC do a before and after nursing weight check as mommal suggests? Doing enough of these (more than one-if possible it would help to do several to get a more accurate picture) can give you a much better idea of what baby is able to transfer at the breast per feeding which in turn may help you figure out more precisely how much baby needs to be supplemented. Now that you have a scale, you could do this yourself-Can you check with your IBCLC for how to do this accurately and what you should expect?

  6. #6
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    Jul 2013
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    Default Re: Dr. visit results - not a good weight gain

    Mommal, I will check with the doctor about the supplement amounts for sure. Thank you!


    Meg, I've never asked about other possible causes. I just always assumed it had to do with my supply and my physiology. I will bring that up to the doctor...the thought of it being something like that scares me.

    You are right that his gain has never been good, but I have never seriously supplemented. When I was supplementing before seeing my IBCLC, it was only one or maybe twice a day, when my little guy didn't seem satiated after a feeding. And when I was doing that, he went back up to his birth weight in 16 days. So I've never fully supplemented, but when I was supplementing just a bit his gain was better than it was the past ten days.

    He has always pooped regularly. He normally has one or two big poops a day, and then a number of smears, usually when passing gas.

    After I talk with the doc, I think I'll ask the IBCLC to come out again and talk with my about supplementing and her suggestions for that. As you mentioned, I'd like to finish at the breast, so that he associates me with comfort and satiety. I'll also ask her for guidance with weighing before and after feedings.

    I did a weight check this morning before and after his first feeding, and he gained 1.5 ounces at the breast. I think I did it correctly - same diaper before and after, and no other clothing - but I'm not entirely sure.
    Last edited by @llli*mrsredhead; July 30th, 2013 at 10:54 AM.

  7. #7
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    May 2013
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    New Jersey
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    Default Re: Dr. visit results - not a good weight gain

    I have no medical basis for this suggestion but from what you have said I would supplement with an oz before or after each feeding (which ever is the more appropriate choice for you) for a week or so and see how that goes. I found that when I was supplementing my LO always wanted to get back on the breast after supplementing for the comfort. i think ultimately that really helped my supply go up.
    I would think that your supply would take less of a hit if you started small with the supplements and increased it until your LO was gaining at a more comfortable rate. Since there is some gain now I wouldnt think you would need that much. My understanding is that the less you supplement the more you nurse the better your supply.
    good luck!
    mommy to Ellie - 2/28/13 8lb 3oz 19.5in

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