3 month old not gaining recommended amount

[@llli*bdprufer]

My daughter Clara has gaining about 4 oz a week since getting back to her birth weight which she accomplished within 7 days post birth. There was a lot of up and downs in the first few weeks since I had had a reduction about 3 years ago. After going to a LC- 2 weeks postpartum, I decided to stop supplementing her with additional formula as recommended by my pediatrician since during our feeding evaluation she was taking in 2 oz., but have been adding dry formula 1 tsp into her pumped milk now that I have gone back to work. She has always been happy and content after a feeding and is growing in height and head circumference. She is currently in the 95th percentile for height and 85% percentile for head circumference. At her 3 month check-up she is now in the 5th percentile for weight-10# 6 oz and the doctor is urging me to start her on rice cereal. I am not sure if I am ready for that and I don't see why if she is taking 3-4oz bottles a day and feeding on demand with me. What are the risks of her not growing in weight? I constantly getting discouraged when people tell me to stop and go to formula. Would my baby be content and not getting enough from me? She is having regular BM and at least 6 wet diapers a day if not more.

[@llli*lllmeg]

What is the purpose of the rice cereal? I mean, why is that being suggested instead of formula? I am not saying either is needed I am just curious.

I don't know where you live but in the US the AAP is very clear, no solids (meaning nothing but breastmilk or formula) until 6 months. Rice cereal IS a solid even if it is watered way down and put in a bottle.

IF a baby is not getting enoguh food to grow normally, then the answer is more food. if the food is breastmilk, the answer is more breastmilk. If the breastmilk cannot be increased, and donor milk is not an option, then formula supplementation is probably appropriate. SOME pediatricians such as Dr. Jack Newman might suggest solids even at this age instead of formula, there is a range of opinions on the subject.

But the very first thing to do would be to make sure you are maximising breastmilk into baby, however than can be done, assuming there is a problem at all.

Forget percentiles for a minute-what is your child’s personal growth rate? Has baby been growing all along in Ht, Wt, and head circ? Has baby stopped gaining, or lost weight? Did baby use to be in a high percentile for weight but has dropped way down to the bottom? Or what? Just becasue baby is in a high precentile for ht and a low one for weight does not mean anything. Most babies are not on the same percentile for both. What about your family? do people tend to be tall and thin?

Also I am under the impression it is not recommended to put powder formula directly into breastmilk. You have to mix the formula as directed by the manufacture and then add it. It has something to do with the concentration of the additive nutrients/proteins/iron(?) being to high per ounce for baby to process properly if the formula is mixed with something besides water, if I understand it correctly. I have no idea how big a deal this is, I am just mentioning it.

I would suggest give your caregiver separate bottles of formula, because formula needs to be treated with more care than breastmilk-for example, if your baby does not finish a formula bottle, it has to be discarded. If baby cannot finish a breast milk bottle, it may go in the fridge for the next feeding. If you make a bottle that is a combination, you have to follow the 'rules' for formula.

[@llli*bdprufer]

Thanks for your reply. My pediatrician recommended adding the dry formula to my pumped milk as a way to make it "high calorie breastmilk". She told me to add the maximum of 1 tsp per 3 oz.; however, I usually add 1 tsp per 4 oz since that is the amount she takes by bottle. Clara has always been in the low percentile and did drop from the first month to the second (10th to 5th), but I assumed that was because I stopped supplementing after each feeding. From month 2-3 she stayed in the same percentile. She suggested that at 4 months we would begin her on rice cereal with her still consuming the same amount of breastmilk as a way to help her increase weight. The doctor thought that she may just have a fast metabolism and metabolize the breastmilk too fast. She has always been growing. In the past month, she grew by an additional 21 oz. And if you look at her progress from birth, it has been a constant 4 oz. a week weight gain- just not the recommended 6 oz. a week. She is on a good consistent schedule taking regular naps and sleeping 6+ hours at night.

My husband is tall and thin and according to his mom was the same way. Clara is happy and content and will turn away the breast if she is not hungry, so if I look at her I think there are no issues. I just get nervous when I hear from others that she is too thin and of course as a mom I don't want to deprive her of anything.

[@llli*lllmeg]

I just get nervous when I hear from others that she is too thin and of course as a mom I don't want to deprive her of anything.

This just made my heart break for you...and for all of us. only in a truly topsy turvy world can a breastfeeding mother be made to feel she is somehow depriving her child of anything BY breastfeeding! It sounds to me that your baby is healthy. And 'thiness' may be her natural state. Would it be better if she weighed more than is normal for her, due to being fed formula-with all the health risks of formula feeding?

So, I cannot go against medical advice. If you are questioning your pediatricians suggestions, I would urge you to discuss the issue again with your pediatrician and/or seek another medical opinion. Unfortunately, most doctors, even pediatricians, are not taught about breastfeeding in medical school. It sounds as if your doctor is supportive of breastfeeding because she is suggesting that breastmilk not be limited, which is great. However, it is very hard to supplement a young baby with anything else and not interfere with how much breastmilk baby gets. Because baby may nurse less or drink less breastmilk IF baby is given anything else. So how more supplements might affect breastfeeding should be considered at least.

Supplements are needed sometimes if a mother cannot provide enough milk. Not due to the milk somehow being low calorie. As far as I am aware, the only reason to increase the calories in each ounce of milk is if baby is not able to take in enough volume to grow normally (such as, with a very young and premature or sick baby.)

[@llli*bdprufer]

I appreciate you taking the time to respond. As a BFAR mother, there is this constant question in your head if you could be the problem. I appreciate the La Leche organization so much as it has been tremendously valuable for me to go to meetings and get support. I was told by the LC at the hospital that I would always have to use a nipple shield and at my very first La Leche meeting they got her to latch on quickly and has been every since. I never realized how much breastfeeding my daughter would mean to me. She had to go to NICU soon after birth for swallowing mecomium and our first moment together was me nursing an hour later. After that moment, I was going to do everything it my power to make sure I had more of those experiences.

[@llli*lllmeg]

I am so glad you have found the support to breastfeed your daughter! It is especially challenging for moms who have had breast surgery or other issues that potentially lower production to feel confident. But any mother can (and often does) feel this way, and it does not help if mom is not getting support from those around her.

I assume you have heard of/read the books Defining Your Own Success and Making More Milk (Both authored by lactation consultants who are also LLL Leaders!)

In this thread from a few days ago, this mom was also trying to figure out what to do after doctor suggested supplementing (formula in this case.) I wrote a long response about different approaches to the issue, some of it may be helpful to you? http://forums.llli.org/showthread.ph...ght-Percentile