Happy Mothers Breastfed Babies
Results 1 to 7 of 7

Thread: At my wits' end re slow weight gain and expressing

  1. #1

    Unhappy At my wits' end re slow weight gain and expressing

    My 10-week old is gaining weight more slowly than than the curves on the WHO growth chart - from his birth weight on the 25th centile, he has just dropped below the 0.4th centile line.*We're trying everything under the sun to improve his gain -*more frequent feeding, deep latch techniques, breast compressions, expressed milk top-ups after feeds, fenugreek, switch feeding to keep him awake if he dozes off, nursing vacation to increase supply, etc. but to little avail. The thing is, the current programme of expressing for top-ups alongside full-time feeding is killing me... Between feeding him on demand every 1-2.5 hrs during the day at 30-40 mins each time, and trying to find opportunities to express enough to make up 120ml (4oz) for top-ups (given in small amount over the day after feeds), I can barely leave the house without missing a window to fit in a pumping session. He feeds every 2-3.5 hrs at night, so that's 10-12 times per 24 hrs, but I don't pump at night so I can sleep. I can't keep it up indefinitely but don't know what to do...

    He was born at 3.24kg (7lb 2), dropped to 3.0kg (6lb 10 - a 7.4% drop) at 5 days, took 3 weeks to regain birth weight, and currently weighs 4.0kg (8lb 11) at 10 weeks. He had tongue tie that was snipped at 3 weeks, then a nasty bout of thrush that was painful for us both, so for the first 5-6 weeks there was a potentially good reason why his weight gain was slow at an average of just over 100g (3.5oz) per week*.*Unfortunately, it hasn't accelerated much since then.

    Week 7, I started taking fenugreek and expressing 50ml EBM per day for top-ups (delivered in small amounts over the day at the end of feeds), and had a breastfeeding counsellor observe a feed and help me latch him more deeply: at weekly weigh-in he had put on 120g. The health visitor suggested supplementing with formula since breastfeeding "wasn't working out" - I refused, with support of local bf counsellors. Week 8, I continued with 50ml EBM per day except for a couple of days where we stayed in bed for nothing but feeding and skin-to-skin: he put on 150g that week but hit the 0.4th centile line, which made the health visitor insist more firmly that I supplement with formula (again I refused, as it didn't make sense to me, or the bf counsellor I asked, to force formula when EBM was available). Week 9, I doubled EBM top-ups to 120ml per day: he put on only 100g...!* I have found a different health visitor who is more supportive of breastfeeding and is no longer putting me under pressure every week, but has referred us to a paediatrician with an appointment in 2 weeks' time.

    Why is the increase in EBM top-ups not increasing his weight gain? It's like he's dropping his intake from the breast as the intake from EBM increases, so he's still taking in the same (or even fewer) calories overall. Is it possible that pumping after feeds means he has to work harder to get the same amount of milk on the next feed, so he ends up taking in less from the breast than if I wasn't pumping? Or is it possible for top-ups not to work because the baby is self-regulating intake to suit appetite (even if it means maintaining slow weight gain)?

    Is it worth me maintaining this gruelling programme of expressing milk if it makes no difference? I had a phone conversation with a lactation*consultant a few days ago, who*thought I was doing everything right but suggested*that 120ml (4oz) per day is not much of a top-up. I thought it was pretty good going, as it takes me about 4 sessions to make it up: I get 20-50ml (0.7-1.8oz) per pumping session, as I can't leave it too long after he finishes feeding to express or I'll still be pumping when he wants to feed again. She also thought that 20-50ml was a poor yield from a double pump and hence a cause for concern, but the kellymom site says 0.5-2oz is normal yield per pumping session for a mother who is breastfeeding full-time. Who is right here? Because I don't know how I can increase the amount I give him in EBM top-ups when I'm struggling to manage 120ml.

    Is his weight gain a cause for concern or not? There doesn't seem to be much agreement on when it's time to worry. He is otherwise fine - alert and active and meeting his milestones, producing 6-7 wet nappies per day and a big yellow poop every 1-3 days, his length and head circumference are tracking the 25th centile, and the doctor was happy with him at his 8-week checkup. So I'm not sure whether there's really a problem or not... The LLL info and a local bf counsellor says 4oz per week is normal, albeit at the lower end, but that doesn't keep pace with the weight charts at all.

    Sorry for length of post. I've been in tears so many times over the last few weeks and have asked for help so many times from different quarters, but don't know what to do to sort the good advice from bad. All I want is to be able to breastfeed my baby normally - no pumps and bottles - so he is healthy and happy but I don't even know if that's possible any more

  2. #2
    Join Date
    Oct 2012
    Posts
    2,214

    Default Re: At my wits' end re slow weight gain and expressing

    Hi mama, welcome to the forum. I'm sorry this has been such a struggle for you, but big kudos for sticking with it and seeking out help!

    There are many reasons for low weight gain. It seems like at least some of the advisers you have consulted with seem to think that low supply is the problem - hence the suggestion to add formula. However, it is not clear to me whether there is any reason to believe that supply is low. I agree that your pumping output says nothing - it is not a reliable indicator. Diapers seem to be on track, head and height are on track, only weight is not - so what explains that discrepancy? In fact you've observed when you increase the bottle supplementation, the intake at the breast seems to go down, which suggests that perhaps baby is getting enough. One measurement that might be helpful is to do several weigh-feed-weighs - weigh baby immediately before and after a feed, naked, to indicate how much he got in. But don't rely on just one measurement as intake can vary throughout the day. To do this you need a very accurate scale - often the LC will have this.

    Does latch seem to be good now, after tongue tie clipping? Do you have any pain with nursing?

    Can you do this for another two weeks? I think it's worth getting the pediatrician's advice on what may be going on. If the pediatrician thinks everything is fine and baby is just skinny (no problem with that, right?), then you can probably start easing off of the pumping and switch to breastfeeding. On the other hand, if the pediatrician thinks there is cause for concern, that might dictate a different course.

    You're doing great mama, hang in there!

  3. #3

    Default Re: At my wits' end re slow weight gain and expressing

    Hi and thanks for the encouragement! The latch is good - feels fine to me, no pain, and deep suck/swallows during letdown. A couple of bf counsellors have observed a feed and thought all was well, though they had a couple of useful suggestions to optimise the latch. One thing is that he does tend to slip to a shallower latch if I'm not vigilant (or am dozing while feeding at night), so each session usually involves several relatches, but it's okay.

    How accurate does a scale have to be for test weighing? To the nearest 5g or 1g? The lactation consultant I spoke with is not local to me but I might be able to get one elsewhere.

    I'm not sure I can make it another 2 weeks until the paediatric appointment... I know some mothers pump many more times a day as well as full-time feeding and I'm full of admiration for them, but don't know if I can do it. If he's fussing between feeds, or just wants to be held, I can't get to the pump. I'm thinking of cutting down a little on the EBM and see what happens to his weight...

  4. #4
    Join Date
    May 2006
    Posts
    21,361

    Default Re: At my wits' end re slow weight gain and expressing

    The scale should go to the 1/10th of an ounce. You're looking for a professional, digital baby scale, like the kind the pediatrician uses at his/her office.

    The PP's suggestion to use one is excellent. By using the scale, you could potentially eliminate all the pumping- if baby is getting enough at the breast.
    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
    Join Date
    Oct 2012
    Posts
    2,214

    Default Re: At my wits' end re slow weight gain and expressing

    Some lactation consultants will rent out the scales, or you may be able to rent one elsewhere. I can't remember how accurate it needs to be - hopefully another mother will jump on with that information, or the lactation consultant should know.

    As for pumping, I think you should to do what you can. Of course you have to take care of your baby as well! If you cut back and baby's weight gain slows further, that provides you with information as well. So just continue to keep track, as you are - how much pumping, how much weight gain. There's always the possibility of adding back more pumping.

    ETA: Just saw mommal's post with the info about the scale - thanks!

  6. #6
    Join Date
    Jun 2009
    Posts
    5,912

    Default Re: At my wits' end re slow weight gain and expressing

    Why is the increase in EBM top-ups not increasing his weight gain?
    Maybe there is an underlying health condition and the slow gain has nothing to do with there not being enough milk? This is a remote possibility but I think this has to at least be considered which is maybe why you were referred to a pediatrician?

    If it is the case that baby is taking in less at the breast due to being full from being topped off, then the supplements are not needed, as baby simply does not physically need more milk.

    Is it possible birth weight was inflated due to ivs or just done incorrectly, throwing off the curve? What happens if you chart from lowest known weight instead? Also, your milk production probably took a hit early on with the tongue tie. some herbs are more effective then others for different mothers. Have you read the book Making More Milk?

    4 ounce per week gain was generally considered ok before the WHO studies/charting was completed in 2005 or 6. There are many who still think it is ok, and others who do not. There really is controversy/differences of opinion from experts in this area. Also some babies are simply outliers and that can happen on either end of the chart.

    four ounces supplement a day is like one big or two small extra nursing sessions a day. So that is not insubstantial at all. Whether that is enough, too much, or just right will depend on the baby and the situation, which is not something that can be ascertained correctly over the phone. As long as your pump is working correctly then what you pump when also nursing around the clock is going to be all there is...know what I mean? You can only give what you have. Whether it is enough depends on why baby is not gaining faster-is it because you do not make enough milk, or because of some other reason, or because, this is just who baby is?

    Did the IBCLC you saw do before and after nursing weight checks after the tongue tie was treated, (the more the better) to see if milk transfer during feedings is still low?

    I would also say, you can only do what you can do. Let's say your baby really does need to be supplemented, and say you are not able to express enough, donor milk is not an option, and the only option IS formula. OK. You can keep nursing and supplement with formula. The benefits of all your hard work, the benefits of breastfeeding, will still be there.

  7. #7

    Default Re: At my wits' end re slow weight gain and expressing

    Quote Originally Posted by @llli*lllmeg View Post
    Maybe there is an underlying health condition and the slow gain has nothing to do with there not being enough milk? This is a remote possibility but I think this has to at least be considered which is maybe why you were referred to a pediatrician?
    Yes, I just want to know if we can rule out something unusual - I asked for the referral because the "wait and see" approach of weighing week after week seems to be getting us nowhere and was stressing me out.

    Quote Originally Posted by @llli*lllmeg
    Is it possible birth weight was inflated due to ivs or just done incorrectly, throwing off the curve? What happens if you chart from lowest known weight instead? Also, your milk production probably took a hit early on with the tongue tie. some herbs are more effective then others for different mothers. Have you read the book Making More Milk?
    I don't think birth weight was distorted as I had no IV during the birth: it was pretty intervention-free, no complications. Charting from the lowest weight of 3kg would put him between the 9th and 25th centiles, though. I haven't read that book but will check it out - thanks.

    Quote Originally Posted by @llli*lllmeg
    Did the IBCLC you saw do before and after nursing weight checks after the tongue tie was treated, (the more the better) to see if milk transfer during feedings is still low?
    No, unfortunately. He has never had a before/after weight check as I haven't had a face-to-face consultation with an IBCLC as there don't seem to be any in my local healthcare system. I'll try to get hold of scales myself if I can't get access to an IBCLC privately.


    Thanks everyone.

Tags for this Thread

Posting Permissions

  • You may not post new threads
  • You may not post replies
  • You may not post attachments
  • You may not edit your posts
  •