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Thread: Milk supply and supplementation issues

  1. #1

    Default Milk supply and supplementation issues

    Hello,

    New here... I have a 12 week old daughter, V, who is have weight issues. Let me start at the beginning....

    Prior to her being born I read up on breastfeeding. She was born naturally (1.5 hrs after first contraction!!) and latched on right away. We co sleep and have since the beginning. She was born at 8 lbs 1 oz. her lowest weight on day 4 was 7 lbs 6 oz. she was up to 8 lbs 2 on day 16. Different scales at this point for each weight. Around 5 weeks she became inconsolable and started refusing the breastoccassionally. Before she nursed all the time however slept for 4 to 5 hrs at night. I didn't try for this it just happened. After I was close to a meltdown I called the lactation consultant at the hospital. At 6 1/2 weeks she weighed only 8 lbs 7 oz. I nearly lost it when I saw that number!! Her diaper count had changed slightly but I thought that was just because she had gotten older. The LC worked with me on breast compressions and pumping and was just wonderfully supportive. Two days later however no weight gain. We made the decision to supplement at this time. We ended up at 9 oz per day. I usually only pump 1 oz per day even with my rented hospital pump. 3 days later she was up 3 oz. we kept with the 9 oz supplementation and she gained 4 oz per week the next couple week which we were happy with. I added fenugreek and thistle and eventually reglan. My milk is definitely up. However after two weeks of cutting back to 8 oz she dropped to just 2 oz gain per week. At her two month check up last week she was 24 inches long and 9 lbs 11 oz. the pedi said to keep waking her up two times per night which I had started doing weeks earlier and as long as she gains not to worry much because she's doing great otherwise. At her weigh in yesterday with the LC still only 2 oz. I called the pedi and got the nurse who said the pedi said to up her formula to 12 to 14 oz and bring her in on Friday. If she was gaining well on 9 oz why would I need to give her 12? I called back but haven't heard back yet.

    Her diaper count is 6 to 9 per day and she's generally very happy and seems healthy! If I hadn't been monitoring her weight I'd never know there was a possible problem!

    I know there are more details that I'm forgetting. For now am I crazy for thinking that's too much if she was doing fine on 9 oz?

    Thanks so much!!! I know this was long!

  2. #2
    Join Date
    Oct 2009
    Posts
    2,626

    Default Re: Milk supply and supplementation issues

    you're not crazy, I agree with your thinking. You don't want to over- supplement bc you risk your supply decreasing. Sorry I can't write more, nursing.
    Nursed my sweet daughter 3 years, 3 mos.

  3. #3

    Default Re: Milk supply and supplementation issues

    Here's dates on weight:
    7/27: 8 lbs 1 oz 19 1/2 inches
    7/31: 7 lbs 6 oz
    8/12: 8 lbs 2, 20 1/2 inches
    9/11: 8 lbs 7 oz
    9/16: 8 lbs 10 oz
    9/22: 9 lbs 4 oz
    10/6: 9 lbs 9 oz
    10/14: 9 lbs 11 oz, 24 inches
    10/20: 9 lbs 13 oz

  4. #4
    Join Date
    Jun 2009
    Posts
    5,334

    Default Re: Milk supply and supplementation issues

    You have worked very hard to keep breastfeeding in a difficult situation! It sounds as if you are doing well overall.

    I agree with krystine. Smart to clarify this with your pediatrician as I imagine something got lost in translation.

    Also, I do not know if the LC visits and the ped visits are all in the same office? It is VITAL especially when weight gain is being watched closely that all weight checks (or the ones that ‘count’ anyway) be done on the same scale, with baby in preferably nothing at all or a dry diaper. This is vital. I am not talking about before and after nursing weight checks you might do with your IBCLC, I mean, the checks that are being recorded as a measurement of growth. Also, if I was dealing with such a situation, I would not only make sure baby was always on the same scale, I would make sure baby was weighed twice at each visit and that both I and the nurse (or doctor) saw the scale and agreed on what it said. Scale and human error DO HAPPEN at weight checks. What jumps out at me is the apparent extremely slow gain from the end of week 2 to week 6.5, after what is apparent normal loss/gain the first 2 weeks. It just seems odd that that could happen without there being more of an outward sign.

    Another thing to be careful of is that frequent weight checks can be overtly alarming, as babies do not normally gain steadily every week. Some weeks WILL be slower than others. So it makes sense to stand back now and then and look at the entire picture. Also, weight gain rate normally slows down somewhere after the first 2-3 months, and slows again around 4-6 months, so weight gain rate may indeed slow with your baby and be ok. It all depends on other factors.

  5. #5

    Default Re: Milk supply and supplementation issues

    Hi,

    Sorry it took me so long to respond with details. Thankfully my pediatrician called back later and clarified...9 oz is good she said if she is gaining 4 oz per week. The nurse had relayed the message wrong.

    LC visits are different from the peds office. The weights that also have accompanying length are on different scales but all the others are the same scale. She's always naked. Other than her being unhappy, which we thought was normal newborn unhappiness, there really wasn't any sign of something being wrong. Her diaper count was still good with daily poops. She stopped napping during that time which the LC also thought maybe had something to do with it, perhaps she was burning so many calories? The LC's have been wonderful and better than the pediatricians!

    We are trying to look at the big picture. Other than being so low on the weight charts (5th percentile compared to 80th at birth) she is doing great. She keeps getting longer and not chubbier. She's meeting milestones, happy, and curious. So when do we know that her weight is just fine for her and when is it something to be concerned about?

    For now, I'm trying to be at peace that she may just need formula supplementation until she can start solid foods. It hurts, but she does better when she gets supplemented. I'm still pumping to make up for that bottle time - 6 times per day with a rented hospital pump.

    Any other suggestions or thoughts? Thanks so much!

  6. #6
    Join Date
    Jun 2009
    Posts
    5,334

    Default Re: Milk supply and supplementation issues

    I think, when there is very slow weight gain, it can help to consider realistically why this may be.

    The first to rule out would be a medical condition, illness, or nutritional deficiency IN BABY that might make it difficult for a baby to gain. If you think about it, THIS-the concern about an actual illness or condition that causes ill health, going undetected-is what led to the creation of growth charts & thier use by doctors in the first place. To give warning to doctors that a child MAY be ill. It had little to do with feeding. All mammals, including humans, tended to keep their babies alive & growing just fine prior to growth charts.

    The second would be to see if there is some reason a child does not get enough to eat. For a breastfed child, they may not get enough to eat due to 1) Baby not nursing frequently enough. This might happen for many reasons. 2) baby is not able to nurse effectively (can’t get the milk out normally, for some reason) –this is probably the first possibility an IBCLC should be looking at) or 3, mom has low production. Or a combination of these.

    Or, some babies simply grow more slowly than even the slowest babies on the chart. And it is normal for that outlier baby.

    If your baby was burning too many calories or using too much energy for any reason, imo, logically, she would be hungry, and wish to nurse more often.

    Not napping- do you mean your baby only sleeps at night? Never during the day, at all, she never dozes off when nursing, for example? When did that start? And how long will baby sleep for at once overnight? I do not know about weight gain, but 3 month old who does not nap has got to be a red flag for something. It is very, very unusual.

    It sounds like you are following your instincts with the supplementing and that is usually smart. You are pumping to try to keep your production as unaffected by the supplementing as possible, also smart. I will just suggest that it is normal for growth rate to slow, sometimes considerably, after 3-4 months, and then again after 6 months, and to keep slowing. So be prepared for what that might look like for your baby.

    A book I cannot recommend enough for all parents, but especially parents of slowly gaining or small children, is My Child Won't Eat by pediatrician Carlos Gonzalez. It is helpful at any stage, even the early months pre-solids.

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