4mo - Weight Gain Concerns

[@llli*sunkist56]

I have lurked on these forums for 2years. Now with my second little one I have a question! I've been doing some reading to try and get to the bottom of this and appreciate any suggestions.

DD was born at 6lbs, 7oz and her weight gains are as follows:
1month 10lbs 13.5oz (90th%)
2months 12lbs 10.5oz (95th%)
Around this time I started the mini-pill and since DD had gained so well Doctor said I could let her sleep a bit longer at night, 6+hours.
4month 12lbs 11oz. (50th%)
Last week was the 4month well visit where she weighed 12lbs 11oz, only a gain of half an ounce in two months. We were all shocked! Nurse re-zero'd the scale and tried again. Same weight. Doctor was very concerned that she had gained only the .5oz in 2months.

My gut tells me that either something was wrong with the scale at 2months or she's fine. DD will feed about 10 times during the day and sleeps a long stretch at night, usually about 6hours, sometimes a little longer. She's not a good napper, we have a very active day of being held, being on our tummy, watching big brother play, etc. She love to roll over. She's been alert and aware since birth and I see more development in her the last 2 months as well. I'm eager to offer her the breast whenever she shows me she needs it; hunger, comfort etc. She has 5-6 wet diapers a day. She seems happy after feedings. She sometimes wants to eat sooner than 2hours after the last feeding but I don't watch the clock too much and up until this point I haven't worried about that. We only BF. I have offered a bottle of expressed milk a few times and she refuses. I explained this to doctor but she was still very concerned.

The Doctor's suggestions were for me to work on bottle feeding with expressed milk so I know how much milk DD is receiving. She's not sure I make enough and would like it if DD received all bottles of expressed milk. Here in our conversation I admit I shut down. I pumped for a while with DS while I worked outside of the home and it led to a dip in my supply and very early weaning. BUT, I was just so worried about DD in this current situation I responded with just nods of my head. I cried when the doctor left. We have a weight check up in 2weeks.

As I said I've tried to read up on weight gain & milk supply now that it seems we have these issues. Obviously in these 2weeks I want to do all I can to be sure DD gains and continues to gain so now I'm stressing out. I also want to go back to the doctor's with as much information to advocate for the feeding choices I would like to make for my DD. I've seen the same doc all this time but I may see someone different for our follow up, sort of a second opinion. Obviously if she is truly not gaining weight well I would do anything for her but it doesn't seem like Exclusive Pumping is my only option is it? I've also read it's common for a BF baby to gain less weight after a certain point, but DD is too young for that I think? I think my supply is ok - maybe the mini-pill caused a dip and I didn't realize soon enough?


I realize this may be a difficult post to respond to since the follow up weight check is in 2weeks. I appreciate any follow-up posts, even to tell me to just calm down! Thank you!!

[@llli*lllmeg]

So baby gained over 4 lbs!!! month one (very rapid gain) 2 lbs month 2, (normal gain) and then, suddenly nothing, but the suddenly nothing happened after starting hormonal bc and baby sleeping longer?

but it doesn't seem like Exclusive Pumping is my only option is it?

I take it doctor wants to know how much milk is going into baby, and she can't figure out another way to figure this. But all that pumping will tell you is how much milk your pump can draw from your breasts, and how much baby will eat with a bottle. It wont really give accurate info about breastfeeding, and of course, pumping instead of nursing is verry likely to harm milk production! You want to know why baby appears to not be gaining normally, and to get to the bottom of that, maybe breastfeeding needs to be assessed.

what about visiting an IBCLC and having some (more than one) before and after checks done and to assess breastfeeding in general, stopping the minipill, (if you can without risking getting pregnant) trying to nurse a bit (or a lot) more frequently, maybe trying some food or herb galactagogues, maybe pumping in addition to nursing to give your production a boost, and weighing baby in a couple weeks? Would your doctor agree to something like that?

other things to consider besides scale error-

gain rate typically slows after 3 months, and it can be a pretty dramatic slow down esp. if early gain was rapid. But baby would still be gaining something, of course, normally.
was baby ill ever in the last couple months?

[@llli*mommal]

Completely with LLLMeg. In particular, I think the long stretch of nighttime sleep would be an excellent time to add in some feedings. I know everyone says "don't wake a sleeping baby", but that doesn't apply when there's concern about weight gain.

[@llli*h.mom]

Just curious, since you mentioned that you thought there might have been an error made at the 2 month weight check...does your daughter seem bigger now? Has she moved up in clothing size (not just due to length, but girth as well)?

[@llli*sunkist56]

So baby gained over 4 lbs!!! month one (very rapid gain) 2 lbs month 2, (normal gain) and then, suddenly nothing, but the suddenly nothing happened after starting hormonal bc and baby sleeping longer?

I take it doctor wants to know how much milk is going into baby, and she can't figure out another way to figure this. But all that pumping will tell you is how much milk your pump can draw from your breasts, and how much baby will eat with a bottle. It wont really give accurate info about breastfeeding, and of course, pumping instead of nursing is verry likely to harm milk production! You want to know why baby appears to not be gaining normally, and to get to the bottom of that, maybe breastfeeding needs to be assessed.

what about visiting an IBCLC and having some (more than one) before and after checks done and to assess breastfeeding in general, stopping the minipill, (if you can without risking getting pregnant) trying to nurse a bit (or a lot) more frequently, maybe trying some food or herb galactagogues, maybe pumping in addition to nursing to give your production a boost, and weighing baby in a couple weeks? Would your doctor agree to something like that?

other things to consider besides scale error-

gain rate typically slows after 3 months, and it can be a pretty dramatic slow down esp. if early gain was rapid. But baby would still be gaining something, of course, normally.
was baby ill ever in the last couple months?

Thanks for the reminder about pumping output. I know this info, my brain just couldn't find it in the moment to tell the doctor!

I am going to try and see a IBCLC. The ones at the hosp were great and we went back during week 1 to fix a shallow latch. Perhaps we've regressed a little and I just don't have a trained eye to see it. There are plenty in the area I came across when I was researching birth doulas. Baby was never ill. She gained a little over an inch in length and some head size as well. I stopped the minipill and added some mother's milk tea to my daily routine. Also as I thought about what I was eating in general, I could probably be eating more calories and more nourishing foods to help with my overall well being & with breastfeeding. Self care doesn't end!

[@llli*sunkist56]

Completely with LLLMeg. In particular, I think the long stretch of nighttime sleep would be an excellent time to add in some feedings. I know everyone says "don't wake a sleeping baby", but that doesn't apply when there's concern about weight gain.

Yes makes sense, thank you!

[@llli*sunkist56]

Just curious, since you mentioned that you thought there might have been an error made at the 2 month weight check...does your daughter seem bigger now? Has she moved up in clothing size (not just due to length, but girth as well)?

Good point. I see chunkier thighs and arms now at 4months compared to 2months. I have pics of her in just a onesie with a date sticker on them and side by side you can see the weight she's put on. She was wearing all 0-3month sizes then and has moved up to 3-6mo now. I wish I could know for sure about the scale. There was an error made by a nurse regarding my weight during my pregnancy so I know mistakes can happen when writing numbers down in a chart.

[@llli*sunkist56]

I saw our IBCLC yesterday. DD had not gained any weight since Thursday, small loss of a few ounces. Our latch was a bit shallow. We tried some different positions. I'm starting to think what if we've gotten shallow due to some overactive let-down and our IBCLC agrees too. For now, to protect DD's weight gain, I'm going to keep one nursing session in the early morning, pump for the rest of the day and feed DD expressed milk. Our goal for her feedings and my pump output is 25-30oz. I have a day or so of milk in the freezer to start with and add to. I hope to be able to keep up. DD was a happy baby to start with but seems even more so now that she's had some additional substantial feeds. IBCLC urged me to come back after DDs weight check at the pediatrician next week so we can do some more work on our latch and continue our breastfeeding journey. I know in my mind how important DDs health is but for some reason I'm just so sad with all this. I'm really hard on myself that we've hit this bump. Anyway, thanks again everyone for their support.

[@llli*mommal]

Pease keep in touch, mama, and let us know how the weight check next week goes.

I know you're really, really concerned about weight gain, and that may be making you scared to nurse- after all, you can't measure output/intake the same way you can with the bottle. Nevertheless, I'm thinking that you might want to nurse more than just 1x per day. The are a few strategies for supplementing and measuring intake which I don't think your IBCLC mentioned, namely:
1. Continue to nurse as usual, but top baby up with a supplement from the bottle after the baby has taken both breasts. Then put baby back on the breast for unlimited suckling- this should help her remember that the breast, not the bottle, is what makes her feel satiated, comfortable, and relaxed.
2. Supplement at the breast using either a Lact-Aid or a Supplemental Nursing System (Medela makes the latter.). At the breast supplementers can be tricky to master, but they enable you to keep the baby on the breast for all feedings.
3. Rent a professional grade scale for a few days. You want something which is accurate to the 1/10 of an oz. By weighing the baby before and after feedings, you can gain a highly accurate picture of how much your baby takes in while nursing. Your IBCLC should have done this at your office visit, but it's best if you can get several days' worth of data. The average feed can vary a lot, and the baby may feed much better or much worse than average when in the IBCLC's office.

[@llli*sunkist56]

Pease keep in touch, mama, and let us know how the weight check next week goes.

I know you're really, really concerned about weight gain, and that may be making you scared to nurse- after all, you can't measure output/intake the same way you can with the bottle. Nevertheless, I'm thinking that you might want to nurse more than just 1x per day. The are a few strategies for supplementing and measuring intake which I don't think your IBCLC mentioned, namely:

Thank you mommal!! I will take everything into consideration. DD took a nap (Funny what being full will do...) so I had a moment to check back in here and I appreciate your suggestions.

I had thought about bringing baby to the breast more than once a day. Mostly, in the evening as we've established a nurse to sleep habit but maybe this is a time to start a different sleep association. I think I'm just super scared my pump output won't be what was suggested - 25-30oz. I want to just give her as much measured milk as I can. I feel this pressure to help her gain weight. So far today I'm about 2oz short (she's had 12 oz and I've pumped 10). I think I will aim for at least some suckling, I miss the closeness with her already!! Some suckling may help my pump output, correct, as well as keeping her familiar with the breast?

It's quite the transition to change our routine. I think we (H, DS(2yo), DD and I are all trying to adjust today. I've been a pumping mama before but I forgot how much work it is!
I'm glad I went and asked for some in-person help and that I have this forum as a resource.