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Thread: Slow weight gain

  1. #1

    Lightbulb Slow weight gain

    Hello!
    I'm here looking for advice on what I can do to help my wee baby girl gain more weight. She's 5 weeks old, and was born at 6 pounds 11 ounces and dropped to 6 pounds 4 ounces at her lowest weight. At her one month appointment last week she was only 7 pounds and was off the chart
    She is a happy baby, makes good eye contact and loves trying to hold her head up. She usually nurses at one breast until it's empty and then falls asleep, but she will sometimes take the second breast. We nurse every 2 hours during the day for as long as she wants and recently we started nursing 1-2 times in the night. (She slept 6-7 hour stretches from birth to 4 weeks and NOTHING woke her).
    I do occasionally pump while she nurses so I have a small stash in the freezer.

    For her to get back onto the chart, even in the 2nd percentile for a 2 month old, she has to gain 2 pounds. I'm very frustrated because I know this isn't likely to happen. Short of putting weights in her diaper, I am at a loss for what I can do to help her gain weight. She's meeting developmental milestones, she nurses to contentment and isn't overly fussy but the ped wants her on the chart.

    My DS was also a slow gainer, and I was bullied into putting him entirely on formula at 2 months (I was told my breastmilk was worthless) so I was hoping to avoid the same thing happening this time around. Any advice is greatly appreciated!

  2. #2
    Join Date
    Oct 2012
    Posts
    2,207

    Default Re: Slow weight gain

    It sounds like the biggest potential problem is the long stretches of sleep at night. Especially early on babies really NEED to be nursing every couple hours around the clock. Even now 1-2 times per night is infrequent especially since she's behind on the weight gain. So I think it would really help to figure out a way to nurse her at night. What are your sleeping arrangements? Having baby close by really helps, ideally in bed with you, or right next to your bed. Also, if baby is being swaddled or given a pacifier at night it might help to stop. The idea is that at the slightest bit of stirring, you take that as baby's cue to feed. And if she's unswaddled and no pacifier and still not stirring, then first you try to breastfeed her in her sleep - many babies will instinctively suck in their sleep, and if she's still not responding, you might have to wake her up more actively. Here are some tips:
    https://www.llli.org/docs/0000000000...py_newborn.pdf

    When you say baby nurses every 2 hours during the day for as long as she wants, are you saying that if she wants to nurse more frequently than every 2 hours, you would not nurse at that time? Most breastfed babies do not follow a strict schedule. They may nurse every hour for several hours, and then go a three hour stretch, and then every couple hours... Or even continuous "cluster feeding," especially in the evening hours. The key is to offer frequently - in your case since you are behind on the weight, you want to offer very very frequently. If baby is not hungry she will not eat so you do not have to worry about overfeeding or that you are "forcing" her.

    Are there any problems with latch? Any pain with latching? Have you seen an IBCLC? Has baby been evaluated for tongue tie?

  3. #3

    Default Re: Slow weight gain

    First off I would discuss with your pediatrician what the goal should be. If baby is truly gaining abnormally, then the goal would be to fix whatever that problem is, so that baby can continue to breast-feed and be gaining. If the baby is not gaining well, it is not ever because breastmilk is "worthless". It would either be because baby is not getting enough breastmilk, which is typically a fixable problem, or there is some underlying health condition that is being missed because the doctors fixating on breast-milk being the problem.

    Solutions may mean adding supplements into the mix, while of course continuing to nurse. But that is not necessarily the only solution or the most appropriate solution other considerations would be having breast-feeding assessed by a lactation consultant, it may mean pumping and giving your baby some of your pumped milk, it may mean nursing more frequently, it may include taking steps to increase your milk production and of course it could mean some combination of the above. But it is important that the goal to not be fixated on getting baby back on some chart, but should instead include as a goal keeping baby nursing. We know that breast-feeding is the healthiest way for a baby to be fed. The American Academy of pediatrics is clear that doctors are supposed to support breast-feeding so whatever the solution is it should include breast-feeding supportive methods. If your baby's pediatrician is not going to support you continuing to breast-feed, then I would suggest trying to get a second opinion.

    So according to the scales, measuring from the lowest known weight to one month check, baby gained 12 ounces in about 3 weeks? Or 4? I'm not clear because babies don't typically begin gaining until they are a few days old. Either way that gain is about half or a Little less then half what would be expected for this time. So if the weight checks are accurate, that is slow enough gain that you do want to try to figure out what's going on in my opinion. But does this gain make sense to you?' Has baby outgrown her newborn outfits? baby feel heavier? Does baby look very skinny? What about output? Has baby been pooping several times the day? Do the poops look yellow, mustardy? I am wondering if we are possibly seen scale error here. To ensure accuracy, all weight checks need to be done on the same scale and baby must be wearing nothing or only a dry diaper every time, and I would also suggest that both you and the nurse or doctor write down the number. I would even suggest insisting on two checks every appointment.
    Last edited by @llli*lllmeg; March 12th, 2014 at 08:41 PM.

  4. #4

    Default Re: Slow weight gain

    I haven't has any issues with pain or problems with latching that I know of. I have seen two LCs and neither indicated there might be an issue.
    What I mean by her nursing every 2 hours is she indicates a desire to nurse about every two hours. If she wants to nurse more frequently, I will happily do so. Usually around 4pm she cluster feeds, sometimes for 2 hours sometimes for 4 hours.

    I don't swaddle her unless I have to shower and there's no one around to hold her and we don't use a pacifier.
    We have pretty unique sleeping arrangements at the moment; we sleep, reclined, on the couch with her in my arms with free access to my breasts. In a couple weeks I will be back in my bed (yay!)and she will be in a co sleeper.

    One of our biggest obstacles is trying to wake her up. She almost always falls asleep and is very difficult to wake (she rarely responds to any gentle waking technique). If we can get her up she almost always goes right back to sleep after a few sucks.

    Currently we wake up around 6/6:30, we go to bed around 10 and she wakes up to nurse at 2am. Sometimes she will be up at 4am as well.

    I hope the issue is as simple as me letting her nap too much. I'll be able to see an LC tomorrow when I go in for my follow up with my midwives.

  5. #5

    Default Re: Slow weight gain

    Quote Originally Posted by @llli*lllmeg View Post
    First off I would discuss with your pediatrician what the goal should be. If baby is truly gaining abnormally, then the goal would be to fix whatever that problem is, so that baby can continue to breast-feed and be gaining. If the baby is not gaining well, it is not ever because breastmilk is "worthless". It would either be because baby is not getting enough breastmilk, which is typically a fixable problem, or there is some underlying health condition that is being missed because the doctors fixating on breast-milk being the problem.

    Solutions may mean adding supplements into the mix, while of course continuing to nurse. But that is not necessarily the only solution or the most appropriate solution other considerations would be having breast-feeding assessed by a lactation consultant, it may mean pumping and giving your baby some of your pumped milk, it may mean nursing more frequently, it may include taking steps to increase your milk production and of course it could mean some combination of the above. But it is important that the goal to not be fixated on getting baby back on some chart, but should instead include as a goal keeping baby nursing. We know that breast-feeding is the healthiest way for a baby to be fed. The American Academy of pediatrics is clear that doctors are supposed to support breast-feeding so whatever the solution is it should include breast-feeding supportive methods. If your baby's pediatrician is not going to support you continuing to breast-feed, then I would suggest trying to get a second opinion.

    So according to the scales, measuring from the lowest known weight to one month check, baby gained 12 ounces in about 3 weeks? Or 4? I'm not clear because babies don't typically begin gaining until they are a few days old. Either way that gain is about half or a Little less then half what would be expected for this time. So if the weight checks are accurate, that is slow enough gain that you do want to try to figure out what's going on in my opinion. But does this gain make sense to you?' Has baby outgrown her newborn outfits? baby feel heavier? Does baby look very skinny? What about output? Has baby been pooping several times the day? Do the poops look yellow, mustardy? I am wondering if we are possibly seen scale error here. To ensure accuracy, all weight checks need to be done on the same scale and baby must be wearing nothing or only a dry diaper every time, and I would also suggest that both you and the nurse or doctor write down the number. I would even suggest insisting on two checks every appointment.
    Sitting here thinking about what she weighed when has made me realize the problem might not be us, but that we were being too closely monitored!
    She was born via c section on 2/4 at 6lb 11oz. When we went to her first appointment on 2/7 she was 6lb 6 oz. one week later on the 14th she was 6lb. 4oz. But the dr. we saw then wasn't too fussed by the loss and told us to come back in a month. I made her 1 month appointment for 3/5, only 3 weeks later! Gah! 12 ounces in 3 weeks is low gain, but not abnormal from what I've been reading(4-7 oz./week).
    She has outgrown in length her preemie outfits (she's not a preemie) and a couple of her newborn sleepers and she's had the appropriate number of BMs from the beginning. I even bought a scale so I could monitor her gain. I'm aware the numbers won't be the same as they are in the dr. Office, but being able to see that they're getting higher will be a huge help.

  6. #6

    Default Re: Slow weight gain

    Well I kind of wish the doctor you saw at day 10 had been a little more proactive because it appears to me that if there was a problem that's when it presented itself. A normally gaining newborn would typically be back or very nearly back to birthweight by the 10 to 14 day point, not continuing to lose weight. Given that difficult start, her gain since then is certainly an improvement although still a bit low. I know that some good sources suggest that gain of between 4 to 7 ounces per week is okay. And it may be for some babies. But more and more lactation consultants are wanting to see, after the typical weight loss of the first few days, a newborn gaining at least about 7 ounces per week or an ounce per day. In part this is because of the more recent charts from to WHO that are based on breast-fed babies. On the other hand I do agree that too close monitoring of weight can cause needless concern as babies do tend to gain in fits and starts so the ounce a day guideline for the first three months is the average gain over that period.

    I think it is smart to encourage baby to nurse as much as baby will. It cannot possibly hurt and it certainly may help. Frequency is probably a bit more important then super long feedings, however if you want to keep baby awake longer at the breast you can try switching sides and also breast compressions. Of course you will talk to your LC about all this, and she can help you assess how breast feeding is going overall.

  7. #7
    Join Date
    May 2006
    Posts
    20,652

    Default Re: Slow weight gain

    Excellent advice from the PPs. I just want to point out that co-sleeping on a couch or other upholstered furniture is the least safe form of co-sleeping. When you're sleeping on a couch, it is very easy for a baby to slip into a gap between cushions and smother; in fact, many of the deaths chalked up to co-sleeping are actually due to this extremely unsafe form of co-sleeping. A lot of moms choose to co-sleep on couches or chairs because they assume it's bed-sharing that is unsafe, not realizing that bed-sharing is safer then couch- or chair-sharing. If you are going to co-sleep, there are plenty of safety checklists to look at, so I'd recommend a little googling as you make decisions about your sleep setup.
    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!"

  8. #8
    Join Date
    Feb 2014
    Posts
    29

    Default Re: Slow weight gain

    My baby fell asleep sometimes in the early weeks and I also have a slow gainer. If you are sleeping skin to skin then try changing her diaper to wake her up. If not, undress her. Sometimes babies are just so snugly they don't want to eat. I know that sleep is essential-trust me before my baby I was the queen of sleep- but getting this figured out will help you rest better. Hang in there and don't give up. Three months later my baby and I are still exclusively breastfeeding. He is still on the low end of the charts but he is still gaining consistently.

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