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Thread: Please help! Slow weight gain + loss in breastfed newborn

  1. #1

    Post Please help! Slow weight gain + loss in breastfed newborn

    Hi all,

    I am feeling sort of desperate and hope someone can offer some advice. My 3-week old and I had a rough start with breastfeeding due to, what I believe, a long labor involving iv/epidural/pitocin, my slightly inverted nipples, and an inability to latch while in the hospital. My baby was 6 lbs 12 oz at birth, but within a week, had dropped to 6lbs despite my best efforts to nurse effectively and frequently, prompting my pediatrician to instruct me to follow each nursing session with 15ml of either formula or breast milk. I am only able to pump around 15ml to 1 oz at a time from both sides for some reason, so reluctantly ended up supplementing with some formula via a syringe or SNS. He gained 3 oz. in 2 days on this regimen. I then saw a lactation consultant who observed our nursing session, gave some tips (along with a nipple shield that I have not used), and ended up saying that we were on the right track right before weighing him at the end of the appointment and declaring that he "got nothing" from that session. She said I should work on increasing my supply and told me about fenugreek.

    At that point, after reading everything I could about breastfeeding, I decided to take matters into my own hands and put baby to breast as much as possible. We typically nurse about 12 times a day and he seems satisfied at first, then seems agitated hungry shortly thereafter. A week later, he gained 4 oz (6 lbs 8 oz). I felt as though we were really getting into a good groove with breastfeeding, it seemed like my supply was increasing with feeding on demand, and I noticed more evident swallowing of liquid than before, which made me feel optimistic.

    However, today (a week after that), his weight check revealed that he has lost 2 oz. since the last weight check a week ago. His current weight is 6 lbs 6 oz., which his ped found alarming, and she sent me over to get an ultrasound right away to rule out pyloric stenosis or something more serious. His ultrasound ended up being normal, so now the ped's protocol is to feed him 2-3 oz. of either breast milk or formula via bottle for every feeding, basically taking my breast out of the equation. I asked her if I could at least finish him at the breast and she reluctantly agreed, citing that she didn't want him to burn too many calories trying to nurse. She has me going to urgent care tomorrow for a weight check after spending the night doing this protocol. I should note that this week, he has been spitting up a lot and projectile vomiting on occasion. He seems to fit the typical signs of acid reflux, but the ped doesn't seem too concerned about it.

    I am feeling extremely discouraged because I've put so much effort into making breastfeeding work and feel like supplementing and formula are working against what we need to achieve. However, I want my baby, who is looking pretty scrawny to be honest, to be healthy and thrive and am willing to do anything to make this situation better. Does anyone have any recommendations for how to best preserve the breastfeeding relationship or am I doomed? It seems like I should be offering the breast before giving the bottle of formula? I am really opposed to formula feeding if I can avoid it and feel quite heartbroken at the moment.

    Thanks for your help.

  2. #2

    Default Re: Please help! Slow weight gain + loss in breastfed newbo

    I forgot to mention that he is producing at least 5-6 wet/poopy diapers per day (often more). The stool is usually mustard/yellow colored, but on occasion, green and mucousy. Also, the ultrasound tech could tell I had fed him before our appointment based on the appearance and contents of his stomach on the screen. So I know he is getting something . . . just maybe not enough?

  3. #3
    Join Date
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    Default Re: Please help! Slow weight gain + loss in breastfed newbo

    Hi I am sure this is very upsetting and frustrating!

    Babies do not gain normally either because they are not getting enough milk or there is some medical issue. (or both) If a baby is not getting enough milk, it may be because baby has issues transferring milk effectively, or mom has low milk production, or a combination. I like to clarify this because sometimes moms are told it has something to do with the content of their milk. But it's about volume into baby, not content.

    First off, have ALL weight checks been on the SAME SCALE with baby in a dry diaper or nothing? This is VITAL. If baby is not weighed correctly every time on the same scale, you have faulty information.

    Is nursing comfortable? Any pain to you, nipple injury?

    How many times a day does baby POOP? I can't tell if the 5/6 refers to poops and wets or combos or what. You want to see at least 3-5 poops of some size each day. enough to scoop up with a spoon, not just a streak. (Streaks are normal they just don't 'count.') assuming baby poops enough, color is irrelevant especially if baby gets formula which changes poops. If baby is pooping lots, that is a good sign of course, but baby does need to be gaining as well. Lots of poops and poor gain would be very puzzling.

    your pump output was normal for a mother who is pumping in between nursing sessions.

    I would suggest seeking a second opinion regarding the bottles replacing breastfeeding. I know of no reason to exclusively bottle feed in such a situation. This is a recipe for the very premature end of breastfeeding, and that would be a serious medical issue for both you and your baby. If baby requires supplements, they can almost always be given on top of frequent breastfeeding. An otherwise healthy baby who is not getting enough at the breast is going to be hungry, so should have no problem taking more milk in if it is offered via cup or bottle.

    Say your baby gains very well overnight. Does this prove anything? No. First off, weight gain is typically erratic. Also, most newborn babies in fact overeat when given bottles. So baby exclusively bottle fed may gain very fast at first, but then slow down again once baby is strong enough to resist being more or less forcefed via the bottle. Everyone will assume that bottle feeding solved the problem, but no one will apologize to you for destroying your breastfeeding relationship if one or two months from now when your milk has dried up, baby continues to be a slow gainer. The fact is, bottles and supplements, which are of course important and necessary in some situations, still only treat the symptom of slow gain and do little if anything to solve the actual problem. The problem is that baby is (apparently) unable to gain normally from only nursing. And you are still trying to figure out why that is. I thin it is reasonable to see if baby can be supplemented as needed while that is figured out.

    I would strongly suggest, if you continue to have to supplement any amount, make sure you are pumping as frequently as you can with a very good pump, a hospital grade rental if possible. Also, if the issue appears to be mostly one of low milk production, there is the possibility of supplementing baby with an at the breast supplementer aka lactation aid.

    Did you like the LC? If not, can you see another? Hasty conclusions about baby getting 'nothing' is an incorrect use of before/after weight checks. Several such checks are needed, along with the accurately measured weight gain overall and the LC's observations, to draw more accurate conclusions.

    I suggest the book Making More Milk for low milk production issues.

  4. #4
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    Default Re: Please help! Slow weight gain + loss in breastfed newbo

    If you decide to continue to nurse, I think you can offer baby any needed supplements both before and/or after nursing as seems reasonable to you. (Unless there is a compelling medical reason to do it one certain way that I am unaware of.) There are benefits and drawbacks to both. Sometimes a little supplement prior to nursing wakes baby up and gets baby nursing better, and this also allows baby to 'finish at the breast' which is helpful for a few reasons. of course the drawback is baby may get full and not want to nurse at all. Supplementing after nursing can work too, it's a very individual thing and you may find yourself doing feedings differently at different times.

  5. #5
    Join Date
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    Default Re: Please help! Slow weight gain + loss in breastfed newbo

    with LLLMeg.

  6. #6

    Default Re: Please help! Slow weight gain + loss in breastfed newbo

    Thank you so much for your quick, thorough, and informative response!

    All weight checks were on the scale in the same pediatrician's office sans diaper.

    Nursing has just started becoming more comfortable, although it is painful when his latch is off. Which happens a lot because he has a little mouth and tucks his bottom lip in very tightly - I try to correct it, but it is difficult.

    Pumping is pretty uncomfortable and was causing my nipples to bleed and scab before I got a larger sized flange. They are healed now but still feel sort of sunburned after pumping or nursing sometimes. I have a Medela Advanced Double Electric that was covered by my insurance. I admittedly don't pump very much, but will start making it a priority. I felt like I had a lot of pain throughout the process of everting my nipples, if that makes sense. I've pumped a few times already this morning and it seems like the amount is increasing a bit. I also started taking Lactation Support by Gaia Herbs according to the directions.

    I looked at my log, and he was doing at least 4 medium to large sized poops per day plus a number of "marks" that were about the size of two quarters.

    I did like the LC until the end of the appointment, when she made that statement and rushed off. I decided against going into urgent care for a weight check today because I would likely spend 1.5 hours in traffic + spend all day in a waiting room, which would be counterproductive to our weight gain goals when I could be feeding him all day at home. The ped wanted me to make an appointment with an LC on Monday (of course, they are going on strike that day), so I will call on Monday and just do the weight check when I get in to see an LC (hopefully a different one).

    I do think that there is a combination of a weak suck/poor latch and low milk supply working against us. I think the hope is that if I can supplement enough and get him to gain weight, then some of the issues related to him being small, like weak suck and tiny latch, will resolve. But I agree that I am sort of being set up to exclusively formula feed if I am already doing just bottles at 3 weeks. I have used the breast supplementer and find it easy to use, but the ped said it "is too much work." So I guess she is just trying to get him to gain the easiest and fastest way possible, but I think that I will move forward with breastfeeding first, then supplementing via supplementer (maybe not even involve the bottle if I can get away with it) and pump after. It is scary adjusting or going against the doctor's advice, especially since I am a first time mom, but I really don't want this roadblock to turn into something larger down the road. I feel resentful about using formula in a bottle when my breasts are dripping milk every hour and a half, you know? I already feel like his latch has gotten a bit weaker today after a night with supplemented bottles.

    I also purchased a scale from Amazon.

    Anyway, thank you so much for your feedback. I truly appreciate it and will definitely check out the book.

  7. #7
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    Default Re: Please help! Slow weight gain + loss in breastfed newbo

    The LC's are going on strike? Well, I hope there is not too much of a delay to see one. Maybe there is a local private practice IBCLC?

    It sounds to me as if maybe your LC ran out of apt time, it happens. If otherwise you liked her, then she could be your best helper.

    So as I suspected, the poops are telling a different story than the gain. All that poop comes from somewhere, so this should definitely be mentioned to your pediatrician and your LC.

    I am not sure why using a lactation aid is too much work. If baby cannot latch and suck well, then baby is not going to be able to remove milk efficiently, and the aid may well help with that if you are using the right one in the right way for your situation.

    Catherine Watson Genna has a good, short article on her website about using lactation aids. It is called 'helping mothers work smarter, not harder" She also has an excellent article on what to expect at a lactation appointment. Find both on her website in the 'clinical corner.'

    Nipple pain indicates a poor latch which of course may lead to poor milk transfer as well. So next steps would include working on that latch, with a helper if possible.

    Has baby been assessed for tongue or lip tie?

    Remember this is early days, many mothers and baby's struggle in the early weeks and go on to have long and satisfying nursing relationships. Keep protecting your milk production and working on the problem. You are making milk and your baby can nurse. Things are not perfect but they could be way worse. So now its a matter of honing in on whatever the blip(s) are that are preventing good gain.

  8. #8

    Default Re: Please help! Slow weight gain + loss in breastfed newbo

    I just wanted to post an update, since I read a lot of these threads & always wonder how things turned out. Unfortunately, we are still struggling and things have become even more complicated. Any advice or just encouragement would truly help at this point because I'm feeling pretty downtrodden in my quest to EBF (but still trying!).

    Since I last posted:
    -We switched DS's care to a pediatrician who is also a certified lactation consultant who helped us improve our latch & positioning immensely and prescribed Zantac for reflux.

    -He started gaining weight, albeit very slowly, but we were encouraged by this & the ped advised me to nurse as much as possible. I noticed mucousy poops & a persistent diaper rash, so cut out dairy with some improvement.

    -I read Making More Milk and started pumping 3-4 times a day after feedings and freezing what I got (I have always only gotten 1/2-1 oz from both sides). I also noticed he swallowed more and my nipples didn't have a lipstick shape in the football hold, so I started nursing him in that hold exclusively, except for side-lying at night.

    -He started gaining approx. 4 oz/week. I kept pumping a few times a day & started giving him a few ounces bm supplement via sns in the evenings to see if it made a difference. It didn't & seemed to make him fussier at the breast in general, so I tapered down to 1 oz, then quit and just nursed him like crazy.

    -He finally seemed to nurse pretty well, with 1-2 let downs on one side and 3-4 on the other, with loud swallows. We nurse at least 8-10 times/day, co-sleep, and I do not swaddle him or use a pacifier.

    -His mucousy poops became more frequent, then for 2 days had a few specks of fresh red blood. My MIL told me her side all had milk, soy, and gluten intolerances as babies, so I cut out soy and again noticed some improvement.

    -He continued to gain 4 oz/week (roughly 1lb/month) no matter what I did, so I started to wonder if that was his norm. I felt like my supply was good & adjusted to his needs & noticed his weight go up by 2-4 ounces with some test feeds using my scale at home and I did switch nursing until he was full, then was able to hand express a bit after he was done. Mucousy poops continued, so I worried about allergies and absorption.

    Since his first month and a half were so rough, this gain ended up only bringing him to almost 9 1/2 lbs with on-track head circumference & length (he grew 6 inches since birth). So at his 4 month visit this week, he was diagnosed as Failure To Thrive, despite meeting milestones and being so happy & bright for the previous 2 months (although I admit, he looks very thin with a large head, but strong). The ped took him off of Zantac because we felt like he might not need it anymore, then referred us to a GI doc to rule out underlying issues. The GI doc ordered a metabolic panel and gave us neocate to supplement a concentrated dose of 2.5 ounces twice/day to help him "catch up." Everything looked good on the labs, but some levels are consistent with him not getting enough calories and being low on iron.

    Fast forward to today, after 6 vaccines, two awful blood draws, and what I suspect is teething, DH has only gotten him to take 2.5 oz of neocate by bottle, with grimacing, gagging, and screaming. We talked to the ped today & put him back on Zantac because he was screaming and arching after nursing. Now he is screaming & crying constantly, won't even go near the neocate, and screaming/refusing my breast unless I have him in the ergo. He is very different from my chilled out, smiley, happy baby of the past 2 months. . And I am wondering if my supply hasn't been enough all along & all of this is going to make him lose weight rather than gain the 1 ounce/day that the GI doc wants to see (we go back in 2 weeks). He seemed full & content before but now he is upset and inconsolable.

    So, our next step is to continue to try to get him to take neocate supplements while I rent a hospital grade pump and work to increase my supply. We also got some iron drops, but I honestly have no idea how he will take the neocate & gain what they want him to. I also feel like he miiiight have an upper lip tie & keep bugging my ped about it, but she insists it is normal.

    Anyway, that is where we are at. I'm pretty exhausted & feel so bad for DS at the moment and just hope this isn't the end of breastfeeding.

  9. #9

    Default Re: Please help! Slow weight gain + loss in breastfed newbo

    I should also add that I have recently cut out gluten, made an appointment to get my thyroid checked next week, and am thinking about taking him to someone in the area who deals with lip ties in infants to check out his mouth, just in case. If anyone has any more ideas for me, please let me know, thanks!

  10. #10
    Join Date
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    Default Re: Please help! Slow weight gain + loss in breastfed newbo

    I am confused- when was baby given the neocate initially? has baby been taking it until now? Did it help with gain?

    Fast forward to today, after 6 vaccines, two awful blood draws, and what I suspect is teething, DH has only gotten him to take 2.5 oz of neocate by bottle, with grimacing, gagging, and screaming. We talked to the ped today & put him back on Zantac because he was screaming and arching after nursing. Now he is screaming & crying constantly, won't even go near the neocate, and screaming/refusing my breast unless I have him in the ergo. He is very different from my chilled out, smiley, happy baby of the past 2 months. . And I am wondering if my supply hasn't been enough all along & all of this is going to make him lose weight rather than gain the 1 ounce/day that the GI doc wants to see (we go back in 2 weeks). He seemed full & content before but now he is upset and inconsolable.
    So is this a temporary issue happening the day of or after vaccines? your baby may be feeling very ill due to the vaccinations, and when someone feels ill they often do not want to eat. We had a horrible episode with my oldest after 4 month shots where he refused to nurse and screamed so hard and long he fainted.

    I would suggest comfort baby as best you can by nursing and in whatever other way baby needs, and also report this severe reaction to your baby's doctor now. , if for no other reason than there will be a record of baby refusing to eat and why.

    your gi doctor wants baby to gain one ounce a day. That is above average gain for a four month old baby. I get it they want baby to 'catch up' but? I just wonder how realistic this is. What happens if baby does not gain an ounce a day?

    And I am wondering if my supply hasn't been enough all along & all of this is going to make him lose weight rather than gain the 1 ounce/day that the GI doc wants to see (we go back in 2 weeks).
    ?? why are you concerned about milk production now, if you were not before? just wondering,

    So, our next step is to continue to try to get him to take neocate supplements while I rent a hospital grade pump and work to increase my supply. We also got some iron drops, but I honestly have no idea how he will take the neocate & gain what they want him to. I also feel like he miiiight have an upper lip tie & keep bugging my ped about it, but she insists it is normal.
    This sounds like a reasonable plan, if a baby is very low on iron it can cause loss of appetite so that would perhaps explain slow gain.

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