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Thread: Please help with 4.5 month old not gaining

  1. #11

    Default Re: Please help with 4.5 month old not gaining

    Quote Originally Posted by @llli*still.here View Post
    It sounds like the dairy elimination helped a lot with the eczema, so I don't think your baby's slow gain is related to the allergy issue.

    I'm going to be completely honest with you. I think you need to let go of the schedule. Your baby is not gaining well because he's not eating enough. Routines are great. Schedules are not. And even routines should be flexible for a baby that young. His needs are constantly changing-going through growth spurts, hitting developmental milestones, all kinds of factors. And all of that is going to alter when and how much he needs to eat on any given day. His tummy can only hold so much at a time and (for now) his body knows how to recognize when it's full vs when it is over-full. Let him learn to listen to those cues and eat when he's hungry (and stop when he's not).

    Your baby is happy and healthy- that is great news. But he's also not gaining the way he should and that is a red flag. The clear solution is to feed him more often.
    I may not have been as clear about his schedule, but it's not imposed by me... I feed him on demand whenever he is hungry, he just seems to be falling into a certain schedule most of the time but I work from home so let him be the boss for when he eats, when he is tired for a nap, etc. I do try to have bedtime fairly consistent (6:15ish) but everything else I go by his needs it just so happens he's fairly consistent. If he only naps for 30 minutes and wakes up hungry, I feed him. If he wakes up at 2am (occasionally does happen) I feed him. Some days we still have 4 naps, other days 3.
    ... But while he does clearly need more, I also am finding it hard to switch from baby-directed feedings to me deciding when he should eat. But from what advice I have gotten here, it seems like adding a 10pm dream feed should be my first added feeding, with also giving additional feeds after or during play times. I do think his spitting up is becoming a problem, but doctor didn't think there was anything we could/should do about it.

    Thanks again.

  2. #12
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    Default Re: Please help with 4.5 month old not gaining

    Throw out the schedule. Your doc may not have thought that nursing just 5x per day was unusual, but most pediatricians don't know much about breastfeeding or about normal feeding frequency for a breastfed baby. That's why La Leche League and lactation consultants exist- to fill that knowledge gap. Your pediatrician's advice- increase the amount per feed but not the number of feedings- is acceptable if outdated advice for formula-fed babies, not breastfed ones.

    Where did you get the 3 hour eat-wake-sleep schedule?

    ETA: I see that the schedule is from the baby himself! With non-demanding babies, you have to be really proactive about offering the breast. Offer in the middle of the night. Offer right before you go to bed. Offer during the day if it's been an hour or two since his last feeding. If he turns you down, no biggy. Just keep offering. Even 1-2 extra feedings per day will add up to significant calories.

  3. #13
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    Oct 2012
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    Default Re: Please help with 4.5 month old not gaining

    Quote Originally Posted by @llli*krisz View Post
    To get in more daytime feeds I would have to feed him before a nap and I didn't want nursing to become a sleep association...?
    I agree with PPs about getting in more feedings, and I like your idea about the 10 pm feeding. But I think another obvious place to add in nursing sessions is before a nap. I'm not sure why you are hesitant about nursing to sleep - a lot of nursing moms LOVE the fact that nursing is their secret sleep weapon! There is absolutely nothing harmful about nursing baby to sleep, in fact in my personal opinion nature has designed it that way (and I think that's why some adults drink warm milk as a sleep aid!). I've always nursed my babies to sleep, my older kids are long since weaned and are perfectly able to go to bed without nursing (they do like a bedtime story and cuddles though!).

  4. #14
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    Default Re: Please help with 4.5 month old not gaining

    Yep, you don't necessarily need to "dictate" when he eats. Just offer more often. (By the way, I don't think nursing him before sleep or right before a nap is going to cause you problems with sleeping unless you are having major reflux where you have to keep him upright for a certain amount of time after eating.)

    If spitting up is bad after trying to push extra into him during infrequent feeds, I think it is an indication that his tummy is too full (probably why many formula fed babies become overweight children, they never learn to stop eating when their tummy is full because they spent all their babyhood having the whole bottle forced into them.)

  5. #15

    Default Re: Please help with 4.5 month old not gaining

    Wow, well lots of you folks seem to not worry about the feed to sleep! I guess I'm afraid of that because I didn't want him to develop a sleep association with it and then NEED me to nurse him in order to be able to fall asleep. I guess I shouldn't worry as much about that at this point since he sleeps really well on his own without sleep props. I'm also always trying not to have his waketime be too long and putting him to sleep at his signs of starting to get the stares or obviously when he yawns. I'll try popping in a few extra feeds during the day, maybe space them about an hour so as not to interrupt his naptimes (again, baby-directed!) and then start a dreamfeed. I hate to mess things up when his natural schedule fits SOOOO well into our lives, but obviously I'd do anything to help my dear one gain the weight he needs!

    Is the fact that he's popping off my breast and sometimes screaming (causing me to do the super switch back and forth) an indication of my supply dropping or is he just going through a bit of a fussy phase? It's hard to tell whether it's a problem with my breast or if it is just him wanting to look around, because he always latches back on hungrily when I turn his head back towards the breast. Am I getting carried away thinking I have a supply problem and pumping after every feeding? It's really time-consuming (not to mention how sensitive my nipples are getting). I rarely feel engorged, never leak milk (I think I have 2 times in 4.5 months), and have a hard time telling if he's completely emptied me.

    As for him not being a demanding baby, I guess I had never really considered that. He's just gradually over time decreased the amount of feedings he wants as he increases his sleep chunks, and I just figured he knows what he needs since he always did in the past and didn't used to have trouble gaining.

    His spitting up happens during feeds too, he'll just sort of leak milk, or spit up between breasts. Sometimes he'll do it after only 4 minutes of nursing. He never ever seems distressed about his spitup, and spits up during EVERY tummy time (we try to save tummy time for the end of playtime, but he still always has big pools of spitup during them).

  6. #16
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    Smile Re: Please help with 4.5 month old not gaining

    If I was concerned that my baby was not gaining normally, and tummy time made my baby throw up, I would stop the tummy time. Tummy time is something that not everyone agrees is absolutely necessary.
    I am sure you have heard many times that if you nurse a baby to sleep it gives them this 'sleep association.' But this is not based on any evidence or science. Nursing to sleep is a universal desire of most babies. Nature would not make most babies love to nurse to sleep and then cause that to be something that is harmful.
    I don't know why your baby is spitting up so much, but I would suspect that the infrequent feeds don't help. Maybe if you are able to increase the number of feeding sessions per day that will also resolve.

    As far as a supply issue, supply is based on demand. If baby has been nursing pretty infrequently for a while, it is a good chance that that has impacted your milk production. But increasing the number of times baby nurses each day should help with that. Adding pumping sessions certainly may also help, but if you're nipples are getting sensitive that signals a problem either with your pump, with your pump routine or with your baby's latch or all three.
    Last edited by @llli*lllmeg; May 14th, 2014 at 05:49 PM.

  7. #17
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    Default Re: Please help with 4.5 month old not gaining

    with LLLMeg, that more frequent feeding and less or no tummy time might decease the spitting up. I am also that the nurse-sleep association is not something to worry about. If it becomes a problem in the future, which is unlikely, you'll do something about it at that time. Right now you have a more significant problem, so that has to come before any other consideration.

    Can you tell us more about the soreness you're experiencing? Is it only associated with pumping, or is it more general? Does it happen when your baby nurses? Is there any possibility that you're pregnant again?

    Also, can you see a different pediatrician? I'm not really liking yours- you came in with a demand-fed baby who is nursing just 5x per day and your doc didn't recommend more feedings and it sounds like he wasn't interested in exploring alternate explanations for the slow gain. I'm thinking that a different doc might possibly pick up on something your current one is missing.

  8. #18

    Default Re: Please help with 4.5 month old not gaining

    Quote Originally Posted by @llli*lllmeg View Post
    If I was concerned that my baby was not gaining normally, and tummy time made my baby throw up, I would stop the tummy time. Tummy time is something that not everyone agrees is absolutely necessary.
    I am sure you have heard many times that if you nurse a baby to sleep it gives them this 'sleep association.' But this is not based on any evidence or science. Nursing to sleep is a universal desire of most babies. Nature would not make most babies love to nurse to sleep and then cause that to be something that is harmful.
    I don't know why your baby is spitting up so much, but I would suspect that the infrequent feeds don't help. Maybe if you are able to increase the number of feeding sessions per day that will also resolve.

    As far as a supply issue, supply is based on demand. If baby has been nursing pretty infrequently for a while, it is a good chance that that has impacted your milk production. But increasing the number of times baby nurses each day should help with that. Adding pumping sessions certainly may also help, but if you're nipples are getting sensitive that signals a problem either with your pump, with your pump routine or with your baby's latch or all three.
    We'll tummy time really just ensures that he throws up, but even without he he spits up (we just can't tell when it will happen, with tummy time it's usually about 5 minutes in). I do try to save it for the end of playtime rather than diving right in.

    He's always spit up, even as a newborn getting 12 feedings a day. I did when I was a baby too (though I didn't have the gaining issues so it was no biggie.

    His latch is good, I think the problem is that the last few days in addition to nursing I've spent over an hour and a half pumping. I think something about when I'm pumping and empty that makes my nipples sensitive, but it's something I only notice when I pump again not bothered much by it during the day.

  9. #19

    Default Re: Please help with 4.5 month old not gaining

    Quote Originally Posted by @llli*mommal View Post
    with LLLMeg, that more frequent feeding and less or no tummy time might decease the spitting up. I am also that the nurse-sleep association is not something to worry about. If it becomes a problem in the future, which is unlikely, you'll do something about it at that time. Right now you have a more significant problem, so that has to come before any other consideration.

    Can you tell us more about the soreness you're experiencing? Is it only associated with pumping, or is it more general? Does it happen when your baby nurses? Is there any possibility that you're pregnant again?

    Also, can you see a different pediatrician? I'm not really liking yours- you came in with a demand-fed baby who is nursing just 5x per day and your doc didn't recommend more feedings and it sounds like he wasn't interested in exploring alternate explanations for the slow gain. I'm thinking that a different doc might possibly pick up on something your current one is missing.
    Yep, agree about switching. We've actually been seeing a family care doc who isn't a pediatrician (my husband and I both see her for our PCP) so we're going to a pediatrician recommended by a friend (who had gaining issues with their first) and have an appointment tomorrow morning with a lactation consultant who will hopefully help get everything back on track for us!

    Fed more often today, shorter naps, and one expressed bottle he drank 4.75oz from. So we really boosted and spread out his intake today.

    Thank you everyone for taking the time to offer suggestions.

  10. #20
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    Default Re: Please help with 4.5 month old not gaining

    http://kellymom.com/health/baby-health/reflux/
    I like mommal's suggestion of reflux/allergy. It's definitely something I'd bring up with the new doctor. When exploring the idea of my youngest having reflux recently, my doctor recommended no caffeine as well as my already dairy free diet.

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