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Thread: Help with newborn

  1. #1

    Default Help with newborn

    Hi! I have a three week old little boy born by c-section. We had no initial problems with latching or feeding in the hospital or after we came home. We went to the newborn first appointment at our pediatrician and he was still at the same weight he was discharged from the hospital at three days prior. We were then asked to return for a weight check three days later. At that appointment he had still not gained any weight. We returned for our two week appointment and he had only gained one ounce from discharge weight. At this appointment the pediatrician had suggested we begin supplementing 6 oz daily with formula. One week later I am very confused. I have begun pumping to see what I get and feeding him the expressed milk at each feeding, possibly supplementing with one ounce of formula if he still seemed hungry. I had been attempting to pump every three hours and exclusively breastfeeding overnight for the past three days, and supplementing. So, at each pumping session I would express between 4 and 1 ounce per session equaling about ten ounces per day with three feedings overnight. This seemed to be working, but I'd really prefer to exclusively breastfeed, however he has become lazy at the feeding...what I'm wondering is, is it too late to get him back to the breast exclusively? How can I go about this and is it possible for me to produce enough milk for him? Please help. With my first child something similar happened and I ended up pumping and supplementing for a year. I thought we were doing well this time around, but he just wasn't gaining weight. Where am I going wrong?

  2. #2
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    Default Re: Help with newborn

    Where am I going wrong?
    I would not suggest YOU are going wrong. I think what was wrong was for your babies pediatrician to tell you to supplement but not ALSO get you help with breastfeeding. If a baby cannot get enough milk when breastfeeding, there is a reason and it is necessary to find out what the reason is so that issue can be solved!

    So, what to do now. First off, NO, it is not too late to get back to exclusive breastfeeding. But the lack of any gain for two weeks is certainly a problem that we still are not sure of the cause. Sometimes exclusive nursing simply is not possible. This does not mean you cannot nurse and supplement as needed. But we don't know if that will be needed longer term or not at this point.

    Milk production depends in very large part on how frequently milk is removed from the breasts. So my first suggestion is to make sure you are removing milk from the breasts VERY frequently, via nursing, pumping, and/or hand expression. At LEAST 10-12 times each 24 hours.

    I have some questions.
    Can you see a board certified lactation consultant for a private consult? She could help you figure out what is wrong ( if anything), what to do about it, and help you wean off the supplements.
    Did nursing ever hurt/does nursing hurt now?
    How is weight gain now?
    How often does baby poop now?
    When baby was not gaining, was baby pooping at least 3 times a day?
    How many times a 24 hour day does baby nurse?
    How many times in a 24 hour day is baby given a bottle of breastmilk and how much is in each bottle?
    How many times in a 24 hour day is baby given a bottle of formula and how much is in each one?
    Are bottles being given using paced bottle feeding tecnnique?
    Have your tried or considered a different way to give baby supplements rather than bottle (cup or at the breast supplementer?)
    How many times a day do you pump?
    What kind of pump and how old is it? If it is old, have you changed out any parts?

  3. #3
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  4. #4

    Default Re: Help with newborn

    I could possibly go to a lactation consultant.

    Nursing hurt the first couple of days, but it does not anymore beside when he first latches on.-Just for the first couple of seconds. My pediatrician observed us and claims his latch is good, so she was not concerned with bottle feeding interrupting our nursing...

    Last weight check my son had gained 5.5 ozs in 5 days.

    I would say we have at least 5+ poopy diapers per day and a very wet diaper each feeding.

    When he was not gaining weight he was pooping each feeding at least once, but the volume was not as large as it currently is. Right now we have less poopy diapers, but more in the diapers.

    At this time throughout the day I make sure I wake him at least every 2-3 hours to nurse/ bottle feed. I had family here for the first two weeks and they encouraged me to let him sleep, so he would sleep some 5 hour stretches and never be set down. Now that we are alone I am not allowing this. At night he will usually sleep in 1-3 hour stretches and we exclusively nurse at night. Now that he is gaining weight, I'm trying to get back to nursing first, then offering the pumped milk after we spend about 15 minutes nursing on each side if he still is showing signs of hunger. If he goes to sleep after that I pump afterward.

    I try not to just offer formula unless I'm extremely exhausted/ frustrated. At most 1-2, 2oz bottles of formula per day, if that.

    When I do offer the bottle I take breaks every half ounce or less, stop to burp at one ounce, then repeat for the second ounce.

    I have not necesarily considered another method of feeding.

    I generally try to pump at least every 3 hours, but sometimes that doesn't work for me with another child in the home. Usually I average between 4-6 times per day.

    I have a Medela pump in style. It is from my first child, so 5 years old. I changed out the tubing on it before using this time around, but it seems to be working as well as it did with my first child.

    I do notice, as I did in the past that one breast produces significantly more milk than the other-between 1-1/2 oz per session. It did in the past as well. Is this normal, or should I be working more with this side to increase production?

  5. #5
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    Default Re: Help with newborn

    Nursing hurt the first couple of days, but it does not anymore beside when he first latches on.-Just for the first couple of seconds. My pediatrician observed us and claims his latch is good, so she was not concerned with bottle feeding interrupting our nursing...
    It is good that baby's latch is primarily comfortable for you. However, latch being 'good' does not mean baby is getting enough milk when nursing, or nursing effectively. Also, latch being good does not mean bottles will not interrupt breastfeeding. It has little if anything to do with it.

    Last weight check my son had gained 5.5 ozs in 5 days
    Great! good gain at this point is about an ounce per day (when a period of time is averaged out-baby will gain differently each day, probably.)

    I would say we have at least 5+ poopy diapers per day and a very wet diaper each feeding.
    Great! That is good output.

    When he was not gaining weight he was pooping each feeding at least once, but the volume was not as large as it currently is. Right now we have less poopy diapers, but more in the diapers
    Interesting. I would have expected a baby who was not gaining at all to not be pooping very much, if at all. The rule of thumb for poops is that a baby is probably getting enough milk if baby is pooping at least 3 times each day, about a tablespoon full of poop or more "to count" (Little squirts here and there are totally normal they just do not 'count.") Some babies, of course, poop much more often, every time they nurse like your baby, and that is normal. The most reliable measure of baby getting enough is correctly done weight checks, but poops do usually tell us something as well.
    I wonder if the change in pattern (fewer but larger) is in part due to the formula.

    At this time throughout the day I make sure I wake him at least every 2-3 hours to nurse/ bottle feed. I had family here for the first two weeks and they encouraged me to let him sleep, so he would sleep some 5 hour stretches and never be set down. Now that we are alone I am not allowing this. At night he will usually sleep in 1-3 hour stretches and we exclusively nurse at night. Now that he is gaining weight, I'm trying to get back to nursing first, then offering the pumped milk after we spend about 15 minutes nursing on each side if he still is showing signs of hunger. If he goes to sleep after that I pump afterward.
    Great. I think those early weeks of baby sleeping too much very likely contributed to the poor gain. Especially under two weeks of age, some babies do need to be awoken or otherwise encouraged to eat often enough, which for the first month or two is usually 10-15 times a 24 hour day. Now that baby is gaining, perhaps instead of supplementing with the bottle if baby is still hungry, you can let baby nurse more. Long feedings are normal at this age, as is baby 'cluster feeding (nursing several times in a short period of time.) If feedings seem very long and unproductive, you can try breast compressions.

    I try not to just offer formula unless I'm extremely exhausted/ frustrated. At most 1-2, 2oz bottles of formula per day, if that.
    so baby is only getting 2-4 ounces of formula a day at this point and gaining so well? This is very good news. That much formula only represents about 10% of typical daily intake.

    When I do offer the bottle I take breaks every half ounce or less, stop to burp at one ounce, then repeat for the second ounce.
    OK, that may be fine. I do suggest check out the video, she suggests pausing every few sucks/swallows, rather than concentrating on how much baby is taking in. Actually I think she says to time it ever 20 seconds or so(?) but I think concentrating on pausing every few sucks/swallows makes the most sense.

    I have not necesarily considered another method of feeding.
    Well I doubt it is necessary at this point. Your baby is being supplemented very little and apparently gaining normally. So I think it is time to consider concentrating on weaning off all supplementing.
    I generally try to pump at least every 3 hours, but sometimes that doesn't work for me with another child in the home. Usually I average between 4-6 times per day.
    Ok. basically it is important to pump whenever baby is supplemented at least, (not at exact same time but close) and more than that if milk production is inadequate and you are trying to increase production. But I am guessing your milk production is normal or close to normal, and that you can start weaning off supplements, so there may be no need to pump at all soon.

    I have a Medela pump in style. It is from my first child, so 5 years old. I changed out the tubing on it before using this time around, but it seems to be working as well as it did with my first child.
    I assume you changed the membranes as well? Pumps are like any other machine. Some last for years of heavy use, others do not. The warrantee of a medela p& s is one year if I am not mistaken. Also, pumps may be malfunctioning without it being obvious.
    If pumping feels comfortable, and you feel that your milk is being adequately 'emptied' by the pump, you are probably ok.

    I do notice, as I did in the past that one breast produces significantly more milk than the other-between 1-1/2 oz per session. It did in the past as well. Is this normal, or should I be working more with this side to increase production?
    It is totally normal, but also there is not harm in pumping the less producing side more, or encouraging baby to nurse that side more often, to try to keep things more in balance.

    So, aside from the formula, is baby exclusively nursing? Or getting bottles of pumped milk as well?
    Bottles can certainly cause a baby to refuse the breast or become lazy about nursing, even if latch is fine. Paced bottle feeding helps, but the best thing of all is to avoid unnecessary bottles entirely. Babies learn to nurse by nursing.

    Here is an article on weaning baby off supplements. It recommends this be done with the guidance of doctor or lactation consultant. If baby is still getting bottles of breastmilk as well, I imagine you can adjust the following to work for weaning off those as well. http://kellymom.com/bf/got-milk/basi...rease-formula/
    Last edited by @llli*lllmeg; June 7th, 2014 at 02:42 PM.

  6. #6

    Default Re: Help with newborn

    Very helpful video on paced feeding. Thank you!

  7. #7

    Default Re: Help with newborn

    My last question would be then, is there anything I can do to encourage my baby to nurse more effectively, or is it just a matter of practice for him? It gets frustrating some times when he just never seems to stop showing signs of hunger and that is when I will give him a bottle of pumped milk or formula. Should I stop that and just let him nurse? My pediatrician advised that anything over 15 minutes on each breast is really just him burning calories trying to get milk, is this true??
    My breasts also never seem to feel full, or even close to, except in the morning when he has slept his 4-5 hour stretch...should they? Could it be a problem that I am just too worried about supply and it is causing issues with my supply?

  8. #8
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    Default Re: Help with newborn

    My last question would be then, is there anything I can do to encourage my baby to nurse more effectively, or is it just a matter of practice for him?
    If your baby is not adequately efficient at the breast, there is a reason. This is why you might see an IBCLC or at least a local breastfeeding support person of some type, to see if there are issues with baby's latch that can be adjusted. See the rest of my post for info on breast compression and switch nursing to help with long feedings, but it is vital to make sure baby has the best latch baby can.

    My pediatrician advised that anything over 15 minutes on each breast is really just him burning calories trying to get milk, is this true??
    No. This is absolutely not true. For one thing, whatever milk that may be stored in a particular breast at a particular time may take a longer or shorter time to extract. But even then, it is fine & normal for baby to continue to nurse. Because breasts are not faucets that turn off and stop ejecting milk when they are "emptied." The lactating breast continues to make milk even as baby nurses. As long as baby nurses, mom can have letdown after letdown. (Some very ill, tiny, premature babies may become exhausted and/or stressed when eating-whether bottles or the breast or any other way. So in those cases, the trick is to get as much into baby as is healthy at once, as quickly as possible. But this is an unusual circumstance.) A healthy newborn nurses for two reasons, to get enough milk to feel sated, and to comfort. Both happen at the same time, And both may well take longer than 15 minutes a side.

    When is timing feeds sometimes suggested? When a mom has low milk production causing baby to not gain normally, so mom has to also supplement baby with a bottle and also pump, every feeding or almost every feeding, and is running out of time to get those activities in. Then, timing feeds may be useful because mom is exhausted and overwhelmed. But even then, timing feeds is done for that reason, not because long feedings are somehow hurting baby. If baby is capable of getting enough milk but is just taking a little longer, it is usually easier to continue to nurse, at least some of the time. How often you might need to 'shorten' a feeding to be sure baby gets a supplement and you have time to pump depends on the situation. Also, a baby can be supplemented prior to nursing so baby finishes at the breast, it is usually a good idea to supplement this way at least some of the time when baby requires supplements. It is important to remember that it is NORMAL for a baby to take longer to nurse in many cases. Newborns nurse 10-15 times each day, and it might be for up to an hour (or more) each time. Frequent and long nursing sessions are normal and not a problem if baby is gaining. What is a problem is if baby is getting all the time at the breast baby needs and still not gaining.

    Unless a mom has low milk production, the typical suggestion is to nurse on one side for as long as baby wishes, and then to switch sides when (and if) baby likes. If baby does not nurse for long or at all on one side at one feeding, start baby on that side at the next feeding. When low milk production is part of what is going on, switching sides once or more each feeding is a usually helpful technique to increase milk production and also to help keep baby nursing more vigorously. But how long you keep baby on one side before switching and how often you switch baby during a single feeding, is entirely up to you and baby, and can change each feeding depending on how baby is doing at that feeding.

    Another trick to keep baby nursing more vigorously, to get more milk into baby at a feeding, and to help with slow gain, is to use breast compressions. http://www.breastfeedinginc.ca/conte...agename=doc-BC

    Could it be a problem that I am just too worried about supply and it is causing issues with my supply?
    If you mean, could your stress over this be causing low milk production, I doubt it. Milk production is not that fragile. What hurts milk production is baby not nursing often enough, long enough, and/or effectively enough.

    I would not worry about how your breasts feel. The normal feelings of a lactating breast will vary, and you are removing milk very frequently. On the other hand, I do think it likely your milk production is not all it could be based on your history. But that is why you are doing all you can now to increase your milk production.

    It is hard to give guidance online like this, and I hope I am not confusing you. Again, I would suggest seeing a board certified lactation consultant or local breastfeeding counselor if you can, or at least, consider it if you are continuing to find baby is not gaining well with baby nursing only (no supplements) or you find you just cannot find a way to wean off supplements.

    I would also suggest www.kellymom.com for good articles on increasing milk production, starting with this one: http://kellymom.com/bf/got-milk/supp...es/low-supply/ as well as the book Making More Milk.

    By the way, please feel welcome to continue to ask questions as long as you like, and to hang around here any way if you like, so you can offer your knowledge and experience to other moms.

  9. #9
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    Default Re: Help with newborn

    Quote Originally Posted by @llli*kat.lo View Post
    My last question would be then, is there anything I can do to encourage my baby to nurse more effectively, or is it just a matter of practice for him? It gets frustrating some times when he just never seems to stop showing signs of hunger and that is when I will give him a bottle of pumped milk or formula. Should I stop that and just let him nurse? My pediatrician advised that anything over 15 minutes on each breast is really just him burning calories trying to get milk, is this true??
    Newborns often take 20 minutes or more per side.

    If baby is still actively sucking/swallowing then I would let baby stay on the breast longer. And if he doesn't keep actively sucking/swallowing and is just kind comfort sucking you could do breast compressions to help him get more milk quicker. I've had issues with ineffective suck because of tongue/lip tie etc and we often have nursing sessions that last over an hour.

    Instead of using bottles we use the Medela SNS to supplement at the breast most of the time.

    Anyway, provided baby is effectively sucking/swallowing/transfering milk then letting baby stay at the beast for longer will help increase milk production as well as get baby the milk he needs. Also remember that sucking is also for comfort and it is ok to put baby to the breast or let him stay for comfort even if he isn't hungry.

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