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Thread: 92nd percentile to 9th percentile in 8 week old infant

  1. #1
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    Mar 2009
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    Default 92nd percentile to 9th percentile in 8 week old infant

    Hello,

    My daughter had her 8 week check up today. She was born at 8 pounds 11 oz and went home at 8 pounds 3 oz. Quite an average birth, though she did have a lot of meconium present and needed to be suctioned right after birth.

    Today she weighed in at a mere 9 pounds 4 oz. She went from being in the 92nd percentile to the 9th in her 8 weeks of life. I felt pretty bad about this.

    She is my third child. I nursed my two sons who are now 4 and 6 until they were 18 mos and 2 years 7 mos old. Never had an issue with growth during all that time.

    I exclusively breastfeed and have four weeks left of maternity leave. The doc said to increase nursing time, decrease working out and increase my fluid intake. I was doing kettlebells which is quite rigorous 6 times a week since my baby was 2 weeks old. I had no idea this would impact my baby's growth! Cutting back immediately to 3 times a week, and much less intense.

    Baby started sleeping for 8 hour stretches overnight a few times a week. I will start waking to an alarm three times per night to make sure she eats. My other children woke more in the night so this is new (the sleeping for longer stretches).

    Doc ruled out medical issues and said her "suction" appeared strong as she sucked on his gloved finger.

    Am I missing anything here to change? My doc is giving me 4 weeks to make a big change, otherwise I will need to supplement. That is totally foreign to me! I really don't want to do that.

    Any helpful thoughts are welcomed. Thank you.

    --Aiden

  2. #2
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    Default Re: 92nd percentile to 9th percentile in 8 week old infant

    Hi! I am with you, I would not have though excercise would be such an issue. Are you also dieting? Not drinking enough water? Taking any hormone based bc?

    Do you thi8nk the issue is your milk production? or maybe something else?

    mostly I am confused how baby could apparently gain so poorly and it not be noticed until now. Did baby have a weight check between the 8 lb 3 oz and this one? Was baby pooping and peeing normally all this time? And how often overall was baby nursing-how many times each day?

    Doctor's suggestions are fine as far as they go. I am not sure what 'increase nursing times' means-nursing more often, or nursing longer? I would suggest trying for both. But were you limiting or timing nursing sessions in any way previously? I also have three kids so I know how busy things can get-do you think baby was very undemanding and so nursing sessions were less frequent>? If you think this is primarily a supply issue, there are other supply increasing measures you can take.

    But aside from that, I would also suggest thinking about seeing an IBCLC if that is in any way possible. There may be more going on here.

  3. #3
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    Default Re: 92nd percentile to 9th percentile in 8 week old infant

    That is what I feel worst about, how could I not have noticed this? Her weight was checked at 1 week of age. Then at 2 weeks. The county nurse at 2 weeks noted baby hadn't gained back her birth weight. I fed as much as possible and maybe by luck or chance, she gained her birthweight back by 4 weeks. That was the last time she had been weighed and I believe she was 8.12 at that time.

    I have been feeding her for longgg sessions I'd say. My other kids two days a week do three sports activities on Tuesdays and Thursdays and I seriously latch her on and she nurses for 2.5 hours just during the kids' sports.

    She eats about 7-9 times a day over a 24 hour period. Usual sessions last about 45 minutes. Sometimes a little more, sometimes a little less. She appears satisfied at the end of a feeding. At night though, sometimes she is hard to settle back in to sleep. I have let her cry which has lasted about 2 minutes (seriously that short) after feeding her at night when she doesn't settle right away. Maybe I should try and feed one more time after she does that and see if that is the missing link. I think doc meant nurse more times per day. Do you think every three hours is enough at night? I want to make sure I am doing enough, yet don't want to completely wipe myself out so I can't care for my other kids.

    I have four weeks left for maternity leave as I said before so I really want to make this work! Oh, and no birth control at this time or other medications.

    Thank you!

  4. #4
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    Default Re: 92nd percentile to 9th percentile in 8 week old infant

    ...from what i can tell various wet and poopy diapers throughout the day. Forgot to add that.

  5. #5
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    Default Re: 92nd percentile to 9th percentile in 8 week old infant

    Ok, I don't want you to feel guilty. if your daughters output and behavior was basically normal, slow gain could be missed, it happens. This is why weight checks are done. I am surprised more was not made of the slow gain initially, because it is certainly a possible sign something is not right if a baby has not gained back to birth weight by 2 weeks and does not get back to birth weight until four weeks. This is when some intervention should have been suggested by your doctor in my opinion (seeing an IBCLC if possible to try to figure out what is wrong, not necessarily supplementing.) It wasn't. That is not your fault.

    So nursing session length is normal or a little long, and nursing frequency is a little low. However, IMO this alone might not account for such slow gain. If a baby is unable to transfer milk efficiently, it is important that that is addressed, even if the issue is also low milk production and baby needing to nurse more often. Even if low supply was not initially the issue, inefficient or not frequent enough nursing will lead to low supply issues.

    It should also be said that sometimes a baby gains poorly due to something that has nothing to do with how much baby eats, and if baby is ill or has some medical issue, that may be hidden if everyone assumes the issue is how much baby is eating.

    So again, I would suggest seeing an IBCLC so she can take a history, observe baby nursing, do a before and after nursing weight check (more than one if possible) and help you get a clearer picture of what is going on. 4 weeks may well be long enough to get this fixed, but it would really help to have clear guidance on what needs fixing.

    Yes, certainly encourage baby to nurse more often, and I would say aim to nurse baby as often as you possibly can, but that does not have to only be at night. You need some time to sleep, so you can encourage baby to nurse more during the day as well. The more often overall that baby nurses, the more milk she will get, and the better for your milk production. So this is very important. I would also suggest breast compressions during nursing (see http://www.breastfeedinginc.ca/conte...agename=doc-BC ) switching sides one or more times every nursing session, and possibly pumping or hand expressing after some feedings if baby is done and they were short. For more ideas for helping low milk production and poor gain, see this article. http://kellymom.com/bf/got-milk/supp...es/low-supply/

    I know it is challenging to give more time to baby when you are already tired and your older kids need you. But this is a potentially serious situation. Typical gain in the first two months is around four pounds, and your baby has gained one.

    You don't mention the doctor or nurse suggesting supplementing. has anyone? I am not saying it is needed or not needed, I am just curious.

  6. #6
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    Default Re: 92nd percentile to 9th percentile in 8 week old infant

    Thank you so much for your responses.

    The county nurse never let me doc know about the slow weight gain to start. My doc was not pleased about this as just like you said, he would have liked to intervene sooner.

    I can look into a lac consultant in the area. I live in very rural MN. We had a lady for many years who isn't officially employed by our area hospital anymore. I thought of giving her a call as well.

    Yes, supplementation was suggested on Friday at my 2 month old visit. The doc said he would let me try to correct the issue in four weeks by waking baby at night and just being very vigilant about feeding her very often. He thinks it is a matter of eating and nothing else (not other medical issues, etc.)

    A family member of mine who is a nurse is strongly suggesting not waiting four weeks and just supplementing right away. I am really torn. She had her shots yesterday (baby) and is very lethargic today, but I am still waking her to eat every two hours during the day and last night I had her up twice and she woke up once to eat. She is a little "out of it" during feedings, but I felt myself letdown at least 4 times in 45 minutes in the last feeding.

    I am planning on having her weighed on the same scale Monday. What could I hope for as a "good" weight gain? She was 9.4 Friday. I am wondering if her having had her shots will work against me with her gaining weight over the weekend.

    Thank you.

  7. #7
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    Default Re: 92nd percentile to 9th percentile in 8 week old infant

    I know when mine got his 2 month shots, he was a bit "off his feed" for a day or so after.

    Do you have a milk stockpile and are you pumping in prep for going back to work? If so you could always give her some supplement bottles of Breast milk (I'm thinking only one a day here) if you supply is in any way on the low side at the moment of course that would mean extra pumping in addition but since you have a month before returning to work......

    I understand normal weight gain is usually between 4-8 oz per week for an infant between about 2 weeks and 6 months. I expect the doctor is going to want you trending on the high side of that over the month. I too am curious about how much weight gain can be expected when "trying to make up for poor weight gain"? I too am struggling with a poor weight gain situation though mine is having milk transfer issues.

  8. #8
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    Default Re: 92nd percentile to 9th percentile in 8 week old infant

    As far as "making up" for initial poor gain, I have no idea how possible or even necessary that is. I simply do not know what the science is on that or if there is science on it, especially for otherwise healthy full term babies. To me, it makes little sense to expect a baby to suddenly start gaining way over the average normal gain for their age, when previously they gained much less.

    As long as a person is not actually malnourished long term, genetics dictate how big a person actually gets. So eventually, everyone 'catches up" if that makes sense. Speaking of that, You did not mention how baby's height and head circumference growth. If that has been normal, that may be why the pediatrician is willing to hold off on insisting on supplementing.

    But if the issue is as simple as baby needs to eat more, if baby is nursing more and there is milk, baby should start gaining more rapidly.

    If your doctor is ok with you not supplementing at this point, I think you can hold off if you like. But I see no reason to wait an entire month and hope for the best, so I am glad you are having another weight check. Don't weight too often, though. That can be misleading because baby's do not typically gain in a constant manner.

    As far as what to hope for, lets break it down. But first I would suggest, ask your doctor what he expects to see. His (or her) answer is important.

    OK- so by dividing 16 ounces (gain) by 60 days (two months), I come up with a number that shows baby gaining an overall average of a quarter ounce per day, or not quite 2 ounces per week, in the first two months of life.


    If you go by the once month weight instead, you would divide 8 (ounces gained) by 30 days. It comes out the same, about a quarter ounce a day. So baby gaining more than that would indicate a step in the right direction. But for an under 3 month old, about one ounce a day or 6-8 ounces per week is average gain.

    If you do wish to supplement, as pp suggests, you can do that with your own milk. Even a few more ounces into baby each day should make a difference in weigh gain. But in order to make sure supplementing is not further interfering with milk production, you will want to try to pump every time baby is supplemented. (not at exactly the same time but as close as you can.) Also, if you are using the same pump you had with your older kids, I suggest trouble shooting your pump, making sure the breast shells still fit you correctly, and replacing worn parts, or getting a new one.

  9. #9
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    Default Re: 92nd percentile to 9th percentile in 8 week old infant

    Very good. Yes, head circ. is good--baby's head grew normally--her head is in the 97th percentile. She also grew an inch so is now 22 inches.

    Thank you so much for the estimates on weight. I plan to have her weighed at the clinic on Monday (she was last weighed Friday) and then again by the county nurse coming to the house on Friday. I only have a couple bags of milk. What I did last time was just had a couple bags and then started pumping right away. I just hate to pump as it reminds me of going back to work..and I will have to do plenty of pumping then. But I can certainly revisit my opinion on that. I just find it hard to pump and breastfeed almost at the same time.

    I noticed tonight, after a good 30 hours now of feeding every two hours during daytime and every 3 at night, that my uterus feels like it did in the early weeks after delivery. Weird. I am hoping this is a good sign that I am making more milk or something...maybe that is my imagination.

    I gave baby tylenol tonight and have found that she ate better afterward. Could be coincidence or maybe it helped with her little achy body.

    Have a good night. I will keep all posted!

  10. #10
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    Default Re: 92nd percentile to 9th percentile in 8 week old infant

    Little update...in four days she gained four ounces! I think ive gotten about four hours sleep a night as well.....but at this time ot is surely helping!

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