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Thread: Weight Gain Decrease

  1. #1

    Default Weight Gain Decrease

    I've grown a bit concerned about LO's weight gain over the past few months.

    Here's some stats:

    birth: 7lb12oz; left the hospital 7lb5oz
    1 month: 9lb8oz
    1.5months: 11lb6oz
    2 months: 12lb12oz (85th percentile height and weight, lowish for head)
    2.5 months: 14lb1oz (it was around here that the gain slowed!)***
    3 months: 14lb6oz
    3.5 months: 14lb12oz
    4 months: 15lb0.5oz (75th percentile for height, just under 50th for weight, same as before for head)
    4.5 months: 15lb3oz

    He eats 6 times a day, roughly every 3 hours 6am-9pm. During the week its 3 nursing sessions (approx. 20 minute sessions, nurses well with occasional fussiness on one side) and 3 EBM bottles (4.5 ounces, drinks every drop). If I offer the breast more frequently and he's not fussing, he plays with it for a couple minutes and then stops.

    Has about 7-8 wet diapers and 1 dirty diaper a day.

    I take fenugreek to help with pumping supply. He's been sleeping through the night since around 3 months (though if he wakes at night and isn't easily resettled, I feed him).

    All signs except weight gain would indicate he's getting enough to eat, but kellymom has 4-5 oz/week as the average weight gain for this age range and we've been well below that for 2 months now. He's pediatrician wasn't concerned but my mommy's instinct is telling me this is wrong. I will add that my husband (who was formula fed), was always at or below 50th percentile for weight (and way above for height).

    Any thoughts? If he'd always been a slow gainer I wouldn't be as worried (especially considering his dad), but his gain seems to have really slowed significantly.

  2. #2
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    Default Re: Weight Gain Decrease

    When you discussed with your pediatrician, did s/he provide any other information about why s/he wasn't concerned, or at what point (after what amount of time, after what rate of growth, etc), or what other indicators would need to be present for her/him to be concerned? Or was it more just like, "Eh, who knows! No big deal!"

  3. #3
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    Default Re: Weight Gain Decrease

    Do you give Vitamin D drops?
    (My son and I had all sorts of weight gain issues but his gain slowed way down between about 2.5 and 5.5 months even with supplementing with EBM I couldn't seem to get his weight gain up much and he was at about the 5th percentile for weight during that time.)
    I changed Pediatricians and his new Dr recommended I give him vitamin D drops and since 6 months he has been rising up the percentile charts so that now at almost 8 months he is at about the 25th percentile. (I will note that at about 6 months we also got off all supplementing and have been nursing Lots. Like hourly during the day and several times at least at night.) Vitamin D deficiency can cause poor growth and though Vitamin D can be passed on in breastmilk, Mom needs to have a really good vitamin D level in order to do that and the amount of Vitamin D in prenatal vitamin normally won't help any. Vitamin D is rampantly deficient since most of us are not going out in noonday sun naked for 15 minutes on a regular basis. So Vitamin D drops are actually recommended for all infants though not all doctors tell people that.

    You might also want to have him checked for iron deficiency (was there anything with the pregnancy or birth or your iron levels after his birth that might put him at risk for lower iron levels?) Iron deficiency can reduce apatite.

    Eating only 6 times a day is really infrequent at that age so I would probably say to make a point of nursing him if he wakes at night or even perhaps dream feeding him at night even if he doesn't wake if you can get him to latch on in his sleep. Not nursing at all overnight can also impact your supply which can make it harder to keep up with pumping too.

  4. #4
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    Default Re: Weight Gain Decrease

    I cannot go over weight check numbers right now, but if it is true baby is not gaining normally, Baby may simply need to nurse more often.

    baby gets a total of 13.5 ounces of breastmilk each week day over three bottles. that is about half typical needed daily intake. It is entirely possible baby is not getting that much when nursing 3 times as 4.5 ounces is a fairly large feeding. It is also possible that even 27 ounces is not enough, some babies require a bit more.

    I would suggest keep encouraging baby to nurse more often. If baby continues to refuse to nurse more often, let us know. ideas in this article may help http://kellymom.com/bf/concerns/child/back-to-breast/

  5. #5

    Default Re: Weight Gain Decrease

    Quote Originally Posted by @llli*erin.in.middletown View Post
    When you discussed with your pediatrician, did s/he provide any other information about why s/he wasn't concerned, or at what point (after what amount of time, after what rate of growth, etc), or what other indicators would need to be present for her/him to be concerned? Or was it more just like, "Eh, who knows! No big deal!"
    She said that it's normal for baby's to gain weight slower between 2 and 4 months compared to the 0-2 month stretch and that she would be worried if he showed slower than average growth at his 6 month appointment. I think she thought I was more concerned about the percentile as opposed to getting that I was worried he went a solid 2 weeks without gaining at all and that overall it had slowed. This was at his 4 month appointment where he technically showed a 2 pound 4ish ounce gain over two months, which is great. The problem was that he had been gaining very quickly (and specifically quickly 2-3 months) and then slowed way down (3-4 months). I showed her where I'd been charting his weight so she could see the slow down but she didn't seem concerned. I'm considering messaging her today as today makes it two weeks past his appointment and I'm anticipating a 2-3 ounce gain as opposed to the expected 8-10.

    I have not been giving him Vitamin D which I may need to consider doing, especially as I've personally been struggling to remember to take my vitamins.
    Last edited by @llli*smcc626; November 11th, 2014 at 03:02 PM.

  6. #6

    Default Re: Weight Gain Decrease

    I'll also add this: There was one week that I was off of work and he nursed for all 6 of his feeds (for 9 days straight) where he actually showed a faster gain. Because of this, I don't think there's an issue of him not getting enough when he's actually at the breast. Unfortunately, this was followed by him showing a weight loss a couple days later. It started to make me worried that perhaps he gets more than 4.5oz at the breast and is the rare bird baby who needs significantly more than the average 25oz/day. I don't have any other clues to this however, other than the daycare provider always notes "he finished his bottles to the last drop!" as if she thinks he could still be hungry (but doesn't say it). My mom who watched him for a couple days said the same thing. I've considered trying to send more in his bottles but am worried that it would result in him eating the same amount overall and just getting less from the breast at home which isn't at all what I want.
    Last edited by @llli*smcc626; November 11th, 2014 at 03:06 PM.

  7. #7
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    Default Re: Weight Gain Decrease

    I would definitely try to get him to nurse more when you are with him. Try offering more frequently or getting up at night to see if he will dream feed.

    And Yes I would definitely do the vitamin D drops too (even if you were taking your vitamin all the time, most pre-natal vitamins only have like 400 iu of vitamin D which is way too little to make sure you get it in the breastmilk unless you are drinking LOTS of vitamin D fortified milk and going out in the sun without sunscreen or much clothing which is unlikely this time of year for most people.)

  8. #8
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    Default Re: Weight Gain Decrease

    Quote Originally Posted by @llli*smcc626 View Post
    I'll also add this: There was one week that I was off of work and he nursed for all 6 of his feeds (for 9 days straight) where he actually showed a faster gain. Because of this, I don't think there's an issue of him not getting enough when he's actually at the breast. Unfortunately, this was followed by him showing a weight loss a couple days later. It started to make me worried that perhaps he gets more than 4.5oz at the breast and is the rare bird baby who needs significantly more than the average 25oz/day. I don't have any other clues to this however, other than the daycare provider always notes "he finished his bottles to the last drop!" as if she thinks he could still be hungry (but doesn't say it). My mom who watched him for a couple days said the same thing. I've considered trying to send more in his bottles but am worried that it would result in him eating the same amount overall and just getting less from the breast at home which isn't at all what I want.
    Well, a couple things.

    A baby who needs more than 25 ounces per day is not rare. The norm for intake is between 25-35 ounces per 24 hour day according to the breastfeeding textbook Breastfeeding Answers Made Simple. This is why the rule of thumb for separations is that baby gets 1-1.5 ounces per hour of separation. (24 hours X 1 to 1.5 = 24 to 36 ounces). And what an individual baby may want daily is likely to vary day to day, although overall it will stay in about that range.

    Nursing more often cannot hurt. It can only help. Some babies get enough nursing (or being fed) 6 times a day, but that is the very lowest end of normal for feeding frequency. Not only would nursing more often help baby get more, it would help your milk production, should that be an issue.

    If baby will simply not nurse more often, ever, even if offered regularly, then that would indicate (in my opinion) that baby does not need more, (or baby has a poor appetite for some reason.) But there are other factors to consider- is baby encouraged to comfort nurse, or does baby prefer pacifiers? Is baby sleeping long hours at night, perhaps in another room? Is baby swaddled for sleep? Any of these things might lead to baby nursing less often than baby would otherwise.

    As far as caregiver and grandma thinking baby needs more, I think almost 14 ounces sounds like a the right amount to be sending for a typical separation of 8-9 hours, but that is only assuming baby nurses enough when home to make up the rest of his daily needs. My next question would be if bottles are given using paced feeding.

    If it is true baby transfers 4 ounces a (breast)feeding, even only ONE more nursing session each day would mean 4 more ounces into baby each day. That is significant.
    Last edited by @llli*maddieb; November 11th, 2014 at 04:23 PM.

  9. #9
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    Default Re: Weight Gain Decrease

    Here is a link to an infographic where Nancy Morhbacher (Author of BAMS) explains why some babies need to nurse more often than others to get the same amount of milk overall. You have to scroll down to the one titled "Breast storage Capacity" with drawings of groupings of what look like old fashioned milk bottles. She uses 30 ounces per day average intake as her baseline. http://www.nancymohrbacher.com/multimedia/

  10. #10

    Default Re: Weight Gain Decrease

    Hm, interesting that the author of book and website above has an average intakes of around 30ounces....I've always followed kellymom which has a range of 19-30 and an average of 25 ounces for 1-6 months (http://kellymom.com/bf/pumpingmoms/pumping/milkcalc/). And of course some (like Dr. Sears) still encourage computing amount needed by weight, not age. Those 5 ounces are a big difference in a little body! I will definitely give Vitamin D drops a try and consider adding in a night feeding (he's not interested in another evening feed). Thank you all!

    ETA (for future readers) in response to above: he's not swaddled anymore (not since 2 months) and he sleeps in a pack-n-play in our bedroom. The pacifier is used primarily at nap times and bedtimes.
    Last edited by @llli*smcc626; November 11th, 2014 at 06:26 PM.

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