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Thread: Advice?

  1. #1

    Default Advice?

    My baby is 18 days old. She still isn't anywhere near her birthweight. She was born on 12/31 at 6lbs 12oz, and she was weighed today at 6lbs 1oz. My milk took 5 days to come in, because I had a c-section. I breastfeed on demand, which is anywhere near every 30mins-3hrs. When I pump, I get about an ounce total, give or take a few mL. We've been seeing an LC, and she told me to supplement her with 3-4oz 6 times a day, but then she will miss 6 feedings at the breast which won't help my supply any. I'm worried that this will cause me to switch to formula completely. I've been pumping whenever I can, but it's hard when I have a newborn nursing almost constantly. I need some advice.

  2. #2
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    Default Re: Advice?

    3-4 ounces 6 times a day? That sounds like a very odd way for a 2-3 week old baby to be supplemented. It is both too much at once and probably too much daily.

    Supplements may well be in order, but the typical suggestion would be to nurse baby and then supplement an ounce or two at some feedings. (probably not all, as it would be normal for baby to nurse about 12 times a day at least, and will probably not need to be supplemented every feeding.) It is usually ok to supplement a little prior to a feeding as well, this can work better some of the time. If the problem is low milk production, the typical recommendation would be to pump after nursing whenever possible, trying to pump at least as often as baby is supplemented. But I do not understand why you are being told to substitute bottles for entire nursing sessions. Are you sure you understood the instructions correctly?

    Was your consult something like this? : http://cwgenna.com/lconsult.html

    What was baby's lowest weight and when was this taken compared to the last weight check? Were both weights done on the same exact scale, baby in a dry diaper?
    How many times a day does baby poop and can you describe them?

  3. #3

    Default Re: Advice?

    She suggested a syringe & tube at the breast but with me being alone with her for 90% of the feedings, I can't. It's impossible for me to do it with one hand she transitions from bottle to breast & vice versa very well. And yes, same scale, but naked. She's been having 5-6 wet diapers & 4-5 poopy diapers. Her poops are a mustardy color but seedy. The other day she only pooped 3 times but they were HUGE blowouts. Required clothing changes lol. Shes very awake & attentive for a pretty big portion of the day. I usually supplement after I breastfeed, and on a good day she'll take 2oz, but today I had enough pumped to give her 2oz after she breastfed & she only took 20mL. I had to toss the rest after an hour because it was warmed after coming out of the fridge. Sad day.

  4. #4

    Default Re: Advice?

    Today was baby's lowest weight. She lost about 1/2 an ounce since 1/15. That's been her pattern. Losing about 1/2 an ounce at each appointment.

  5. #5
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    Default Re: Advice?

    Ok bear with me so I can go over a couple things about modes of supplementing first. As far as transitioning from breast to bottle- yes, babies do tend to do this just fine at first. Bottles causing breast refusal (aka, nipple confusion) is something that comes about later, the longer bottles are given, the more often they are given, and if they are given in a non-breastfeeding supportive way (too much too fast.) However, if your baby requires supplements, then you have to give them, and if bottles are the only way, that is totally fine. The most important thing to worry about is feeding the baby. You can deal with any issues that bottles may cause later. There are other options aside a syringe or a bottle, such as a cup or spoon, but let's leave that aside for now because I am much more concerned about what you are saying about your baby's weight.

    Ok, so baby is 18 days old and still losing weight? That is very strange, especially if baby is pooping and peeing within normal parameters as it sounds like baby is! While it is typical for a baby to lose weight at first, they then will start re-gaining around day 3-6. So based on your first post I thought you meant baby was regaining weight, but not back up to birth weight yet. I did not understand baby is still losing weight, according to the scales. That misunderstanding is was what I based my first reply on.

    A baby losing weight steadily from birth weight for over two weeks is very, very concerning.

    Here is what I suggest thinking about doing:

    First, Consider if it is possible there is some scale error going on? Does your baby seem like a baby who is steadily losing weight to you? Is baby very sleepy, weak, dehydrated? It just does not make any sense at all, given that poop and pee output. Have all weight checks been on the same very accurate digital infant scale, carefully measured with the same units of measurements, baby entirely naked or only in a dry disposable, with both you and nurse or whoever noting the result on the read out?
    Talk to the pediatrician immediately and request an exam for tongue tie and tests for malabsorption issues or whatever else might be causing your baby to keep losing weight despite getting enough to eat to poop and pee normally! If they tell you to forget it and just give baby formula, without trying to help you figure out why in the world your baby is not gaining weight at the breast, consider finding another doctor.
    Talk to LC again (or a different LC, see the link above for an overview of the kind of care you and baby should be getting from a qualified IBCLC) and get clarity about the supplementing. Even if baby does need 18 or more ounces a day in supplements, why such large feedings at a time? A two week old baby eats about 1-3 ounces at a time at the breast. Are you sure she thinks you should not nurse and supplement only at 6 feedings a day, and why? There may be a good reason for this, but you need to know what that is.
    Last edited by @llli*maddieb; January 18th, 2016 at 07:04 PM.

  6. #6

    Default Re: Advice?

    Baby is very active & attentive, she stays awake for a few hours at a time. Her pee is a very pale yellow, a healthy color. She doesn't fuss often. And they checked her for tongue tie, she doesn't have it. They checked her thyroid levels today, results should be in tomorrow afternoon. I have Graves' disease, basically an overactive thyroid. So they're wondering if she has an overactive thyroid as well because she was exposed to my medications in utero. That could be causing her to lose weight. The LC did almost all of the things on the link you showed me, she didn't check my anatomy but she did everything else. She believes that she should be eating 3-4oz at each feeding. They did the weights on the same scale every time (we always get the same room at the pediatrician for some reason!) and she was completely naked every time. It was me & the nurse every time. She said she needs 3-4oz of formula 6 times a day. She said I can nurse after she gets the formula but she won't be hungry & will refuse the breast.

  7. #7

    Default Re: Advice?

    Also, at the LC appointment on 1/15, they weighed her before & after she nursed. She gained 3oz, which showed she drank 3oz from one breast.

  8. #8
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    Default Re: Advice?

    If she is drinking 3 oz from one breast, I don't understand the need for formula. That's plenty of milk for a young baby- average feedings are 2-4 oz, with frequent feeding making up for small (relative to formula-fed babies) feedings.

    Can you get a scale for home use? I would be interested to know what your own weigh-feed-weight measurements would show. Sometimes babies feed a lot better than average at the LC's office, and sometimes a lot worse. So I think it could be really useful to know what the baby gets at her average feeding- which would mean doing lots of home measurements.

    Also, if supplements are required, why do they have to be formula? If you can pump enough to make up the supplements, that is? It sounds like that has been difficult for you, which makes me wonder what sort of pump you are using. Good double electric, hospital-grade, or something else?

  9. #9
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    Default Re: Advice?

    Ok, well it sounds like they suspect baby has a condition that is causing baby to lose weight despite getting plenty to eat. Right? So are they saying baby needs much more than a baby would typically need to gain well? Do you sense that is what is going on? Because the output and the before and after nursing weight check indicate normal intake.

    That still does not explain why it has to be 3-4 ounces or formula 6 times a day, rather than 2 ounces 9-10 times a day, or some other configuration. It also does not explain why you would not nurse at those times baby is supplemented. Baby might not nurse if they get such a large formula feeding, but maybe baby would.

    I would suggest discuss this with the LC. Explain your concerns about being able to continue to breastfeed, and see if she will suggest a tweak to the way supplements are given that make more sense to you. Also, is the pediatrician saying baby needs that much formula, or is it the LC saying that? Or both?
    I am curious-
    Exactly how many times in a 24 hour day does baby nurse? Any changes in frequency recently?
    Does baby typically take one side at a time or both?
    How long does baby typically nurse for? 15 minutes? 45 minutes? Other? How do you know a nursing session is over?
    Do the home feedings "seem" as good to you as that one at the LC office?
    Last edited by @llli*maddieb; January 19th, 2016 at 09:28 AM.

  10. #10

    Default Re: Advice?

    I will definitely look into getting a scale. When I pump I only get about an ounce at a time so I usually save it until I have 2oz or more & then I give her that as a supplement. I have a brand new Medela Pump In Style Advanced. It gets better each time. I also use a lasinoh manual for middle of the night feedings. I pump the breast she isn't on. She usually only takes one breast, but I always offer her the second. Her thyroid results came back normal. She nurses anywhere from 8-18 times a day. 18 if she's cluster feeding, back to back. She nurses about 30-45 minutes usually. Every now and again she'll have a power session of an hour or more. Sometimes less if she just wants a snack & then bed. The LC is the one who wants me to supplement. We haven't seen the pediatrician since the 6th, her next appointment is tomorrow. Today the nurse came for an in-home visit & she weighed her at 6lbs 2oz. Yesterday was business as usual, she only took one bottle of formula. My husband gave me the day "off" yesterday for a few hours. While i was gone (5 hours) she drank 4oz of breast milk & then I nursed her & she had another 2oz after (I had just pumped before I went home). Today she's been nursing on & off, she had 2oz of formula this morning after nursing.

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