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Thread: No Weight Gain for 3 weeks

  1. #1

    Default No Weight Gain for 3 weeks

    My 22 week old daughter has shown no weight gain in the past 3 weeks. Our pediatrician saw her yesterday and does not seem that concerned, since her length and head growth curves are normal. BUt he advised we begin to offer more solids and a bottle after evening feedings, which I know is counterproductive to our EBF. She has always had 6-8 wet diapers/day, is a happy baby with fat cheeks , and no one else seems concerned but me. I went back to work 2 half days (8-12) about 6 weeks ago, and she's never taken a bottle very well (1-1.5oz at best, for 5 hr period). we usually reverse cycle to catch up. Since her activity level and distractibility increased at 4 months, night nursing has become the best quality session--usually 2-3 times per night she wakes to feed. The newest challenge is teething-her first tooth just erupted and has been causing immense pain. She withdraws a lot at the breast, fussy, sometimes not latching and sucking long enough to get a let down, and getting angry cry. Sometimes she can be helped with cold teethers and pressure on her gums intermittently, but sometimes we have to give her Tylenol at night to sleep comfortably (physician recommended). Please help! I don't want her to lose weight! The last LC I had visit about a month ago when she started dropping growth curves suggested if things didn't improve to have her checked for posterior tongue tie, but felt this would be a last resort. She ended up gaining 6 oz in a week, so we stopped worrying until yesterday when she showed a big plateau at her weight check. TIA!

    Weight history:
    2/19 7-13 Birth
    2/24 7-7
    2/25 7-11
    2/27 7-13
    3/24 10-13 (had oversupply issues too)
    4/19 12-13
    6/1 13-13
    6/21 14 (teething started about 4 mo)
    6/30 14-1
    7/7 14-7
    7/30 14-7

  2. #2
    Join Date
    Jun 2009

    Default Re: No Weight Gain for 3 weeks

    But he advised we begin to offer more solids and a bottle after evening feedings,
    IS baby offered any solids at this point, and when did they start? Also, a bottle of what?

    How do you know your baby did not gain anything in 3 weeks? What I mean is, why was baby weighed on the 7th and then again on the 30th? Were these weight checks both at the doctor and on the same scale? If they were both at the doctor, why did baby see doctor in each case?

    Were all checks always on the same scale?

    And why did you see an LC last month? Did she do a before and after nursing weight check and find that intake was below normal? I am wondering where the tongue tie supposition is coming from.

    You say you had OP. Did you do anything to reduce your milk production? If so, what and for how long?

    According to the numbers, your baby gained very fast- faster than average- during March and April. Then between 4-19 and 6-21 gain slowed considerably. So I am wondering what, if anything, changed around mid-April? Illness? Meal scheduling? Block nursing? Baby sleeping longer stretches? Etc.

    I do not think two half days a week of low bottle intake while you are at work is going to be all that significant assuming baby is able to nurse as much as baby pleases day and night and gets no other bottles. So overall, how many times in 24 hours does baby typically nurse? Does baby take a pacifier? Is baby swaddled for sleep? Is baby sleeping in a separate room from you? Are any meal or sleep scheduling methods being done?
    When baby nurses, does baby prefer both sides? Have you tried other positions? How do you know baby is not getting a "letdown' when baby nurses? Nursing is usually soothing, but if it is not for baby, I think the methods you are trying for teething pain already make sense. If Tylenol helps her sleep, what about Tylenol or Advil to help baby nurse more comfortably? I realize you do not want your baby to get too much medicine, but if the teething pain is so great it is causing baby to not be able to nurse that is pretty serious.

    Couple things:
    Babies move up and down growth curves. This is entirely normal.
    Weight gain rate normally slows at age 3-4 months.
    Weight gain is rarely steady. Yes, baby should not LOSE weight unless baby is quite ill. But a weight gain plateau here and there is 100% normal.
    Scales matter. If baby is weighed on different scales, the weight checks have to be assumed to not be accurate. Also, the possibility of human error must be taken into account.

    You are worried. Well, you are mom and know your baby best. Is your worry due mostly to the weight checks, or does baby seem unwell or as if baby is doing poorly to you? Skinny? Hungry? Disinterested in nursing? Do you sense that something else might be going on aside teething pain?

  3. #3
    Join Date
    May 2006

    Default Re: No Weight Gain for 3 weeks

    with MaddieB!

  4. #4

    Default Re: No Weight Gain for 3 weeks

    Maddieb, thank you so much for your responsive followup!

    Our Ped advised go ahead and start solids at her 4 month checkup, just for intro to textures. So we have been offering one a week (every few days, a tablespoon or two at most) starting with oatmeal/breastmilk, then avocado/breastmilk, then sweet potato/breastmilk. She really likes to eat from a spoon and has all the developmental markers for eating, so I was in agreement at first. Now, I think we should back off solids when MD is telling us to increase so she gets more calories when I am away from her at work, when she's not taking a bottle of milk >1-2 oz. He didn't push formula at all, and we haven't tried it.

    We went in at 4 months for a checkup and she had slow weight gain (only 4 oz in 4 weeks). She had recently begun sleeping through the night, and moved into her crib in nursery at around 3 months (sometimes waking at 3am for feeding but otherwise 8pm-6am, so I attributed it to that). The doc wanted to see us once a week for weight checks. That's when we saw the LC who thought it was all teething but told us to check into tongue tie if things didn't resolve-she noticed some clicking occasionally but latch looked good to her. On the third week, she gained 6oz in one week so we were released from weekly weigh-ins. All was well. Then teething pain worsened, distractibility worsened, and my period returned. I feared a dip in my supply, and also felt like she wasn't getting any heavier when I held her. So I voluntarily took her in at 22 weeks, hence the 3 week interval. All weight checks on same scale, different nurses though. Never have done before and after nursing checks, but will possibly tomorrow at a new pediatrician who is supposed to be more pro-breastfeeding.

    I did blocked feeding to help reduce oversupply early on, which is why I think she gained a lot early--heavy letdown and choking issues, engorgement, mastitis, etc. Now I am pumping to keep supply up, like I have undersupply now. We do use a pacifier for initiating naps and bedtime but she drops it out and doesn't bother with it.
    With the last checkup, we moved her back into our room to increase prolactin and feedings (now she wakes up 2-3 times sometimes, I think to catch up). NO scheduling, have always fed on demand and she's always demanded about every 2-3 hours. Have never gone 4 hours.

    We also started reclined nursing again, so I think it's helping her deeper latch. Sometimes she falls asleep on one side, and I offer other but she is done. Sometimes I switch back and forth if she is continually fussy. I also do compressions to help her get steady flow and try to keep her on one to get hindmilk when she is agreeable to settling on one side.

    Her diapers are fitting looser, and her belly has gotten skinny--we were used to fat belly. She still has some fat wrists and a crease or two on her thighs but definitely leaner, taller, thinner baby. Makes me sad sometimes to hold her and feel her little ribs when I used to only have baby fat in my hands! Also, her length increased a lot at 4 month mark by 2 inches (26inches), which has stayed the same since the last check.

    I have worried about my supply, her "almost nursing strike", and the consequences if we keep going down this cycle. Tomorrow should help with a new MD, and I have the name of a specialist who assesses tongue tie also.

    Thank you so much for all the good inquiry and any info is so appreciated!

  5. #5
    Join Date
    Jun 2009

    Default Re: No Weight Gain for 3 weeks

    Yes I think checking for tongue tie or some other reason baby might no longer transferring well makes sense. Sometimes when there is OP, baby gets lots of milk despite having issues with transfer, and when the milk production is reduced, baby starts gaining less rapidly. But I do think a before and after nursing weight check would give you more information on if that is the problem- of course, a single before and after nursing weight check only tells you what happened at that nursing session so it is not definitive.

    When you pump, how much do you typically get and how long does it take?

    So, maybe the doctor will have more for you.

    Overall, I think it helps to understand why weight gain rate might reduce.

    1) It is just who baby is, this is their growth pattern and it is normal and healthy.
    2) Baby is not getting enough milk for some reason.
    3) Baby is ill or has some medical condition.

    So, assuming it is number 2, the cure would be to increase milk into baby. This can be done a number of ways but basically it would come down to encouraging frequent nursing and doing what you can to improve transfer when baby nurses. Also if mom has low milk production, doing things to increase milk production, which would usually mean nursing frequently, pumping, and maybe considering some type of galactagogue.

    If solids are offered once a day or less and mixed with breastmilk, I am not sure how they could impact gain so dramatically, although if the solids also decreased nursing frequency that would have reduced milk production. But maybe it was a combo of things- sleeping longer at night, you being back to work part time, solids, plus the teething creating a perfect storm of issues that reduced baby's breastmilk intake.

    We do use a pacifier for initiating naps and bedtime but she drops it out and doesn't bother with it.
    I am not sure if you mean the paci is instead of nursing baby to sleep? If the paci takes the place of nursing, ever, than it might impact intake as well.

    For increasing milk intake during a nursing session, breast compressions and encouraging baby to switch sides at least once per session might help.

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