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Thread: 4 month old not gaining adequate weight

  1. #1

    Exclamation 4 month old not gaining adequate weight

    Hi, we had our 4 month check up with my son 2 days ago and discovered he has only gained one pound since his 2 month visit. The doctor recommended pumping after each feed and feeding him the pumped amount by bottle for two weeks, and then we will reweight him.

    I'm so disappointed and upset. I thought things were going well- we got over some latch issues, he went from eating for 30 minutes- 1 hour at a time down to 15 minutes, and he seems happy, healthy, and is meeting all milestones. I feed him on demand whenever he wants and occasionally pump in the evening after he's gone to bed to have a small freezer stash on hand. He is on the breast at least 10x a day.

    He does have reflux and spits up a lot. We briefly tried medication but it didn't seem to help so we discontinued it. I'm unsure weather his weight issues are due to the reflux or low supply on my part, but until we see the dr in 2 weeks I'm doing my best to attempt to increase my supply.

    Along with pumping after feeds what should I be doing to increase my supply? I also have 4 year old twins that are a handful and getting to the pump right after he eats isn't always feasible- on those occasions I get to it asap and then feed it to him after the following feed (I'm trying to be one pump session ahead for precisely this reason). The doctor said I shouldn't worry about also pumping after feeds at night. He often sleeps 8-10 hours at night (should I be getting up at some point there to feed him or pump to up my supply?). Also if his naps get mixed up he will occasionally take a really long nap during the day (4 hours)- he did this today so after he was down for a couple hours I pumped.

    Also- any ideas on why my supply might be low? I got the mirena iud at 6 weeks pp but they said it wouldn't affect breastfeeding. Could his long night stretches be affecting my milk supply (but then don't many babies eventually sleep that long and still breastfeed?).

    Thanks in advance for the help.

  2. #2
    Join Date
    May 2006
    Posts
    24,794

    Default Re: 4 month old not gaining adequate weight

    Welcome to the forum!

    My first question is, are you 100% sure that baby was weighed correctly? That means being weighed in the nude and on the same scale used to record his last weight. (Differences in scale calibration are a common source of error.)

    Second question: can you post a complete weight history for the baby, including birth weight, lowest known weight, and weight at every subsequent checkup? It helps if you can give it in the following format: baby's age in weeks or months/baby's weight in lbs or kg, e.g., 2 weeks/9 lbs or 5 weeks/2.5 kg.

    Third question: has the baby continued to grow in length and head circumference? Has he gone up a size in diapers? Outgrown some of his outfits?

    A couple things jump out from your post. First, baby's feeding frequency is terrific- except at night. Yes, a lot of breastfed babies eventually sleep through the night and it doesn't harm their weight gain. But when weight gain is a concern, very long sleep stretches are your enemy. Nighttime is a great time to pack some extra calories into a baby. You can encourage this by doing some or all of the following things: sleep in close proximity to the baby, so that you can catch him stirring and nurse him; adding in a "dream-feed" right before you go to bed; if the baby sleeps swaddled or with a pacifier, take those sleep-extending tools away.

    Second, you have a Mirena. Yes, it is supposed to be just fine for breastfeeding, but there is very good anecdotal evidence that for some women, Mirena has a negative impact on supply. This is why I think it makes sense to avoid hormonal contraception- even the supposedly safe forms- for the first year. Not such a long time to rely on condoms or some other barrier contraceptive, right? Especially considering the reduced amount of sex most couples are having in the first year!

  3. #3

    Default Re: 4 month old not gaining adequate weight

    Thanks for the reply!

    At birth he was 8lbs 12oz, 22" (born right at term). At 5 days he was down 7lbs 13, at 16 days 8lbs 8oz, at 1 month 9lbs 11oz, 2 months 11lbs 7oz, and now 4 months 12lbs 11oz, 26". Same scale every time at the doctors office, always naked without a diaper. He was also weighed at the lactation consultant's later that day and the weight was confirmed.

    He's definitely grown out of clothes. I cloth diaper and he grew out of the newborn size into one size but the waist has remained the same in the one size. He's gone from newborn clothes to 6/9 month, but that's all length. Head circumference has grown normally as well, I don't have all data points, but it's around 37th percentile right now.

    I made an appointment to have the mirena taken out. I woke him for a dream feed yesterday evening that seemed to go well (as in he didn't really wake but seemed to drink a bit and then go back down easily), how often should I do that? Every 4 hours?

    Today we've been at home all day for the first time since starting pumping after every feed so I've been able to keep up with it pretty well. I've been getting 1-1.5oz out after he pops off and won't relatch again, and he readily drinks that from a bottle. This morning he was still acting hungry after he wouldn't relatch and had drank 1.5oz of bm, so I gave him 2oz formula, he still acted hungry so I gave him 2oz more and then he was happy. It's alarming to me to have him drink 4oz after getting everything my boobs had.

  4. #4
    Join Date
    Jun 2009
    Posts
    10,754

    Default Re: 4 month old not gaining adequate weight

    Hi since I am online I am going to pop in and offer some thoughts. PLEASE check my math.

    It's alarming to me to have him drink 4oz after getting everything my boobs had.
    Babies are notorious for taking more from bottles than they really need. So this may not mean anything.

    I wonder if your baby may simply be a long and lean baby? If I understand correctly your baby has never stopped growing, nor is baby growing (in height anyway) at all slowly, but rather, quickly? Just gain seems slow. Also it sounds like there is still milk in the breasts after baby voluntarily stops nursing, which would indicate baby indeed did get enough milk when nursing, and if not, might nurse again after a break? It sounds like you know what you are doing around babies and frankly I think that by 4 months you would have figured out If you had a hungry, unsatisfied baby on your hands.

    So, lets look at the numbers. This is where the detective work comes in. I am throwing out birth weight as it is irrelevant at this point.
    At 5 days he was down 7lbs 13, at 16 days 8lbs 8oz, at 1 month 9lbs 11oz, 2 months 11lbs 7oz, and now 4 months 12lbs 11oz, 26"
    So from 5 days to 16, a period of about 10 days, baby gained 11 ounces. Normal average gain.
    From 16 days to 1 month, a period of about 14 days, baby gained over a pound- 19 ounces. Slightly above average gain.
    from 1 month to 2 months, a period of about 30 days, baby gained almost 2 pounds -slightly under 30 ounces total. Still normal average gain
    From 2 months to 4 months, a period of 60 days, baby gained a little over a pound- 20 ounces.
    Somewhere in between 2 and 4 months, that is where growth began to slow. (Or maybe gain stopped for a period and started again, or baby lost some weight at some point and is gaining again- in other words based only on weight checks, there is no way to know if gain was slow that whole period, or only part of it, and if it was part, which part- recently or several weeks ago? So based just on those numbers, whether or not gain is normal right now is also unclear.)

    Now some slowing of rate of gain after about 3 months is entirely normal. But I wonder if anything else happened in the last 2 months. We know the bc happened. What about illness in baby or you, especially something that would impact gain or nursing effectiveness like diarrhea or a severe cold? Did baby start sleeping longer stretches, nursing less often or for shorter periods, go from both breasts at a time to one, etc.

    Either the gain of the last 2 months is normal for this particular baby, and there is nothing to worry about, or something changed to reduce the amount of milk baby was getting. (Or baby has some undiagnosed health issue causing slow gain, this is the least likely but is a possibility.) Up until 2 months ago (or more recently) your milk production and your baby's gain were both clearly fine. Milk does not just stop being enough for no reason. So IF this gain is not normal, something happened. I am pretty sure reflux would have to be very severe to cause poor gain. But maybe the reflux is a symptom of something else- allergy? But again, I think it would have to be severe to cause poor gain.

    I think you can wake baby for dream feeds as often it works for you. 4 hours sounds fine. More frequent nursing, more milk into baby, and if milk production needs any help, more nursing helps that too.
    Last edited by @llli*maddieb; November 12th, 2016 at 12:02 AM.

  5. #5
    Join Date
    Oct 2009
    Posts
    2,710

    Default Re: 4 month old not gaining adequate weight

    When did baby start sleeping so long at night? That would definitely be my first place to start if I were looking to increase supply.

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