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Thread: 5-month-old eats only 15-20 ounces, not gaining weight

  1. #1
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    Default 5-month-old eats only 15-20 ounces, not gaining weight

    I posted before about my daughter when she was almost 3 months old. That post is here. No one has ever accused me of not being thorough, so apologies in advance for the very long post.

    Starting at 2 months she began to scream at the breast, completely refusing to eat a lot of the time. While she no longer screams at the breast, her nursing problems have only become worse.

    During the day, she might suck a little then pull off when there's a letdown and not go back. I have an overactive letdown. I am wondering if this traumatized her around 2 months and ruined our nursing relationship, but there are plenty of times where she nurses fine despite the letdown. It's also much less strong than it used to be. I used to have five streams shooting out but now it is just one. I have much less milk now too.

    Or she might nurse just a little. One ounce then pull off and refuse to eat any more.

    Or she might refuse to nurse at all. Definitely when we are in public or if there's something even remotely interesting in the room. She will be visibly hungry, clawing at me to eat and then refuse to eat or just eat a little. And I know babies can be efficient eaters. I am certain she is not eating as I weigh her and can hear minimal swallows. I know a good feed from a bad one.

    I often have to wait for her to go to sleep to feed her. I can't remember the last time we had a good awake daytime feed. Now even when she's asleep during the day I can tell she's not eating much. I do a dreamfeed before bed and she used to wake once to eat during the night, but now it's twice. Those night feeds don't feel as full as before but now there's two instead of one.

    All this means she barely eats. I would estimate that she eats about 15 ounces per 24 hours (weighted feeds and diaper output). This has gone down recently from about 20 ounces.

    I got a scale but it is only accurate to the half-ounce and it is hard to weigh a squirmy baby. Nevertheless, I can tell she has not gained weight recently. Below are her weights from the last month. All these weights are several hours after the previous feeding, same day of week and same time of day.

    Week 20: 13,8.5
    Week 21: 13,12.5
    Week 22: 13,15
    Week 23: 13,15
    Week 24: 13,13

    (Her previous weights seem irrelevant to me, but the gist is that she gained 9 oz/week for the first month, then 6 oz/week for the second month, then it's gone down to about 3 oz/week til a few weeks ago, when it's 0-3/week.)

    I weigh her diapers. In the morning they're often 8 ounces (not including diaper weight) but then throughout the day they're usually only an ounce or less (maybe 3-4 additional diapers, so 4-5 per 24 hours making about 10-15 ounces of urine.) Her urine is clear/light yellow and she doesn't seem dehydrated.

    She is very happy most of the time and is developmentally on track. In fact, she's way ahead of where my son was at this age. She rolls all over the place and is starting to try to crawl. She spends most of the time on her tummy--she flips over immediately and won't flip back. I'm wondering if her activity has led to her losing weight recently.


    I have emailed the pediatrician (since we haven't been home in 1.5 months) and last I emailed with him he was not concerned--that was when she was eating about 20 ounces a day and before she lost weight from one week to the next. He's waiting to see if she settles into a lower percentile. She had dropped from 27ish to 20ish but now it's 18th. He also said some babies just need fewer ounces a day. I appreciate that he's not concerned and not pushing formula but I'm starting to think there's something really wrong and that I need to talk to an IBCLC.

    He does think it's ok to start feeding her solids and she is chomping at the bit to eat our food. I plan to do BLW and may start next week to see if it helps her gain weight. But I know she doesn't just need calories; I'm terrified she's not getting enough BM and that her brain development will suffer.

    To complicate matters, we are traveling for 2.5 months (starting at the age of 4 months). Literally. Flying all over the U.S. and visiting several countries in Europe. So I don't get the benefit of having a controlled, quiet home environment. To make matters worse, she refuses to eat on the plane (I've been on 5+-hour flights with her) or at car rest stops. However, I know the travel is not the start of all our problems, as they well preceded the beginning of travel.

    Is it possible she has silent reflux? I've read lots of websites on the symptoms and the only one she has is the fussy eating. She has no other symptoms, so I don't think this is it, but I'd feel awful if she had some problem like this and I was missing it.

    I've thought about giving her pumped milk or formula in a bottle, but I don't think she'll take a bottle and I'm not sure how a bottle would solve the problem.

    I am sure my supply has tanked because of the lack of demand, so I'm thinking I may start pumping 3-4 times a day to up it. Not sure that will help either.

    Any ideas as to what's going on with her? Why won't she eat? What can I do? What would be your next step(s) in my situation?

    Thank you for your help!

  2. #2
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    Default Re: 5-month-old eats only 15-20 ounces, not gaining weight

    Since you think your baby is not getting enough to eat, and baby will not nurse any more often even when offered, I would suggest pumping when you can and offering that milk to your baby and see what happens. If the supplements simply replace nursing, in other words, if baby actually nurses less, and is not taking overall more milk and gain does not improve, then it probably would make sense to go back to only nursing. But you cannot know that supplements of your milk will not help until you try. The added benefit is pumping will increase your milk production if that is needed.

    Supplements need not be in a bottle, so no need to worry she won't take a bottle. Many babies do very well lapping/slurping milk from a cup, in fact many prefer eating this way to bottles. I will post a video if I can find it.

    It sounds like while it may not have caused the problem, travel is possibly contributing to it because baby refuses to nurse while on the move. If distractibility is part of the problem, that is something that often becomes more pronounced as baby gets to 3-6 months or so. IN fact it is so common at 4 months the phrase "4 month fussies" was coined to describe it. After that some babies become less distracted as they get older, but others may continue distracted.

    Babies normally gain more and more slowly as they age, and it is normal for a baby to take dips on the chart. As your doctor has said, some babies really do take much less than others and still gain normally. I also am not sure it is possible to accurately estimate intake amount from nursing duration. Estimating with any accuracy how many ounces your baby is taking each day would probably require doing before and after nursing weight checks for at least some sessions every day. However, as I think I posted before, I do think the extreme infrequency with which your baby nurses is unusual and personally that would concern me as well.

    cup feeding- I think this baby is 6 months. Shaky video but good info: https://www.youtube.com/watch?v=R95FUa7_s84

    Since your primary goal is weight gain, look for higher cal and higher natural fat foods when offering solids. Kellymom has a comparison list: http://kellymom.com/nutrition/starti...yfoodcalories/

    Low iron causes poor appetite, so maybe offering higher in iron foods might be interesting to see if baby seems to want those.

    Kellymom on weight gain and "older" baby: http://kellymom.com/ages/older-infant/enoughmilk-older/

    Did I suggest the book My Child Won't Eat before? This is a great book that will offer lots of practical info you can use to figure out if there really is a problem or not.
    Last edited by @llli*maddieb; November 20th, 2016 at 02:18 AM.

  3. #3
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    Default Re: 5-month-old eats only 15-20 ounces, not gaining weight

    Thank you for your reply! Today during the day my daughter ate about 7 (yes, only seven!) ounces over three feedings. (I know how much she eats because I weigh her.) I tried several times to feed her while awake but all three times I ended up being able to feed her it was while she was asleep because she refused while awake. Twice she was obviously very hungry and very eager, but as soon as she started to nurse she protested and gave up. Even when she was asleep, she never got a letdown on my left side, which was always my bigger producer for my son and for her. Now of course I'm worrying about why I'm not letting down on my left side.

    I'd obviously love to get at the underlying issue. What could possibly be going on? What can I not be thinking of?

    -letdown: I no longer have an overactive letdown as far as I can tell.
    -taste: Is it possible she doesn't like the taste of my milk? Is that even a thing?
    -silent reflux: Again, I see no symptoms of this other than refusing to nurse, fussing at the breast, poor weight gain. I don't hear anything coming back up, she has no problem lying down, and she is happy pretty much all of the time.
    -allergy: I also don't see any evidence she has an allergy. Do I need to go on an elimination diet?
    -physical pain: I don't think she's in any physical pain when she nurses.
    -teething: I neglected to mention she is teething A LOT, especially in the last couple weeks. I see two teeth just barely. But that doesn't explain the first 2 months of our problem.
    -low supply: My supply was always ample (but not an oversupply), but now that she's nursing so little, I know my supply is much lower. Now I'm wondering if she's frustrated because I don't have a lot, even though her not nursing for some other reason may have been the cause of my decreased supply. (For what it's worth, I successfully nursed my son for 15 months, and had no supply issues with him.)
    -distracted: She does get very distracted. But at this point she will not even nurse in a calm room with nothing going on.
    -Vitamin D: around 2 months I stopped giving her the drops, and that's when her problems started. Coincidence? (I'm really stretching here, trying to think of anything that has changed!)

    Last weekend she nursed quite well, and I was so happy and surprised, especially because I was spending the weekend with friends and their babies. She even nursed while I and others were talking. I assumed she had a growth spurt. I came back to our home base after the weekend, weighed her, and discovered that she had lost three ounces. I was so disappointed because she'd been eating well. I guess this gives me some hope that there may not be an underlying issue, that she will eat when she wants, but I am mystified as to how she lost weight after that weekend (weighing at a controlled time).

    I watched the cup feeding video. I will try that. I pumped today and a couple times recently and got almost no milk (a few drops). I pumped the second month of my daughter's life and responded well, and I even donated milk to another mom. I'm hopeful by pumping regularly I will respond well. Of course, traveling is a big impediment to pumping regularly. I suppose if I can't pump anything in the next week I will have to try and see with formula. What a bummer, because I have some milk stored in my freezer back at home (but won't be home until January!).

    I will buy My Child Won't Eat for my Kindle. Thanks for the rec. I'll also research low iron. Maybe I need to supplement with iron drops?

    I would love to know my daughter somehow is totally fine eating 15 ounces a day, but it seems so outside the realm of normal that I probably won't relax about this until my daughter is completely weaned!

  4. #4
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    Default Re: 5-month-old eats only 15-20 ounces, not gaining weight

    I do not think intake of 7 ounces over three feedings is necessarily a problem. That would be an average of 2 ounces per feeding and I am pretty sure that is normal, although certainly on the lower side of normal for a 5 month old.
    The problem again would be the unwillingness of baby to nurse more often if baby is only getting that much per feeding. A baby who nurses 6 times a day would typically be getting much more than that per feeding.

    I think at this point you are right to be concerned. You may decide all is actually normal after reading My Child Won't Eat, but based only on the concerns you are expressing here, to my mind there is something concerning about a baby who wants to nurse so little. I think it is time to be sure you can rule out a nutritional deficiency or underlying health issue. I would suggest, if at all possible, get in to see a breastfeeding supportive and knowledgeable pediatrician. Someone who is really going to listen to your story and understand that your baby appears disinterested in eating to the point of poor gain, and has behaved this way for a long time. In other words, the issue is not (or at least was not previously) that there is not enough milk or baby cannot nurse. It is also not that baby has been trained to bottles or for some other reason is refusing to nurse. If I understand correctly, Your baby can and does nurse- just really infrequently and with very low intake. So something else unrelated to breastfeeding may be the cause.

    A lactation consultant would be the person to see if you suspect milk flow, or latch, or milk production - in other words, if it is not a medical issue but a breastfeeding issue.

    -letdown: I no longer have an overactive letdown as far as I can tell.
    Ok that would be normal.
    -taste: Is it possible she doesn't like the taste of my milk? Is that even a thing?
    I do not think taste of milk 'right at the tap' can be a thing. I mean I guess it is within the realm of possibility, as there have been some studies that indicate that breastmilk changes subtly in smell and taste according to what mom eats. But I am not sure what you could be eating in such large amounts that it would effect the taste of your milk that dramatically.
    What does happen is some babies dislike the smell of mom's new soap, lotion, deodorant etc. and refuse to nurse. This has long been suspected as the trigger for nursing strikes sometimes.
    -silent reflux: Again, I see no symptoms of this other than refusing to nurse, fussing at the breast, poor weight gain. I don't hear anything coming back up, she has no problem lying down, and she is happy pretty much all of the time.
    I just have no idea why reflux would make your baby nurse less. Breastmilk is a soothing substance and nursing is comforting, so a baby with reflux more typically nurses more, not less. But I suppose this is something you could discuss with that breastfeeding friendly and knowledgeable pediatrician you are hopefully going to see.
    -allergy: I also don't see any evidence she has an allergy. Do I need to go on an elimination diet?
    I am not aware that poor appetite is a result of allergies. Poor gain may be, but you suspect that the problem is not that baby has trouble digeting what she eats, it is that she does not eat enough! However, I do think this is something you can test without too much trouble. By far the most common allergic reaction in a breastfed baby is to dairy. How difficult would it be to eliminate dairy from your diet for about a week? If you see absolutely no improvement at all in a week, then you can go back to eating dairy, and, if you like, try something else.
    -physical pain: I don't think she's in any physical pain when she nurses.
    I think you would know if a 5 month old was in pain. But what about discomfort? Some babies have muscle issues from birth interventions or circumstances or how they were positioned in the womb, causing tightness and stress in normal nursing positions. Come to think of it how much have you experimented with different nursing positions?
    -teething: I neglected to mention she is teething A LOT, especially in the last couple weeks. I see two teeth just barely. But that doesn't explain the first 2 months of our problem.
    Well some babies teeth for a long time. But maybe you can try some soothing things and see if it helps. Are you adverse to giving baby a little infant advil or something? I forget the rules on that for baby, if you have to ask doctor or what. But I wonder if offering pain relief and seeing what happens might be a good test as well.
    -low supply: My supply was always ample (but not an oversupply), but now that she's nursing so little, I know my supply is much lower. Now I'm wondering if she's frustrated because I don't have a lot, even though her not nursing for some other reason may have been the cause of my decreased supply. (For what it's worth, I successfully nursed my son for 15 months, and had no supply issues with him.)
    I have no idea how you are measuring your production or how you know it is low, but I would agree with you that baby nursing so little is more likely than not going to cause low milk production.
    -distracted: She does get very distracted. But at this point she will not even nurse in a calm room with nothing going on.
    Yes I think this goes beyond something that can be explained away by only chalking it up to distraction.
    -Vitamin D: around 2 months I stopped giving her the drops, and that's when her problems started. Coincidence? (I'm really stretching here, trying to think of anything that has changed!)
    I am not sure vitamin D or lack there of would cause this specific issue. But some other vitamin/mineral deficiencies might. Out of curiosity, why did you stop the drops?

    I'll also research low iron. Maybe I need to supplement with iron drops?
    If your baby tests low in iron, then the doctor will probably prescribe iron supplements. If you plan to start solids anyway, you could also offer iron rich foods.
    Low B12 also causes anemia and low folic acid I think? I really am not sure what all. B12 is a vitamin that is most commonly lacking in moms (and their babies) if they eat a vegan diet or some other very restrictive diet or cannot absorb nutrients normally.
    Last edited by @llli*maddieb; November 21st, 2016 at 12:18 AM.

  5. #5
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    Default Re: 5-month-old eats only 15-20 ounces, not gaining weight

    Thank you again for replying! I agree we need to see someone. The problem is that we are traveling and I'm basically unable to see a doctor until we get back home in January. I'm calling the pediatrician today but I'm not sure how to get her tested for anything. Is that something an urgent care can do? I assume not! We leave the U.S. on Sunday and it's a holiday week. Bad timing.

    She ate 13 ounces total in the last 24 hours. I weighed her feeds. Bad, I know. She used to nurse 4 ounces at a time. Now I think I have so little supply that even when she's sleeping she's only getting 2-3 ounces at a time. But the frequency of her feeds has not changed, except at night.

    -forgot to give baby Vitamin D drops, but have resumed today.
    -maybe she's been teething since 2 months, as that's when she started putting her hands in her mouth and drooling constantly
    -I am not vegan and my diet is ok. I eat a huge amount of 90% chocolate though. Have since before she was born. Way more than a serving a day. I probably should give that up for many reasons!
    -I am not averse to giving her Advil/Tylenol. Tried it once before and it didn't help. I'll try again.
    -I will give up dairy for a week. Thanksgiving be darned! (bummer!)

    I'm bummed because I'm so much more limited in what I can try to do to solve this problem since we are traveling.

    I'll do my best to post updates here so anyone else dealing with similar issues may be helped.

  6. #6
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    Default Re: 5-month-old eats only 15-20 ounces, not gaining weight

    I think any doctor, including urgent care, could order tests, and I imagine labs are open at least part of the week? Of course I have no idea what tests would be appropriate or even if tests are appropriate.

    A huge amount of super dark chocolate huh? First, yum- second, do you eat anything else that contains caffeine- soda, coffee, tea? Some babies respond negatively to too much consumption of caffeine by mom- although I think it has to be quite a bit of caffeine. Not sure chocolate would cause a problem, but the darker the chocolate the more caffeine per ounce.

    Personally I would wait until after Thanksgiving to give up dairy. It is kind of a long shot anyway.

  7. #7
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    Default Re: 5-month-old eats only 15-20 ounces, not gaining weight

    My chocolate addiction is ridiculous and I am quitting. I was planning to today and then my sitter gave me three chocolate bars as a gift. Gah! I tend to eat large amounts of a few things, like peanut butter and almond butter. I drink Coke Zero anywhere from 0 to 3 times a week but no other caffeine. All of these things I did before she turned two months old and started fighting me.

    My baby nursed three times today while awake! Very little intake, but it's wonderful to know she will do it.

    I talked with my pediatrician. He does not want to do blood tests at this point; he says we are nowhere near needing to do that. We came up with a game plan, a lot of which is just trying things to cross them off the list, including eliminating dairy. He is baffled. He has only had one other case like mine and the baby ended up having silent aspiration.

  8. #8
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    Default Re: 5-month-old eats only 15-20 ounces, not gaining weight

    I have to say I like it that your baby's doctor is kind of "non-interventionist." That is how our pediatrician is and we feel very blessed to have found him after some bad experiences with doctors who did not know how to leave well enough alone. I hope the book My Child Won't Eat will be helpful.

  9. #9
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    Default Re: 5-month-old eats only 15-20 ounces, not gaining weight

    I read through this thread with interest- and sympathy! I don't have any additional wisdom to offer- MaddieB ably covered it all! But I do want to add one bit of anecdata, which is that I do know a mom whose second baby had a significant and undiagnosed dairy allergy. It didn't manifest in some of the usual ways, i.e., eczema or blood poops. Instead, it manifested itself as a disinterest in eating, slower-than-average growth, and some pretty severe silent reflux. Mom cut dairy and things improved a lot. So I think it's a grand idea to cut it for a week or two and see if anything changes!

  10. #10
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    Default Re: 5-month-old eats only 15-20 ounces, not gaining weight

    Thanks for that anecdote, @mommal. On one hand I'm hoping it's dairy so I can have a reason for her behavior. On the other hand . . . no cheese would be so sad!

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