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Thread: Fussy nursing and slow weight gain

  1. #1

    Default Fussy nursing and slow weight gain

    Dear all, I'm hoping for some tips to help my 3 month old son nurse without fussing. His weight gain has slowed down lately and I think it's because he has become impatient at the breast as my supply has settled down, so I'd really like things to pick up again.

    A typical nursing session starts with him happily feeding, he gets a letdown within a minute or so and gulps away, but then as soon as the flow slows down he fusses and pulls away. If I try to re-latch him, he sucks a few times and then pulls away fussing again. It often takes several minutes for the next letdown to happen so I've been using breast compressions and switch nursing to keep him interested and actively feeding, but they seem to be less effective lately as his fussing has increased. It sometimes helps if I walk around to nurse him, or play white noise, or go somewhere dark and quiet... but he's just as likely to fall asleep as get in a good feed. I offer to nurse fairly often, probably every 1-1.5 hours during the day, and I think he nurses around 3 times during the night (we co-sleep so I'm not always awake enough to remember). Is there anything else I could try?

    As for weight gain, I suspected he was taking in less milk than he should, and when he was weighed today he had only gained 1 lb in the last 4 weeks

  2. #2

    Default Re: Fussy nursing and slow weight gain

    (Message got cut off!)

    He has only gained 1 lb in the last 4 weeks. (Same scale so I'm sure it's pretty accurate). Nursing in the early weeks went well - he lost only 4% and was back to birth weight by two weeks. It's really just the last month where things have slowed down:
    2 weeks - 7 lb 12
    4 weeks - 8 lb 13
    9 weeks - 10 lb 9
    13 weeks - 11 lb 9

    So... where does that leave us? 4 oz/week is too slow for that age, right? I must admit I'm getting a little stressed out over his weight because my older son had serious weight gain problems that (as we eventually found out after months of investigations) were due to a viral infection. I know circumstances are different this time but I'm finding it hard to relax and enjoy nursing when there's a question mark over his weight gain

  3. #3
    Join Date
    Jun 2009
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    10,754

    Default Re: Fussy nursing and slow weight gain

    When you say baby has been fussy lately, what do you mean? How long has baby been fussy when nursing? Is baby fussy in general or only when nursing?
    It sounds like you encourage baby to nurse often enough. Are you concerned about your milk production?

    I am not saying a baby might not be so fussy they will not eat enough. This is a common concern. On the other hand, does it really make sense? Why would a healthy baby who is offered to nurse lots and mom makes enough milk not nurse enough to get enough to eat? Like all living things, babies want to live and grow, and they do not want to feel hungry. All mothers experience a slowdown in milk flow rate as time goes on. It is not any problem for most babies. There may be a period of adjustment, but not so severe it causes poor gain typically. Also this age is very typical for colic and fussiness and again, weight gain is not usually harmed. So if a baby really is having a gain issue at this point, I wonder if something else might be going on. Some babies have a milk transfer problem - an inability to latch or suckle effectively-that only becomes clear when the milk flow slows down. Have you had breastfeeding assessed by a board certified lactation consultant?

    Also you want be sure about whether or not there really is a problem with gain. Was the weight check a month ago on the same scale as the one today?
    Is doctor concerned about your baby's weight gain?
    What is baby's output like? Poops in particular.

    So... where does that leave us? 4 oz/week is too slow for that age, right?
    Not necessarily. I am pretty sure 4 ounce per week gain is on the low side of normal.
    Also, weight gain averages are not figured out in small time increments (at week or a month.) Because weight gain is not typically steady, they are figured out in large increments. This is why doctors do not typically weigh a baby every month. There is no need and it can give a false impression there is a problem. How often babies are typically weighed varies, but I think in the US it is usually some thing like 2 weeks, 2 months, 4 months, 6 months...is that right?
    Or in some countries, once it is established that a baby is gaining ok after birth, it might be 3 months then 6 months. It varies.

    If we look at the overall average your baby has gained in the last 11 weeks, it averages to .79 ounce per day, or an average of 5 and a half ounces per week. No this is not super fast gain but I do not think it is abnormal either.

    That said, if there IS a gain issue, the quicker you figure out what it is the better, typically. That brings me back to if you have seen an IBCLC.

  4. #4

    Default Re: Fussy nursing and slow weight gain

    Thanks maddieb, you make some good points. There are no IBCLCs around here, unfortunately. Breastfeeding support tends to be run by volunteers and it's hard to get hold of someone in person who has actually had some training. Baby's latch seems (seemed?) good to me but I'll try to find some proper support to check it. He does sometimes splutter and struggle to keep up with the milk flow during letdown, so there could be room for improvement there.

    Baby started to fuss when nursing at about 6-7 weeks, pulling off and crying after a letdown finished while still rooting for more milk. He didn't do it every feed at first, but it has intensified over time and for the last 2 weeks it has been pretty much every feed unless he's half-asleep. I'm beginning to be concerned about my milk production but I guess any dip should recover if he ate more(?)

    He's not usually fussy the rest of the time, though, and thankfully he doesn't have colic. However, the last day or two before he poops is clearly quite uncomfortable for him and it can make him a lot fussier than usual. As soon as he poops, he cheers up! He poops every 5-7 days and they're pretty huge, regular orange-yellow colour and soft with no mucus or anything. He has 4-5 very wet diapers per day. I thought it seemed in normal range.

    After the first month, babies tend to get weighed here when they go for their vaccinations, which is why the schedule is roughly monthly. It is optional, though - I could decline the weigh-in. The doctor had no concerns last month. However, it was a nurse we saw yesterday rather than the doctor, and she was a little concerned by and wants him to be weighed again in 2 weeks. The fact that she suggested this when we'll be back in 4 weeks anyway for the last vaccinations has made me a bit anxious about it, tbh. She had no advice to give other than to talk to someone to get support with nursing.

    I guess if I had never seen his weight, I wouldn't be worried as he's generally an alert and happy baby. I would just assume he has an annoying habit of fussing during nursing and hope he'd soon grow out of it!

  5. #5
    Join Date
    Jul 2010
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    Default Re: Fussy nursing and slow weight gain

    Icon, you are describing pretty much all my babies. I had an overactive letdown and they got so used to the flow that they would get mad when it would slow down between letdowns. I had to cut off baby when it first let down HARD and fast; and squeeze that out onto a towel. Boy were they mad while they waited. Eventually though, that helped them get used to a slower flow because they never got that super fast flow to begin with; and the later letdowns were a bit more reasonable. I would also suggest strapping baby on you in a wrap or something similar; like when you are out and about shopping for a whole day. Look up how to nurse them in there. I found my babies re-learned to love comfort nursing when being strapped on to me for a day. Oh, and yes, laying down as well while nursing, which I think you mentioned above. That helped with my letting down more often, and it seemed to help with their frustration.

    If anything, just rest assured that this is totally normal. I'm on my 11th baby and all of mine have been JUST like yours and have all done awesomely.. you could be in my boat with the 11th who has the opposite problem and hates letdowns, has reflux and refuses to eat. LOL (the reason I am up here, I am clueless how to handle a sweet one like THAT! lol) So you are doing good, mama.

  6. #6

    Default Re: Fussy nursing and slow weight gain

    Wow, I never thought of it being an overactive letdown! :O Ummm... what's normal? For instance, if baby pulls away during a letdown (sometimes does when he's sleepy) the milk fires out about 12-18 inches on the "good" side, or drips fast on the "bad" side. Does that sound like normal or overactive flow?

  7. #7
    Join Date
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    Default Re: Fussy nursing and slow weight gain

    Seeing milk shoot 12-18 inches definitely sounds like it could be a forceful letdown. Imagine being the baby at the other end of that- it's really hard to keep up with that rate of flow, particularly if it lasts more than a few seconds. I know when I had forceful letdowns and oversupply, I would see 3-4 streams of milk fountaining from the breast, usually to a maximum distance of 12-18 inches, and they might persist for 10-15 seconds... Maybe longer.

    Have you tried using reclined nursing positions while feeding?

  8. #8
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    Jun 2009
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    Default Re: Fussy nursing and slow weight gain

    Breastfeeding support tends to be run by volunteers and it's hard to get hold of someone in person who has actually had some training.
    Are the volunteers LLL Leaders? LLL Leaders do have training in most typical breastfeeding concerns. A weight gain slow down, fast letdown, low milk production, most latch issues, that kind of thing would all be appropriate to talk to (or better yet, see in person) a LLL leader about. No they can not give medical advice but an IBCLC technically can not either.

    I agree what happens sounds like it could be fast letdown...but again I just do not understand how fast letdown corresponds to slow gain. It is just inconsistent with what typically occurs when there is fast letdown and OP.

  9. #9

    Default Re: Fussy nursing and slow weight gain

    Mommal - I feed in reclined positions most of the time, except when he's refusing to feed unless I'm walking around. He sometimes splutters even when reclining but mostly deals with it okay. It's after the letdown stops that the complaints start!

    I don't have oversupply, though. My supply settled down okay at 6-7 weeks (round about the time his fussing started). It's just that the letdown seems to be forceful on his preferred side, and was even stronger for the first few weeks.

    Maddie - my original worry was that a slow flow and long delay between letdowns was leading him to give up or fall asleep sooner than he had previously done. Less milk so slower gain.

    I'm now wondering if baby's latch isn't as good as I thought and that he relies on the fast letdown to get milk. It worked out fine in the early weeks so he gained fine, but now he can't rely on it any more, he's not transferring milk well by himself, and his gain has slowed. It's only a guess, I really don't know.

    The volunteers in my local group aren't LLL leaders, unfortunately. I wish! They're peer support groups where the volunteers are mothers who have had a day's training. I've already reached the end of their expertise, though - they think his latch looks fine and one of them suggested I could always supplement with formula if I was concerned about his weight, which is precisely what I want to avoid!

    I think I need to find some proper in-person support. Maybe his latch can be improved or maybe there's something else I'm missing. There's a LLL group a couple of hours away so I'll see if I can make contact with the leader. Thanks folks

  10. #10
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    Default Re: Fussy nursing and slow weight gain

    I agree there might be something going on with latch. IMO latch issues would explain poor gain AND baby having a problem with too fast milk flow even at 3 months when most babies have figured it out.
    Aside from OP, the primary cause of fast letdown is too much time elapse between nursing sessions. It sounds like baby nurses pretty frequently but, just throwing that out there.

    I believe some IBCLCs will work long distance with moms using Skype or whatever. Maybe if you contact ILCA they can help you find someone.

    Also I recently came upon this info about mom kneading the breast prior to nursing to try to homogenize the milk. From what I can gather it is not a cure all but helps in some cases. The magic milkshake part in particular starts on page 10, slide 60, and goes on for the next few slides. Remember this is from a presentation for lactation consultants, teaching them how to communicate these ideas to moms. So it makes more sense if you read it from that viewpoint. https://classic.regonline.com/custIm...ng-Smillie.pdf

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