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Thread: Helping 4 month old eat more

  1. #1
    Join Date
    Nov 2016
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    Default Helping 4 month old eat more

    I have a 4 month old whose weight gain has been the following:

    Birth weight: 8 lbs 8 oz
    Low point (as far as we know): 8 lbs 1 oz
    1 month: 10 lbs 13 oz
    2 months: 12 lbs 1 oz
    4 months: 14 lbs 1 oz

    His doctor was never concerned about his weight gain until his last appointment, at 4 months. At that point he evidently dipped into a lower percentile, and his doctor said we needed to be helping him gain more.

    To be honest, I don't have a lot of confidence in his doctor. He is a family doctor (not a pediatrician), but more importantly he has said several things in the past that I have questioned, and on breastfeeding issues in particular he doesn't seem to be stellar. We'd like to switch but we're probably moving in a few months so we've been trying to just hold out until then. So, I want to take what he says seriously but I don't know how concerned I really should be about his weight gain.

    He wets frequently and poos about every other day, he's growing wonderfully in head circumference and height (he's 97 percentile in height), and he's very alert and happy when awake. If you had to guess simply by looking at him you would definitely get the impression that he is thriving.

    So I have two questions:
    1) How concerning do you think his weight gain is?
    2) How can I encourage him to eat more?

    He has always nursed very fast, usually only 5-8 minutes, usually on one side per feeding. I know fast can be fine if he's keeping up with a fast flow but I don't know if he's doing that or simply stopping before he's fully finished for some reason.

    The most obvious strategy would seem to be to offer more frequently, but there was a time when I was offering too often and he would get upset and pull away even more, so I want to be careful about not pressuring him too much again.

    Thanks very much for your help!

  2. #2
    Join Date
    Jun 2009
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    10,664

    Default Re: Helping 4 month old eat more

    Since you do not feel terrific about this doctor, can you get a second opinion (or switch doctors?)

    Gain usually slows after 3-4 months, and in some cases of very fast gain early on, it might reduce pretty significantly. But from what I am seeing, the gain rate drop off started between 1 and 2 months. Is that your impression as well?

    From my calculations, baby has gained 3 pounds and change in the last three months. (Between month 1 and month 4 checks.) This averages out to 1 pound a month, and yes, that is definitely on the slow side...but I am not sure how alarming this is, given what happened before that-

    Before that, baby gained almost 3 pounds in one month? From birth (or rather, from date of lowest know weight) to one month? So, that sounds like very very fast gain.

    Altogether the gain from birth weight is 5 and a half pounds, 6 pounds if you go from lowest known weight. This would be pretty close to average gain but still a tad on the low side.

    So I think the question to ask is WHY baby might have gained so fast at first and why it seems to have slowed down so much and so rapidly. Is it related to your milk production? Infrequent nursing? Could it simply be a matter of scale error? For more definitive answers you might need to see a board certified lactation consultant. (IBCLC) See one for a complete consult so breastfeeding can be assessed. I am not saying this is necessary, I am not sure it is at all, but that would give you your clearest picture, probably.

    And the other question is, does it matter? Baby is growing normally in all other respects, and appears healthy and on track developmentally. Weight gain is not the only measure. But, what if gain continues to slow because there is an unresolved issue? That is something to consider as well.

    My best and easiest suggestion is to read the book My Child Won't Eat. The author, Carlos Gonzalez, who is a pediatrician and breastfeeding expert, talks specifically about weight charts and how they should and should not be used. He also talks about things like weight gain rate slow down around 3 months etc and that may help you. If your child continues to be a slower than average gaining child, I think his ideas and perspective will help you deal with that and give you confidence to handle questionable advice. He also talks very briefly about what medical issues might cause poor appetite and/or slow gain- this is an area overlooked by too many doctors who want to blame everything on breastfeeding.

    Also don't be afraid to offer to nurse. Offering a four month old the breast should not cause any problems. After all you are only offering, which amounts to reminding as in, "hey remember these?" - not pressuring. If offering is causing issues, I would suggest look at how you are offering. Some babies are kind of like cats. They do not want to be picked up and cuddled especially if they are doing something else interesting, (to them) so picking up baby and assuming "the position" might make them squawk. But this is not the only way to offer to nurse. Know what I mean?

    And again a second opinion might be helpful. Maybe you can ask around to find out if there are doctors with more knowledge about breastfeeding and more experience with breastfeeding babies.
    Last edited by @llli*maddieb; February 14th, 2017 at 05:01 PM.

  3. #3
    Join Date
    Nov 2016
    Posts
    22

    Default Re: Helping 4 month old eat more

    Gosh, thank you so so much for all of this, this is extremely helpful. I just ordered the book on Amazon.

    We are looking into getting a different doctor.

    I think you're right that his weight gain started slowing earlier, but I didn't notice that until you pointed it out and I looked again at the numbers. (His doctor was never concerned until just now because it was at this last appointment that he dipped into a lower percentile). My milk flow did seem to be faster at first and has now regulated more, so, that could have something to do with it, and of course there could always be a scale error. I don't think infrequent nursing is the problem, since he still nurses about every two hours (and always has, or more) but I don't know if nursing too briefly could be part of the problem? He finishes very quickly so maybe he isn't really done? Once he comes off he usually isn't interested in getting back on.

    Regarding offering to nurse in other ways...do you mean in other positions? Simply showing it to him while he's playing or something without picking him up and interrupting him?

    Thank you so much!!

  4. #4
    Join Date
    Jun 2009
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    10,664

    Default Re: Helping 4 month old eat more

    Regarding offering to nurse in other ways...do you mean in other positions? Simply showing it to him while he's playing or something without picking him up and interrupting him?
    Yes. And in whatever other ways you might think of.

    I think it makes sense sometimes to think about how all other mammals behave and how humans 'started out.' By which I mean, naked, or clothing mostly for protection and warmth, rather than modesty or decoration.
    In other words humans developed as a species and lived for hundreds of thousands of years with the breasts always available to baby, usually visible, or at least very easy to get to. We also usually held our children before they could stand on their own or walk, but in a wide variety of ways and positions. In a sense, the breasts were constantly being "offered" from every direction imaginable.

    As far as length of nursing time possibly being a problem, I think you are right, that can be a problem just as not nursing often enough would be. You mentioned increasing nursing frequency, and that is why I made a suggestion about that. But I also mentioned frequency because I think it is often easier to increase nursing frequency than to keep a baby at the breast longer than baby seems to prefer. This is all assuming baby really needs more milk due to slow gain, which again I do not think we are 100% sure of. On the other hand, more nursing time for baby is certainly not going to cause any harm.

    For increasing length of sessions, it can be tricky. If baby is losing interest because of slow flow, then breast compressions or switching sides might help. If baby is instead just getting lots of milk fast, then maybe flow is a little fast? That would be something that is helped by increasing nursing frequency. If baby is just distracted and active, then offering again shortly might work best.

    Many babies like to nurse more than once in an hour part of the day, and then might go several hours another part of the day without nursing. This might be a less tiring pattern for mom as well as it can be hard to maintain nursing every 2 hours night and day. So if baby can be encouraged to change up the nursing pattern a bit there might be other benefits as well.
    Last edited by @llli*maddieb; February 15th, 2017 at 08:39 PM.

  5. #5
    Join Date
    Nov 2016
    Posts
    22

    Default Re: Helping 4 month old eat more

    Thank you so much. Being distracted and active is at least part of the problem. He wants to play with my shirt, investigate the Boppy, etc., and if he hears a sound it's all over. But that has been more of an issue relatively recently, and he's always been a fast nurser, (though he's faster now), so I don't know if there might also be a too slow/too fast issue going on as well. Not sure.

    What you said makes sense about how it might be easier to get him to nurse more often than to get him to nurse longer. I'm going to try to offer more and in different ways like you suggested and see how he responds to that. It can't hurt anything to encourage him to nurse more while I look more into whether the weight gain is really a problem or not, and I wouldn't mind if he changed his patterns a bit, as you mentioned... Sometimes when he has a particularly "light" day of nursing he seems to make up for it by nursing more often at night. I'm glad that he's getting it at some point but that's definitely a less than ideal pattern for me.

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