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Thread: Failure to thrive and now low supply

  1. #1
    Join Date
    Nov 2014
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    Default Failure to thrive and now low supply

    DD3 is 6 months, 2 weeks old.
    2 weeks ago she weighed only 11lbs 10oz. I requested the weight check as I suddenly realised she was very skinny and was worried.

    Her weight history is as follows -

    Birth: 8lb 6oz at 38 weeks

    Lowest weigth: 7lb 13oz at 2 days

    5 days: 7lb 13

    8 days: 8lb 3

    3 weeks: 8lb 12oz

    5 weeks: 9lb 2oz

    7 weeks: 9lb 13oz

    10 weeks: 10lb 13oz

    13 weeks/3 months: 11lb 13oz

    Next weight was 6 months: 11lb 10oz ( 2 weeks ago)

    She was on the 91st centile at birth and is now between the 0.4 and the 2nd.

    Her length was on the 75th at birth and is now on the 9th.

    Doctor has referred her to the paediatrician, awaiting that appointment, and will see her again and weigh her on Wednesday this week (2 weeks later) He said to feed her all the time and as much solids as possible too. I was due to start her on solids anyway that week at 6 months.

    Feeding history:

    4th baby, 2nd to breastfeed successfully. (Breastfed my 3rd child until 15 months, she's now 2 1/2 years)

    Tongue tie released at 3 weeks old.

    She is also allergic to egg (as was my DD1) and I have eliminated it from my diet since she was 3 months old.

    She settled into feeding every 3 hours approx quite quickly which was very different to my last bf baby who fed much more frequently.
    She almost always took just one side and wasn't interested in the other side so I fell into mainly just one side only. My last baby (DD2) also did this until around 5/6 months when she looked for the two sides and continued the two sides until then. I had some oversupply with her but not with this baby.
    I was waiting for DD3 to look for the second side but she never did.

    She fed 7-8 times a day (again less than DD2 but was always content) and at 5 months old found her thumb and started sleeping through the night. She then went to 4 times a day.

    She always had lots of wet and dirty nappies(daily) Right when I got her weighed she had gone 6 days with a dirty nappy which was a first. She has since gone back to once or more daily.

    Looking back after she was weighed I realised that for the previous 2/3 weeks she had stopped looking for food and mainly it was me who initiated the feeds, I'd realise it had been 4 hours since she fed and would feed her or I'd feed her before the school run etc but not because she had looked for it. Right when I got her weighed I'd even have to take her thumb out of her mouth to latch her on.

    Also looking back she had gotten quite lethargic, lying still sucking her thumb a lot and just a bit too quiet.

    She has no other symptoms at all. She looks and acts like a healthy 2/3 month old but she's 6 months. She's not rolling or sitting but my other children had very varied times for achieving these milestones.

    We don't know what her weight did between 3 and 6 months only that she weighed (a little) less at 6 months than she did at 3 months. Also her 4 month pictures look chubbier than her 5 month pictures and by 6 months she's very skinny.

    For the last two weeks I have fed her all the time, always both sides and introduced solids. I had planned to go slower with the solids but of course with her low weight I couldn't so she is now on 3 meals a day and BF in between.

    She still wakes up and doesn't cry for food but when I pick her up she now looks to feed so appears to have more of an appetite.

    Initally we saw quite a boost in her activity and alertness but not sure its as noticeable now but maybe we're just used to it.

    So for the past 10 days I have been feeding her lots and no supply issues. All of a sudden 3 days ago by the afternoon she started fussing at the breast and seemed to be looking for more and it wasn't there.

    Next day same again in the afternoon and also evening.

    Yesterday I pumped after each feed and across the whole day got 3oz. But nothing at all after the evening feeds. I also swapped sides a lot during the feeds.

    Today was a little better but again by this evening she was fussing and there was nothing left for her when I squeezed, or at least it was taking a lot of sucking for her to swallow. Now this was only at the end of the feed she had gotten the let down and a good bit more on each side and I kept swapping her as well. I took her out of the room to get the pumped milk from yesterday but she actually just seemed sleepy and went to sleep. I felt she had had an ok feed and wanted to feed more to fall asleep on (she only does this at night) as opposed to still being hungry but hard to know with her recent lack of appetite.

    I am distraught and so upset that I may have caused her failure to thrive by the way she fed?? But then I can't understand why in recent weeks she didn't ever look for more when she so obviously needed it. And why her weight is as low as it is.....

    The doctor said the paediatrician will do lots of tests but feels its a lack of calorie intake issue and we may never find out why but if her weight goes up and stays up then it won't matter.

    I assumed my supply would respond to the increased feeding and am terrified now to see the above issues. I do not believe I had low milk supply before this.

    I desperately need some advice for my baby and our breastfeeding journey.

    Thanks so much for reading it all!
    Last edited by @llli*mamer3; May 29th, 2017 at 04:25 PM.
    Feb 2007 BF for 4 weeks
    Nov 2009 BF for 3 days
    Oct 2014 BF for 15 months
    Nov 2016 BF 6 months and counting....

  2. #2
    Join Date
    Jun 2009
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    10,754

    Default Re: Failure to thrive and now low supply

    Hi mamer. I am so sorry you are going through this frightening experience with your dear baby.

    Here is what I would suggest.
    First, do not let the "experts" blame breastmilk or breastfeeding for your child's poor gain. It may turn out that your baby has not been getting enough milk to eat, (more on this below) but it may also turn out that she is actually ill. It is also quite possible that some illness or condition led to a poor appetite.

    So, this worries me:
    The doctor said the paediatrician will do lots of tests but feels its a lack of calorie intake issue and we may never find out why but if her weight goes up and stays up then it won't matter.
    Would he/she "feel" this way if your child had been bottle/formula fed? You have to watch out for prejudice against breastmilk and breastfeeding in the medical community. Prejudice based on ignorance. I am trying to say, I know it is hard but you have got to not blame yourself. You need to be strong so you can be a good medical care advocate for your child. Breastmilk has just as many calories per ounce as formula and more than most foods. If baby needs more calories, getting baby as much breastmilk as possible while supplementing with high calorie foods or formula as needed makes the most sense.

    Ok, so I do not think this is your fault as you were following baby's cues and even offering to nurse, and clearly the apparently normal output was confusing the issue. But I do see a problem with how often baby was nursing. A baby of 3 and 4 months nursing about 7-8 times in 24 hours- this is low, but on the low side of normal. in other words, it would be enough for some but not all babies.

    But at 5 months, baby started nursing 4 times a day. So, that is not enough. it would be almost impossible for a baby to get enough milk to gain normally nursing 4 times in 24 hours.

    It does sound like baby began to pacify with her thumb, and that may be part of what happened to decrease nursing frequency, but I do not think that would explain how little your baby nursed. So the question is what was happening with baby that this occurred? Again, I would think some medical cause is very possible.

    A baby of several months old appearing overly sleepy or lethargic is not normal. Of course, lethargy could be caused by baby not getting nearly enough to eat. Dehydration causes lethargy too. But as you say, why was baby suddenly content to eat so little? this very may well indicate some illness, nutritional deficiency, a malabsorption issue or something caused baby to not want to eat enough or to not have the energy to eat enough.

    It is good there is going to be testing for anything that might have caused poor gain and make sure they follow up with specialists as needed. You will have to be a strong advocate for your child's health.

    It is possible that the low nursing frequency over the last few weeks has decreased your milk production. Here is info on increasing it: http://kellymom.com/hot-topics/low-supply/ Your baby fussing at the breast etc, may not indicate a supply issue at all, and rather may indicate that baby is now feeling well enough to complain if flow is not to her liking or whatever! Read the article closely, it is common for moms to be concerned they do not make enough when in fact all is well.

    This article on slow gain may also be helpful: http://kellymom.com/health/growth/weight-gain_increase/

    Calorie content comparison: http://kellymom.com/nutrition/starti...yfoodcalories/
    Last edited by @llli*maddieb; May 29th, 2017 at 06:44 PM.

  3. #3
    Join Date
    Nov 2014
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    19

    Default Re: Failure to thrive and now low supply

    Maddieb thank you so much for your kind and detailed reply, I really appreciate it.

    It means so much to have you say you don't think it is my fault and you are so right I was worrying so much that it was, that I was likely to go along with the dr's suggestion re calorie intake.
    I am lucky he is a breastfeeding advocate and so far has not mentioned formula at all and has congratulated me on feeding thus far (VERY low rates here in Ireland) He did a very thorough check up and the lack of other symptoms was what led him to suggest that I think. Plus I know he is quite concerned but I think just wanted to reassure me. He phoned again last week to see how she was and has been in touch with the paediatrician as well to get a sooner appointment. But I definitely will be aware of a breastfeeding bias and there certainly is a massive lack of educated healthcare professionals here. (he was actually my second dr as both the first doctor and community nurse who originally weighed her pretty much brushed it off and took a wait and see approach!!! So I sought a second opinion.)

    I agree it is the lack of appetite and being fully content to feed so little which worries and confuses me so much and was the only thing stopping me from completely blaming myself. She also started sleeping through the night so can't have been hungry...


    I'm SO glad to hear it may not be low supply. Thank you for the articles, I had read the first two as I always go to Kellymom for imformation. I was still afraid it was low supply but maybe it is her new reaction to a different flow, I hadn't thought of that. I will see how today goes, I'm definitely fuller in the morning than I was a few days ago as a result of the extra pumping/feeding but it does seem to decrease during the day but I guess it always did and just is unsettling her now. Which in some ways is a good sign!

    The third article is really great thanks, I hadn't read that one, really helpful to see the calorie content of different foods, I'm off to buy avocado and sweet potatoes!

    Can I ask what would be the expected weight gain over 2 weeks at this age? Would she be expected to gain more as she has had a huge jump in calorie intake with double or more feeds and all the new solids as well...?
    I just would like to be prepared to discuss with the dr tomorrow depending on the numbers.

    I'm also conscious that feeding her up and hopefully seeing her weight go up might just be putting a plaster on the problem and will we still find out the reason. Though I'll certainly be making sure the paed investigates everything when I get that appointment. And I've been wondering when will I be able to trust her appetite again and feed on demand!

    Again thanks so much for your support during this worrying time. I will let you know her weight after tomorrows appointment.
    Feb 2007 BF for 4 weeks
    Nov 2009 BF for 3 days
    Oct 2014 BF for 15 months
    Nov 2016 BF 6 months and counting....

  4. #4
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    Jun 2009
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    Default Re: Failure to thrive and now low supply

    She also started sleeping through the night so can't have been hungry...
    But now she is nursing at night again, right? Unfortunately, some babies will sleep so much they do not eat enough for various reasons.

    Can I ask what would be the expected weight gain over 2 weeks at this age?
    Normal average gain after 2 weeks up to 3-4 months is an ounce a day according to some sources, and 5 to 8 ounces a week according to others, or a half- pound a week according to others. Sorry I can only think in pounds and ounces I hope that works for you. This is AVERAGE gain, meaning what the average baby gains over that period of time. Of course some babies gain faster and some slower, and no baby gains exactly the same each day or each week.

    After 3 or 4 months, average gain slows. Most sources note that gain slows considerably, but do not give an exact number. The only number from a reliable source I have seen on that is it slows to about 3/4 ounce a day from about 1. 3/4 ounce a day would be about 5 ounces per week. If a baby was already gaining only 5 ounces per week, it might slow to less than that normally? Gain slows again after 6 months, the same source says to about 1/2 ounce per day.

    Would she be expected to gain more as she has had a huge jump in calorie intake with double or more feeds and all the new solids as well...?
    I think you could expect gain to at least be at the average "norm" for this age if baby is now getting enough to eat, and was not before. How much over that that could be expected or desired by the doctor I do not have the expertise to comment on.

    I'm also conscious that feeding her up and hopefully seeing her weight go up might just be putting a plaster on the problem and will we still find out the reason. Though I'll certainly be making sure the paed investigates everything when I get that appointment.
    I think given the seriousness of this diagnoses of failure to thrive (at least in the US it is serious) then getting baby to gain quickly is ok as long as it does not amount to force-feeding baby. Yes, make sure all the tests are given as well.

    An excellent book you might want to take a look at is My Child Won't Eat. The author mostly is talking about children who are gaining "normally", however he does devote some time to poor gain and possible causes. Mostly, I think his calm and reassuring perspective may be very valuable to you now and in the future dealing with a baby/child who has/had weight gain issues.

    And I've been wondering when will I be able to trust her appetite again and feed on demand!
    Feed on demand (or even feed on request, or cue feed) is not terminology I like or agree with, because in fact, some babies just do not "demand." Add in a busy household and/or a very sleepy "good" baby, and/or a busy, very distracted baby, and you can see a baby who is not eating enough even when fed whenever they request. So I usually suggest to moms to nurse when baby cues and also in addition to offer to nurse how many times over that mom wants or thinks is needed.

    So, I would suggest that there is no reason to ever go back to nursing only when baby cues. You can offer to nurse as much as you like or think necessary.

  5. #5
    Join Date
    Nov 2014
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    Default Re: Failure to thrive and now low supply

    Thanks again for more advice, yes definitely feeding at night again now. She doesn't wake up or look for it but I still feed her.

    Thanks for the info on weight gain averages, glad to have that ready for tomorrow.

    Yes it is a serious diagnosis here too and you're right getting her weight up is all that matters. I will definitely have a look at that book, thank you.

    That's great advice about the feed on demand, I will definitely keep that in mind for the future as well as doing it now which I am and have been doing.

    Thanks again, will update with her weight tomorrow.
    Feb 2007 BF for 4 weeks
    Nov 2009 BF for 3 days
    Oct 2014 BF for 15 months
    Nov 2016 BF 6 months and counting....

  6. #6
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    Jun 2009
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    Default Re: Failure to thrive and now low supply

    Yes please update me when you can. Getting weight up is not all that matters, but of course it would be best for baby if she could start gaining ok again, and, also, since your doctor is being supportive about you continuing to breastfeed, (great!) then getting the weight gain rate up would hopefully act to reinforce/validate that recommendation for both of you. This in turn would give you more breathing room while you are looking for more answers.

  7. #7
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    Nov 2014
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    Default Re: Failure to thrive and now low supply

    Agree! Thank you
    Feb 2007 BF for 4 weeks
    Nov 2009 BF for 3 days
    Oct 2014 BF for 15 months
    Nov 2016 BF 6 months and counting....

  8. #8
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    Nov 2014
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    Default Re: Failure to thrive and now low supply

    Just back from the doctors, she has put on 6oz over the 2 weeks. Thank goodness she had gone up!

    He also felt she was much more alert and less floppy and able to hold her head up better when on her tummy etc He had been speaking with the paediatrician and she had wanted her admitted but was ok to wait and see what her weight was this week. We are still waiting for the appointment with the paediatrician but in the meantime because there was improvement today the Dr will be keeping a very close eye on her with fortnightly appointments and she can be admitted at any point if he's not happy. And to continue with the feeding and spoon feeds. Fingers crossed she will continue to go up and up and nothing too serious will be found when she gets her appointment.

    Thanks again, will update again soon.
    Feb 2007 BF for 4 weeks
    Nov 2009 BF for 3 days
    Oct 2014 BF for 15 months
    Nov 2016 BF 6 months and counting....

  9. #9
    Join Date
    Nov 2014
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    19

    Default Re: Failure to thrive and now low supply

    Just wanted to update and fill you in maddieb after all your help.

    So 2 days after my last post, DD got a simple cold but it meant she went off her solids and so the doctor decided it was time to go to the children's hospital. His referral letter stated that she was severe failure to thrive with fine and gross motor delay She was admitted and we stayed there for 5 nights. She had chest xray, bloods, pre and post feeding weight check (she went up 6oz's) and lots of assessment and discussion with a paediatrician and dietitian. In the end nothing was found! Which was great but still quite confusing how she ended up so small.

    The dietitian was very pro breastfeeding and very supportive, the paediatrician less so and appeared to be frustrated with not being able to tell what her intake was and had been, but overall there was good support. The paed at one point mentioned giving formula but was leaving that to the dietitian to decide and thankfully she was having none of it.

    Whilst in there her weight went from 5.38kg (she'd lost weight in the few days before being admitted and a different scales too I suppose) to 5.77kg So the paed said we needed to see now if that continues and if not further tests on her kidneys etc will be done.
    So we were sent home to have weekly weights and follow up appointments. The dietitian wants a 4oz weight gain a week. And gave lots of info on high calorie foods etc plus minimum of 6 feeds/day and not to let her go more than 6 hours at night without feeding.

    So the first week home she got mainly high calorie foods and feeds ++ etc. However sadly my grandad died ( I went directly from the hospital to the hospice and he passed away the next day )so with that and his funeral it was not a typical week. Anyway for her first weight check after her first week out of hospital, instead of gaining 4 oz she LOST 3.5oz And definitely correct as same scales and we checked it a few times. We were very worried about her again but knew it had been a less than normal week and I had been using my freezer supply of homemade foods that had not been all cooked in butter, sweet potoates etc so I just hoped that would explain it. I had of course been feeding her lots and lots and at night etc etc....

    Anyway thankfully last Wednesday her second weight check showed a 6oz gain!!!! We had stuffed her with cream in her porridge, full fat protein rich greek yoghurt added to many dinners, avocados, custard, rice pudding, meat dinners etc etc! And of course all the breastfeeds. She got small/moderate amounts of everything as too much and she would be sick plus I really wanted her to have an appetite for her breastfeeds as well, though my family think the solids are way more important but anyway we just made sure every mouthful counted.

    There is a huge difference in her thank goodness, she is sooo much more alert, I can put her in the high chair now without her flopping over, she is no longer pale, you can no longer see the bones in her head the way you could, she has lovely cheeks! And physically looks bigger. She is now 12lb 13oz/5.86kg and is 7 months old. She just looks soooo much healthier.

    It's wonderful to see the difference and scary to think of how unwell she was.

    It does niggle me that we don't know why/what happened...? And that we have to feed her soooo much to be sure she does gain...? Though I know we are trying for catch up growth now all the time...

    Anyway fingers crossed she will continue to gain at each weigh in Wednesday!
    Feb 2007 BF for 4 weeks
    Nov 2009 BF for 3 days
    Oct 2014 BF for 15 months
    Nov 2016 BF 6 months and counting....

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