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Thread: Slow weight gain

  1. #1
    Join Date
    Mar 2017
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    12

    Default Slow weight gain

    My 19 week old was doing well gaining weight until I went back to work when he was 14 weeks old. Here's his weight gain history

    Birth 1/21 6lb 4oz
    1/23 5lb 11oz
    1/24 6lb
    1/30 6lb 8oz
    2/1 6lb 10oz
    2/7 7lb 5oz
    2/15 8lb 5oz
    3/1 9lb 14oz
    4/6 11lb 15oz
    4/27 12lb 10oz
    I went back to work 5/1
    5/23 13lb 5oz
    6/8 13lb 6oz

    Typically I nurse him 3-4 times when I'm home in the evenings and during the day he has about 12-14oz between 7am-5:30pm. What am I doing wrong to make his weight gain slow down so much? Pediatrician is suggesting starting solids to increase his weight but shouldn't he have more breastmilk to increase weight? He has about 7 wet diapers and 3 dirty ones a day.

  2. #2
    Join Date
    Jun 2009
    Posts
    10,393

    Default Re: Slow weight gain

    Were all these checks (or at least the last month or two) always on the same digital infant scale, with baby in a dry diaper or naked?

    Anyway, let's stand back a minute and look at this entire picture. Please check my math and reasoning to make sure I have this correct, I am a little punchy as it is late here.

    Between birth on Jan 21 and the 5/23 check, so over a period of 4 months, baby gained 7 pounds. This means weight gain for this period was close to the normal average of about two pounds a month- so, normal looking at it overall. This is good and may indicate that if there is a problem, it is not a major one.

    But I am seeing that gain actually began to slow before you went back to work. Up until 4/6, gain averaged a half pound (8 ounces) a week. This is high-normal or high average gain for baby's first 11 weeks.

    But between 4/6 and 4/27, the next three weeks, gain total was 11 ounces, or an average of just over 3.5 ounces per week. So that was the first sign that gain rate was dropping precipitously.
    Then, between 4/27 and 5/23, about 4 weeks, baby gained 11 ounces again, so a slightly lower average of about 2.75 ounces per week.
    Then in the last two weeks, of course, gain appears to have plateaued.

    So, thinking the issue was just the last month, I was just going to write this off as scale error or baby just having a little gain plateau, which is not unheard of. Also, a reduction in average gain rate to about 5 ounces a week after age 3 or 4 months is typical anyway. However, since gain has been slowing way down since 2 months ago, meaning the slow down in gain started when baby was not yet 3 months, and it is much less than 5 ounces per week, I do wonder if something is going on.

    So I cannot say for certain something is wrong. But I do think this warrants a closer look.

    What is odd is that baby's output seems normal. 3 poops a day must be coming from somewhere. Was there any other sign that baby was suddenly not getting enough to eat? Aside the gain slow down, was there any other problems doctor noticed when baby was examined? Have you noticed anything going on with your milk production? Are you taking hormonal birth control or anything else that might decrease your milk production? Have you or baby been ill? Does baby use a pacifier much, or sleep long stretches over night?

    Increasing weight gain, if it actually is needed, could be as simple as nursing baby more often when you are together, and also making sure baby nurses lots on your days off. Breast compressions, and encouraging baby to take both sides when baby nurses may also help. Since these ideas would cause no harm, and may help, no reason to not encourage baby to nurse more often etc. and see if it helps. But I also think it makes sense to see a board certified lactation consultant (IBCLC) in order to make sure breastfeeding is optimal.

    Your baby's intake while you are at work seems within normal range. Are you currently able to pump each day about what baby is eating each day? If you were able to pump a couple more ounces a day, would baby drink it? Has your caregiver noticed baby wanting more to eat?

    Introducing solids to a 4 month old? This carries some risk as we know early solids can actually be detrimental to breastfeeding, and it is not likely to help much as most baby foods would have no where near the healthy fat or calorie content as breastmilk.

    However, some doctors (notably Jack Newman, a breastfeeding expert) does think that in the absence of enough available breastmilk, introducing solids at this age for a too-slowly gaining baby is an option that makes sense as a way to avoid formula supplementing if that is what mom would prefer. However, I am not at all sure that what is happening is even a problem, and if it is, there is no evidence at this point the problem is that there is not enough breastmilk available. In other words, I think you need more info before assuming that solids are the answer.

    Would seeing an IBCLC be something you could do?
    Last edited by @llli*maddieb; June 10th, 2017 at 12:53 AM.

  3. #3
    Join Date
    Mar 2017
    Posts
    12

    Default Re: Slow weight gain

    The weight checks were on the same scale with baby naked (somehow we were always in the same exam room at the pediatricians office the last few visits).

    The only medical issues baby has had is some eczema and food sensitivities which has been resolved by eliminating them from my diet. My milk production did go down for a week but is now back up. After baby nurses I am able to pump and hand express more milk so I don't think that's an issue. When I am at work I pump enough for the next day and a little for the freezer.

    Baby does sleeps longer stretches at night and can go 4-6 hours between feedings sometimes but that is something new within the last 2 weeks.

    How do I go about finding a lactation consultant? Do I go to the local hospital?

  4. #4
    Join Date
    Jun 2009
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    10,393

    Default Re: Slow weight gain

    How do I go about finding a lactation consultant? Do I go to the local hospital?
    Finding an LC can be easy or hard. It depends on where you live and many other factors.

    You can look up local IBCLCs on two different websites. Not all of them will be on both and some might not be on either. International: http://www.ilca.org/why-ibclc/falc US only: https://uslca.org/resources/find-a-l...!directory/map If you do not live in the US, search online for a database for where you live.

    More info: http://kellymom.com/bf/concerns/bfhelp-find/

    You can try a search online with the search words your location and the words lactation consultant or breastfeeding help etc.

    You can call your local breastfeeding coalition and/or LLL or other breastfeeding support group and ask.

    You can ask at the hospital or ask your pediatrician. This is usually the least helpful but you never know.

    You can ask your insurer for names. Again, might be least helpful on the other hand, it depends on your insurer.

    You can call any local public health program (for example, in the US call WIC)

    If you try those and find nothing, please feel welcome to PM me with your precise location (city or town) and I will see if I can find anything out.

    Once you have a number, or ideally, 2 or 3 numbers, I suggest CALL the IBCLC(s) and tell them you are having trouble with very slow weight gain in a 4 month old after excellent gain and if that is the kind of issue they help with. Of course, it should be. But this is a way to get into a brief conversation that can help you figure out if this sounds like the right person for you and your baby to see. You will want to know a little about their experience and training, how long the consult will be, what might happen at the consult, cost, and what follow up care they offer. Do NOT take advice over the phone (although this can be ok for follow ups) but to assess a breastfeeding situation properly an IBCLC has to see the mom and the baby and watch baby nurse in order to even begin to identify what might be going on. (Skype or similar is one option if in person consult is not possible.)

    Here is an example of what happens at a proper, professional consult with a lactation consultant: http://www.cwgenna.com/lconsult.html

  5. #5

    Default Re: Slow weight gain

    You definitely need to be careful. Your baby is at the fifth percentile and that's when many doctors start looking at possible failure to thrive and malnutrition. I would keep a breastfeeding log and try to get a lactation consultant to do a weighed feed. Also, seriously consider waking your baby up to nurse. Four to six hours is too long if you're having a supply problem. It could also be a feeding problem and she's not nursing as well as you think. Don't wait any longer to get help regardless.
    A baby should get around 30 ounces a day at that age, especially if there's been weight gain issues. Even if you resolve the problem, you might want to supplement a little so the doctors don't freak out.
    I agree that the problem seems to have actually started a month before you went back to work. After three months, supply is maintained by frequency and quality of nursing. Maybe try a galactogogue along with more frequent nursing? But seriously, don't go to your next doctors appointment with your baby's percentile so low. That's just asking for trouble.

  6. #6

    Default Re: Slow weight gain

    Right. Also forgot to mention that sleeping longer is a problem sign if there's a weight gain issue. I hate to say it, but if you can't get help from a lactation consultant immediately, you should consider supplimenting some until you can to be safe. Or if you have patience for it, buy or rent a scale and do weighed feeds for a day so you know how much your baby is getting. You definitely want to be able to prove to your doctor that your baby is getting enough, in case there's some other problem.

  7. #7
    Join Date
    Mar 2017
    Posts
    12

    Default Re: Slow weight gain

    Thanks I am going to go to a breastfeeding support group to do a weighted feed. The pediatrician wasn't worried about his slow weight gain because she said he has been on the petite size since he was born. I will wake him more to feed throughout the night as well. My baby tends to be distracted during the day when he is awake and won't feed much so I am able to have him take a full feed when he is about to nap, same issue when he is bottle fed while I'm at work.

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