Slow Weight Gain, Green Mucous Stools, Happy Baby

[@llli*akr1220]

Hi! First post here. I have an exclusively breastfed 4.5 month old. Since probably 2 months of age, she has had intermittent green, mucous stools. For at least the past month, they have pretty much all had mucous but they're not always green. It varies. She gained weight quickly the first 2 months and then between her 2 month and 4 month well checks she was only gaining 3 oz per week. The other night I saw a couple of small bloody specs in her diaper. The poop was also green and a little foamy.

I struggled with overactive let down for a while, especially on the right side. I have a very healthy supply. I'm not sure if I would call it an oversupply, but there's plenty of milk. Wondering about the foremilk/hindmilk factor here.

Baby is happy and hitting milestones. She is not overly fussy. She does spit up, probably 2-3 times a day, but it's a small amount. Maybe quarter-sized or so.

I rented a digital baby scale from the hospital (medela III maybe? can't remember) for a full week and weighed many feedings. This was about 2 weeks ago. She transferred anywhere from 3.5-5.5 ounces per feeding and it seemed to be averaging 25-30 ounces per day. Again, I definitely do not have a low supply.

I'm just at my wit's end trying to figure her out. I want her to be gaining steadily and having normal poops. Her ped doesn't seem to be concerned but I just feel like something is off. Does anyone have experience with this? I read such varying advice on the subject. Could it be a food intolerance when she is not fussy? I thought that was kind of a "must" with food intolerance in babies.

[@llli*maddieb]

Hi and welcome! So this is a bit of a puzzle. 3 ounces per week is a little below average for gain at this age, but baby's per session intake seems normal or even high, but possibly a little on the low side of normal overall (more on that below.) So I am curious. For the week you rented the scale, and weighed the feeds, how much did baby gain overall over that week, according to that scale?

Also, prior to 2 months, how fast was baby gaining? When did you notice a drop in gain rate?

Have you made any diet changes over the last few months?

Wondering about the foremilk/hindmilk factor here.

As far as I know, no correlation has been shown between slow weight gain and babies who are getting lots of foremilk and consequently, not as much hindmilk. Since these baby's moms usually have overproduction, baby typically gains faster than average, not slower.

However baby getting lots of foremilk MIGHT cause small amounts of streaks or flecks of blood in stool as well as watery/very liquidy stools, explosive poop and gassiness, and green stool. As far as mucousy goes I have never seen evidence that this means anything out of the ordinary in a healthy baby. Of course some babies start having mucousy stools due to swallowing mucous (they have a cold or seasonal allergies) and this look might also be caused by baby swallowing lots of drool when teething. But mucous occurs naturally in the body and is needed in the healthy digestive track. Also, what some moms think looks like lots of mucous just looks normal to others.

I want her to be gaining steadily and having normal poops.

As far as poop "look" goes, "Normal" comes in a wide variety. At this age even frequency of poop is utterly unreliable as a sign of "normalcy" with some babies pooping several times a day and others pooping once a week or less! If this is your first baby, you will be in for quite a surprise when baby starts solids because at that point every poop is an adventure.

As far as gain, it is not normal for a baby or anyone else to gain "steadily." Gain is a measure of growth, and so it occurs in spurts- one reason everyone talks about growth spurts! This is why weighing a baby too often can drive someone crazy because some weeks baby might barely gain at all, at least once baby is past the newborn stage.

Also average gain normally decreases over time. This is because babies do not keep growing as fast as they do as newborns, they are not supposed to. Every one talks about how much baby should gain in the first few months but few mention that babies will not and should not always gain that quickly! One source I found on this suggested average gain is about 7 ounces per week up to age 3 months, 5 ounces a week from 3-6 months, and about 3.5 ounces per week after 6 months. (Even that source only went up to 6 months.) Of course these are generalities and gain rate probably reduces in a gradual slope, not in stair steps.

If you offer to nurse more often, would baby be interested? For one thing, Frequent nursing is helpful for reducing issues caused by fast letdown (too much foremilk.) Also, If your baby is really averaging 25-30 ounces of intake a day, it may be baby needs just a bit more to get her gain rate up. Average intake is 25-35 ounces per day- meaning there are some babies who do better with gain if they get more like 35 ounces or even more a day, while others are fine with less than 25. I agree your production is likely entirely fine, I am just wandering what would happen if baby nurses 2 or 3 times more each 24 hours.

I would also strongly suggest the book My Child Won't Eat. An excellent source of clear info and reassurance for parents of any baby or child whose growth is slower than average.

[@llli*akr1220]

Thank you so much for this reply! This makes me feel better, especially the bit about the mucous. I actually looked back at her pediatrician record online and from 5/19 to 5/30 (scale was rented 5/24-5/30 but I went in for a weight check on 5/19) she gained 7 ounces over 11 days, which ends up being an average of over 4 ounces per week. From her 2 week to 2 month appointment, her gain was over 5 ounces per week, and then dropped to 3-3.5 per week from her 2 month to the weight check, which was very close to her 4 month appointment. Part of me just feels like maybe that is her growth curve, even if it isn't textbook. Or, maybe she had a growth spurt after her weight check/4 month. I don't really trust the regular scale I have at home, but I am going to go in for a weight check on Monday to see where she is.

I've tried offering the breast more often outside of our typical routine and she will sometimes take it for a few minutes (maybe 5) but I feel like it negatively affects the next feeding. She eats every 2.5-3 hours during the day (of course I'll feed her sooner if she is crying or seems hungry - we aren't "scheduled" but she has fallen into a fairly predictable routine at this age) and I do the dream feed because she is a sleeper at night. I'm definitely not comfortable putting her down at 7:30 and then her not eating until 6:30-7 when she wakes up, so I do a dream feed around 10 and she seems to eat well for that. I may try offering more often again over the next few days and see how it goes.

Honestly, I think I have been driving myself a bit crazy with the slower weight gain and mucous poops that are often green/greenish, but maybe I just need to relax and let her be her. We'll see how the weight check Monday goes. Fingers crossed!

[@llli*maddieb]

Yes to me it sounds as if you baby has always been on the slower gaining end of the curve, some babies just are and it is fine! I again suggest My Child Won't Eat, I love this book.

As far as offering more often, I am a big believer that healthy babies/children know what they need and do not need to be pressured to nurse (or eat.) But I also think that because in our modern society child care reality is usually so different than that of our prehistoric ancestors, it also makes sense to offer to nurse even if "offering" simply means holding baby and making the breast available and not worrying about it beyond that.

I base this on the idea that we developed as a species for hundreds of thousands of years in a nomadic situation where babies were most likely almost constantly - day and night-held against mother's bare body and were able to/encouraged to nurse pretty much constantly as a result, as is the case with many mammals and certainly the case with primates.

I am not sure what you mean by the nursing session negatively effecting later nursing sessions but if you mean intake is consequently less each session, that is actually normal- in other words it is normal for per session intake to vary from very little- an ounce or even less- up to several ounces. Normative feeding seems to be small, frequent meals, although of course exactly how small and how frequent can vary quite a bit baby to baby, meal to meal and day to day. If you mean the next session baby is fussy or not interested, I am not sure what that would mean, but obviously you and baby have to find/accept/develop whatever pattern works best overall, and it may take a week or two, or even more, to get baby nursing more often in a way that seems natural to you both. On the other hand if encouraging baby to nurse more often does not result in more rapid gain after giving it at least a few weeks, or for some other reason seems to not be working, you can simply abandon that strategy. Basically I am saying that gently offering more often may help and is not likely to hurt.