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Thread: Slow weight gain

  1. #1

    Default Slow weight gain

    Hello. I am at a complete lose with my 4 month old. He was born at 7lbs 14 oz. 21 inches long. He is now 18 weeks old and just weighed 3 days ago for his 4 month appointment. He was 11lbs 14oz and 25 inches long at his appointment. Heshad several weight checks. Since his last one, one 20 days prior, he gained only .5 oz.
    he was gaining great in the beginning while I was on maternity leave. Since starting daycare and taking bottles, he has dropped off his growth curve. He refuses the bottles pretty regularly at daycare.
    Supply is not an issue. I'm pumping anywhere from 14-18 oz a day while at work. He's away from me about 9-10 hours a day. I send a total of 12 oz to daycare. He'll take anywhere from 3 oz, to everything. By the end of the work week he does better taking the bottles. Mondays are terrible. Barely taking anything.
    I've been to an IBCLC and we did a weighted feed he took 2 oz from me in 7 minutes on the breast about 2-3 hours between a feeding. She says his latch is fine. He's transferring milk well. She agrees that the issue is in the bottles.
    I'm at a complete lose as to what to do. He's so little. 0% on his growth chart. Dr is concerned. We're doing probably our fifth or sixth weigh in in about 4.5 weeks. I was told to supplement, but he won't take the breastmilk from the bottle, so I don't know why he'd take the formula from a bottle.

    Should I be overly concerned or just let him do his thing? I really don't know how to fix it at this point other than quitting my job. Which is not very feasible. He's happy and healthy is every other way. He's not rolling from tummy to back, but is from back to tummy. Otherwise meeting all milestones for his age.

    Please help.

    Thanks

  2. #2
    Join Date
    Jun 2009
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    Default Re: Slow weight gain

    Hi, and welcome. So sorry you are having this concern!

    If the problem is intake (or lack thereof) at daycare, Have you talked to the daycare about how baby takes/is given bottles? Have they really tried everything? What about using something aside a bottle. like a sippy cup or open cup?

    Many babies do not take much milk when separated from mom, but will make up for it when with mom. Do you see that happening? How often does baby nurse when home? How many times will baby nurse from the time baby is picked up at daycare until he goes again the next day? What about on weekends? On the days he takes in less at daycare, will he make up for it by nursing more overnight?

    Ok, so let's look at growth. I do not know from length- is that length growth normal or not? What about head circ?

    Ok, gain. When did the slow down in gain start exactly? Can you give us a complete weight check history?

    I've been to an IBCLC and we did a weighted feed he took 2 oz from me in 7 minutes on the breast about 2-3 hours between a feeding. She says his latch is fine. He's transferring milk well. She agrees that the issue is in the bottles.
    It does sound like you make enough milk and baby can transfer milk normally. So what did she suggest about solving the bottles problem?

    Formula would not appear to be the answer as you can pump more milk than baby takes in at day care. But if you cannot get baby to nurse more often at home, what would you think of supplementing baby with your expressed milk when you are at home- again, perhaps with something aside a bottle, maybe even an at the breast supplementer? (Lactation aid.) I am not saying this is needed, I am just trying to help you figure out ways to work out some kind of compromise with the doctor who is telling you to supplement.

    Some babies really do gain more slowly and it is normal. On the other hand you know there actually may be an intake issue. There also may be some underlying health issue that is being missed because everyone including the doctor is focusing on intake. Weight checks are not just to make sure babies are getting enough to eat. They also help doctors recognize when they may have a sick baby who needs appropriate diagnoses and treatment. Unfortunately that is often missed when a baby is breastfed as the doctor assumes the issue is the feeding method. It sounds like your baby is healthy however, the whole point is lack of appetite or poor gain may be an early signal something is wrong.

    My Child Won't Eat by Carlos Gonzalez is an excellent book that can help you figure out charting and weight gain issues and when to worry and when not to worry, I strongly recommend this book in any slow gain situation.

  3. #3

    Default Re: Slow weight gain

    I do not have all the other weights exactly. I do know he was gaining fantastic up until he started daycare at 6 weeks. He was seen right after he started for thrush, then again shortly after that for his 2 month well baby. It was at the 2 month that his weight gain dropped dramatically and we started weight checks.
    When he first started daycare they were lucky if they got him to take one oz the entire day.
    I would say in the evenings he is at the breast every hour or so. He usually doesn't take terribly long. 10 minutes or so. Weekends he nurses pretty frequently as well. Never more than 2.5 hours between. He does not often wake more overnight to get more calories.
    In the midst of his weight checks we had one really good one. I credit that to it being done first thing on a Monday morning after having nurses with me all weekend and no time at daycare yet that week. Every other weigh in has been on a Wednesday or Thursday. The first half of the week he barely takes anything. It gets better as the week goes on.

    His height is average but his head circumference is 4%.

    No suggestions were really made for the bottle problem. We've tried different people feeding, different settings, 5 different bottles, different positions. Me giving the bottle. The person giving the bottle having one of my shirts. He can't quite figure out a cup yet, so that hasn't really been tried.

    Today, for whatever random reason, I had a go at a 2 oz bottle in hopes that if he has at least one bottle each day over the weekend, maybe Monday will go better. At first he didn't fuss at the bottle. Just played with the nipple. After a couple failed attempts he took the whole bottle from me no problem. He is the most random baby ever.

    We have another weigh in in 4.5 weeks.
    Last edited by @llli*cricketswife; July 1st, 2017 at 06:38 PM. Reason: Typo

  4. #4
    Join Date
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    Default Re: Slow weight gain

    Ok well I would suggest caregiver try an open cup, just because it has not been tried. This is a way to supplement even newborn infants, there is no need for baby to figure it out but the caregiver will need to! I can link videos if you like.

    Today, for whatever random reason, I had a go at a 2 oz bottle in hopes that if he has at least one bottle each day over the weekend, maybe Monday will go better.
    that is a good idea.
    At first he didn't fuss at the bottle. Just played with the nipple. After a couple failed attempts he took the whole bottle from me no problem. He is the most random baby ever
    another idea is to have the caregiver watch you give a bottle the way you did today? maybe you are doing something they are not.

    He does not often wake more overnight to get more calories.
    How long a stretch does baby usually go without nursing overnight? Most babies need to nurse overnight and this is something that can be encouraged if baby is not waking on there own to do that. I can give you some ideas if you like, but first it would help to know how long baby is going without nursing and also what the sleep arrangements are- is baby sleeping with you, or on a different surface? swaddling or pacifier used?

    Are all weight checks done on the same scale, naked or in a dry diaper?

    Has doctor said anything about head circ?

  5. #5

    Default Re: Slow weight gain

    He goes, at most, 6-7 hours overnight. Lately he has been getting up at least once. Usually after 4-5 hours. For a while I tried setting an alarm for me to go in and wake him during the time he was sleeping longer stretches. That worked for a while but then I started sleeping through the alarm. He sleeps in his crib in another room. If he slept in bed with me, while easier on me to get up to feed him, I feel like he'd sleep longer stretches with me.
    (Daytime naps usually go longer if they are with me.) no swaddling. Rare occasions he takes a pacifier to fall asleep but drops it rather soon after falling asleep and usually doesn't require it again for that sleep.

    He is always weighed naked on the same scale. Usually by the same nurse as well.

    Dr hasn't really voiced any concerns other than wanting him to gain. She said we start to worry about brain development with lack of nutrition and that head circumference is usually the last time to start dropping

    I've given her all this info and the fact he's doing way better with the bottles now than he was several weeks ago. Not perfect, but better. This last appointment she made the comment "maybe he just has a high metabolism".

    Myself and my husband are not big. And weren't growing up either. Neither are/were our two older daughters. (6 & 4).

    The most frustrating thing is he can and will take the bottles. He just refuses to more often than not.

    She has not told me what the solid plan is if the weigh in next time does not go well. He will be just over 5 months and she mentioned rice cereal at that point. She also mentioned sending him to a GI specialist if it continues to not go well.

  6. #6
    Join Date
    Jun 2009
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    Default Re: Slow weight gain

    Ok, so I guess it is unclear if there really is a concern about growth, at least per doctor. So, I am going to make this suggestion about upping intake just fyi.

    While 6 or 7 hours stretch of no nursing could be fine for many 4 month olds, when there is any question about a baby's gain, gently encouraging baby to nurse more overnight probably makes sense. Also when a mom and baby are separated during the day, night nursing can be important for mom's future milk production as well. Of course you may find that your baby does not rouse to nurse when sleeping next to you, but that would not be typical. While bedsharing often does help both mom and baby sleep longer, baby is more likely to rouse enough to nurse in their sleep if mom is right there.

    Yes there are safety concerns (there are concerns no matter where baby sleeps) and you would want to read up on how to make your bed safe to share with baby just as you have surely read up on how to be sure a crib is safe. Usually a couple simple adjustments can be made if needed, but in some cases bedsharing is contraindicated- for example if the adults are smokers or on sleep inducing meds. An excellent book that covers the science of sleep including the safety of different sleep scenarios in detail is Sweet Sleep from LLL. Here is some info as well: http://www.llli.org/sweetsleepbook/tearsheets

    If actually sharing the bed is not going to work for you, I would suggest try having baby in your room. This is actually the current recommendation I believe for this age.

    The reasons for baby in bed or at least in your room are that a baby sleeps differently than an older child or adult, and moves in and out of multiple sleep cycles very quickly with only short periods spent in deep sleep. When a baby is sleeping separately, that pattern will still happen, but baby may not come to the state where baby actually rouses enough to alert others who are not close that they are needed, as that would require baby come to or almost to a completely aroused state. What is more typical is that as baby moves through the cycles, baby will rouse enough to squirm around, smack lips, etc. indicating to mom baby wants to nurse. When they are in close proximity, mom also rouses and turns to baby and nursing often happens with neither coming fully awake.

    My other suggestion, again, is the book My Child Won't Eat. I would suggest give that a read before seeing doctor again, or at least the parts that have to do with breastfeeding, charting, and starting solids. It is not a long book but packed with good info.
    Last edited by @llli*maddieb; July 1st, 2017 at 10:48 PM.

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