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Thread: Advice on weight gain

  1. #1

    Default Advice on weight gain

    I'm struggling emotionally with breast feeding because my doctor wants me to supplement with my pumped milk using a bottle.. my LO lost 11% of her body weight in the first 5 days due to latching difficulties (she's a 37 weeker & I have extremely large nipples), but has been doing great since we introduced a nipple shield. She's gained back 4.5 oz, at a rate of about a half an oz a day, and the doctor says she should be gaining about an oz a day at this point. She's 11 days old, and still about 7.5 oz away from her birth weight. We've given her a bottle of 1-2oz a few times and she has still been latching okay, but after our visit the doctor wants us to let her nurse for only 5 mins or so and then give her the bottle because she thinks that maybe LO isn't getting enough when nursing - not because of low supply, but because she isn't sucking efficiently.It feels wrong to me. My gut is telling me she's eating fine - she has 8-10 wet and dirty diapers a day, she isn't fussy, and is waking to feed every 2-3 hours. She was also jaundice after birth and very sleepy which added to the feeding difficulties. I just don't know what to do - is there a way to measure what she's getting from the breast every feeding? Or does anyone have any advice on how to keep her sucking efficiently while nursing? I am just having a really hard time with this.

  2. #2
    Join Date
    Jun 2009
    Posts
    10,740

    Default Re: Advice on weight gain

    Hi nhecht12, I am so sorry you are having this concern.

    It does sound like baby's gain is slow, but at this point you do not really know why. Is it because baby needs to nurse longer? more often? Is baby not able to transfer milk normally, or is your produciuton low?

    In a case like this, some supplementing may be appropriate. What is not appropriate is limiting time at the breast. There is no need to do this in order to supplement. Baby is proving they can gain while nursing, if slowly. This means baby is getting a good amount of milk from nursing- the difference between slow gain and normal gain is usually just a few ounces total per day. Limiting time at the breast is only helpful if MOM needs to limit the time because of time management concerns- in other words if the strain of nursing, pumping and supplementing is so great it is harmful to mom, then limiting time at the breast somewhat might make sense, but it is still likely to cause more issue for breastfeeding. 5 minutes? That is a ridiculous number- a baby this age typically will nurse from 20-60 minutes 10-15 times a day, that is normal, limiting a baby to 5 minutes is likely going to destroy your breastfeeding relationship.

    Of course it is also possible you are on the brink of getting baby nursing well, and no supplements are needed, it all depends on what exactly caused the slower gain and if that is self-correcting or not.

    Here are my suggestions:
    -If at all possible, see a IBCLC in person for a consult. Nipple shields are only meant to be a temporary solution. Even if baby were gaining well, you would need help figuring out why the shields are needed and weaning off them. Here is info about what to expect at an apt: http://www.cwgenna.com/lconsult.html
    -If you are using shields, you probably want to be pumping to protect your milk production,. How much is going to vary and in some cases pumping is not needed but it is an important safeguard when using shields. More on shields: http://kellymom.com/ages/newborn/nb-...s/wean-shield/

    Consider giving baby a small amount of supplement here and there if gain continues to be slow. (1/2 to 1 ounce at a time.) Use an open cup or a syringe, not a bottle, if possible. if you must use a bottle, make sure you use paced bottle feeding. Offer only a small amount at a time, and it need not be every time you nurse, you can offer either before or after nursing whatever works better.

    Other ways that might increase gain rate without supplementing would be to encourage baby to wake more and nurse longer (baby may start doing this on their own soon anyway) but in the meantime you can wake baby to nurse if needed. Baby should be nursing at least 10 times in 24 hours. also you can try breast compressions.

    I have to run, let me know if you need more info on any of the above.

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