slow weight gain in 4 month old but supply seems okay? Supplement?

JJ1973 · May 2014

Hi guys. Sorry for the length of this - m any questions!

My LO is almost 4 months. We've had a slew of issues: he was born 3 weeks early due to a complication, he was in the NICU for a week due to concerns over his breathing. When he came home, he wasn't gaining weight. We later discovered he had tongue tie and ended up getting two revisions (the first one wasn't cut far enough). I had to pretty much exclusively pump for two months. His latch and transfer finally improved at the 2 month mark, we worked with a lactation consultant (two actually) and we've been at the breast since that time (except for my return to work, part time). Along the way (pretty early on), he developed severe silent reflux. I am now dairy free and his new medication routine seems to be working well controlling his symptoms (or maybe my giving up dairy - not sure). Feeding has never been an especially happy thing, unfortunately, but it has all improved a huge amount, particularly in the past month. Oh - and I nursed my 3-year-old until about 18 months with no issues, so this is all new to me.

We had a pediatrician appointment yesterday for a weight check. He only gained 7 ounces in three weeks, which is concerning. He is already below the 1st percentile, which was also true of my now 3-year-old (I guess I just have small babies). His birth weight was 5 pounds, 15 ounces and he is now 11 pounds. The discussion naturally shifted toward supplementation, but I'm really confused. He has tons of wet diapers (his BMs are less frequent now, but he has large ones every few days), and when I pump at work, I usually get about 4 ounces per missed feeding. When he feeds, I see milk around his lips, he gulps, and my breast is much less engorged afterwards. All signs suggest he should be getting enough. He isn't a comfort sucker, so he does not stay on the breast for long after he's gotten what he wants. I always offer both breasts (and he usually takes both). Due to his reflux, he's never been especially happy after feedings, but after a moment or two he is always very content these days.

I'm worried about supplementing with formula due to a reaction he had to formula early on - we would have to experiment to find the appropriate one. I've been pumping after many feedings during the day to increase my supply. I also have a prescription for domperidone I secured during our tongue tie saga - I never used it because my supply seemed fine, but I'm beginning to wonder if I should try it? In the past, I tried fenugreek and he had an awful reaction to that (painful gas).

Any input on what I should do? I've contacted the lactation consultant again, but all signs suggest he is transferring just fine now. I don't know what to make of this.

Asivec · May 2014

Count wet/dirty diapers? Trust your instincts? I supplemented due to pedi's concerns and wish I didn't, but it may have been the best for my LO. Although you could offer a bottle of pumped breast milk as extra or 2oz of formula and see if the weight piles on. Formula is not the enemy. I don't think there is a right or wrong answer. It really is a personal choice.
Good luck!

cinderin · May 2014

If you want to supplement, it sounds like you could supplement with your own pumped BM.

I did that when my DS was having weight gain problems.

I fed at the breast then pumped after each feeding. i gave him a bottle of pumped BM about 3x a day. It actually helped him gain weight.

jessib10 · May 2014

personally.. I don't think you need to supplement. I agree with PP who suggested counting wet diapers.

It's my opinion though, that if baby is gaining some weight overall, and having plenty of wet diapers throughout the day there is no need. Just because their medical text books tell them if a baby doesn't gain x amount of weight in x timeframe you need to supplement--doesn't mean it holds true for every baby.

JJ1973 · May 2014

Thanks, guys. He gets about 9 feedings a day (at least two being during the night). When I am at work, I've been leaving 14 ounces, but maybe I'll try to start leaving more. I'm hesitant to supplement with formula, given the trial/error method we'll have to take given his dietary sensitivities. The first couple months were absolute hell on us for several reasons - formula reactions being one of them, since we were supplementing with formula then, before we figured out tongue tie was the real issue (not my supply). I certainly want him to gain appropriately, so I think I'm going to try to boost my supply as much as possible and supplement with my own milk, and see how it goes. The pediatrician was pushing 6 ounce bottles, but that seems like overfeeding to me. I may just add some smaller feedings during the day and nurse like crazy. Developmentally he is doing just fine, so I'm not especially panicked about this.

Chichigo · May 2014

He is really close to doubling his birth weight, which i was told should happen by six months.

Can you see another doctor for a second opinion?

JJ1973 · May 2014

I guess I could get a second opinion but this doctor seems to be the most breastfeeding friendly in this particular group practice, and I'm not sure I want to venture someplace new. In general, I haven't been especially pleased with this particular pediatric group as it relates to breastfeeding. They've been great with my 3-year-old, but this infancy stage has been challenging.

sishamarie · May 2014

I agree with PP. Keep a close eye on the weight gain and increase feedings. Since your baby is close to four months you also be able to add rice ceral mixed with breast milk which might also help with weight gain. I would be very hesitant to supplement with formula.

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slow weight gain in 4 month old but supply seems okay? Supplement?

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