Slow Weight Gain...Concerned About Pedi's Advice- UPDATE...Saw LC Today- More Advice Needed

hydrangeagirl · June 2014

Our 8w old little guy is experiencing slow weight gain. His birth weight was 8lb 5oz; at his one month wellness checkup on May 30 he weighed 9lb 3oz. DH jut bought a professional baby scale and we started weighing LO a few days ago and doing weighted feedings. We became very concerned when he had only gained 4oz since May 30 as of a couple of days ago. We brought him to the pedi today and he weighed 9lb 10 oz.

LO feeds on demand about 8-9 times a day and stays on my boobs anywhere from an hour to two hours. I let him drain one boob before offering the second which we always takes. We did a few weighted feedings and he transfers anywhere from 2.5 to 4.5 oz each session. He has plenty of wet and poopy diapers. He is a happy little man who is reaching all of his developmental milestones.

The pedi said that LO look great and not to worry too much about his slow weight gain. He advised me to stop feeding him for so long and to start feeding for no more than 15-20 min each side...followed by me giving LO a bottle with pumped milk after each feeding. He said that I need to teach him how to be an efficient feeder. He said that LO should be receiving 6-8oz of milk with each feeding. He said I should follow this new plan for 2 weeks then we can re-evaluate his weight at his next wellness appt on 7/2.

So, I have major concerns with almost everything that the pedi suggested. I thought that I should feed my LO on demand and let him feed for as long as he liked on both breasts. I also thought that me giving him a bottle was a big no-no (my DH has been giving him a bottle w/ pumped milk w/ no problems). The pedi said that me giving LO a bottle was not a problem at all and would not interfere with BF. Lastly, isn't 6-8oz of milk per session way too much? I thought it should be around 3-4oz.

I am interested in seeing what you think about what the pedi suggested and any other thoughts/suggestions you might have to increase his weight.

TIA

****I saw the LC today. She observed my latch and said it was fine. She did a weighted feeding and he transferred 2.5 oz in about 40 minutes. I then pumped after the session but I only yielded about .5oz (I normally yield about 1.5-2 oz after a session). She concluded that I have a supply issue. She said that at 8 weeks I should be producing more than 2.5 oz during a nursing session and should be pumping more than 1.5oz-2oz after each nursing session. She concluded that his poor weight gain is a result of poor milk supply. She said I need to increase my water and food intake right away; I should start seeing an increase in my supply within a couple of days between pumping and more water/food.

She said that I need to nurse him every 2 hours for no more than 15-20 minutes on each side, then pump both breasts until they are empty, then give him the bottle of the pumped milk. I should repeat this every session except for the late night feeding sessions (I should sleep after each nursing session instead of pumping.) She said that I can give him the bottle using paced feeding.

Before the LC visit, my DH weighed LO and his weight has increased to 9lb 11.5oz; and he transferred 3oz in about 40 minutes. We are seeing a gradual increase in his weight every day, so perhaps he is on the upswing?

The LC's plan is very similar to the pedi's which I had concerns with. What do you think about her plan? Do you think I have a supply issue based on my output? I just want to do what is in the best interest of my little guy, so any additional feedback on my situation is greatly appreciated.

Thanks,

linzeek44 · June 2014

I agree that the pediatrician's advice comes from a place of not having a great understanding of breastfeeding.

1) Feeding on demand is beneficial for boosting your supply and getting baby the milk he needs. Babies go through growth spurts and might need more some days. I mean, I eat a lot some days and some days I eat less. Why would it be different for a baby?

2) Your baby is nursing frequently throughout the day. That's awesome.

3) Weighted feeds show that baby is taking in a good amount of milk.

4) Bottles can interfere with breastfeeding. It depends on the baby and the bottle and the way the bottle is given, so it may or may not happen. Paced bottle feeding helps bottle feeding mimic breastfeeding and can help so baby doesn't prefer bottles over nursing.

5) It is VERY rare for a baby to take 6-8 ounces a feeding and VERY rare for a baby to take in the same amount at each feeding. Baby might take 6 ounces in the morning from the breast and then take 3 or 4 or 2.5 ounces at other feedings.

6) Since the average amount of milk consumed is about 25-30 ounces you can divide that number by the number of feeds. I bet you'd get something around 3 or 4 ounces, not 6-8 ounces.

7) For me, it was helpful to ask local breastfeeding moms which pediatricians they thought were breastfeeding knowledgeable and breastfeeding friendly. At the very least, one who would say, "here, talk to the LC about that" instead of giving advice that doesn't support your breastfeeding relationship.

8) My son had slow weight gain. I kept feeding on demand or encouraging an extra feed, and I did lots of breast compression to squeeze out hind milk. I didn't pump or bottle feed. And I found a pediatrician who said "Let's just watch and wait since he is looking healthy and happy overall."

hydrangeagirl · June 2014

Thank you @linzeek44! It is very reassuring to know that I am doing the right things..just as I thought I was

My DH has been doing at least one paced feeding every other day in preparation for me going back to work in about 4 weeks. Fortunately, LO does not seem to mind the bottle.

I also do breast compressions w/ every feed too, so I guess I just have a slow weight gainer! He has grown so much in length and is long and lean. I will continue to do as I am doing and forego the plan the pedi instructed me to start. Hopefully, he will start to pick up some weight soon.

Thanks again!

SunflowersBride · June 2014

My pedi suggested during the early days that I should feed 10 min on one side, switch to the other for 15-20, and then switch back for another 10 if baby was still hungry. I just ignored that advice knowing that everything else I read about breastfeeding said to allow baby as much time as they want on one side before offering the other. Your baby will become a more efficient nurser in time, no need to force it to happen right now. My DS would nurse a lot and for a long time, and around 12 weeks he began to nurse for shorter periods of time. Now he's a champ and can nurse in about 10 min. It sounds like you're doing great, I would just keep it up, and go to see an LC if you want a weighted feed. It was very helpful to me early on!

hydrangeagirl · June 2014

AmyG* said:

You may drive yourself nuts with the scale!
We like to think babies gain weight on an even keel, but really they don't.
They grow in fits and spurts.
If you use the weight gain calculator at https://kellymom.com/health/growth/weight-gain-calculator/
you can plug in all the baby's weigh ins to see what is going on.
The concern is that weight gain should stay betwee 4-7 oz a week as a bfed baby and yours is a bit lower than that, 1.8 oz per week from 1 mos to 8 weeks if I entered the data correctly.
That is a big concern. Now time of day of weigh ins if they weren't the same can account for a few oz difference, but probably not enough to boost weight gain for the last 4 weeks over 4 oz a week that's a low minimum. like I said it looks like only 1.8 oz gain per week which is TOO LOW.
I would do some weighted feeds on your scale, to see if the amount has changed.
If nursing sessions for 8 week old are still at 1-2 hours long there could be something wrong with latch or milk transfer that means it takes a long time for baby to get enough to eat. I would do a check again for tongue tie and latch issues with an IBCLC. Sometimes if your milk supply is higher at first, a bad latch can still get baby enough milk without them working too hard. But as your supply regulates between 6 weeks and 3 mos, if baby is not transferring milk well their growth slows drastically.
I would switch sides a bit sooner in feeds in case he's doing a lot of comfort nursing but really needs the extra milk volumen of a side switch--like after 20-30 minutes switch sides, not 10-20 minutes. use breast compressions and massage to make it easier for baby to get milk, and get evaluated again to see what the LC thinks is happening. I probably wouldn't pump and give supplement, but I would consider it soon depending on weighted feeding results since weight gain is so low. I would NOT give a bottle at every feeding and would NOT give 6-8 oz.

Thank you for your feedback. Believe me, I was devastated when we first weighed him and saw such poor weight gain.

We have done several weighted feeds at LO is transferring anywhere from 2.5 to 4.5 oz per feed.

The pedi did a quick check and did not find tongue tie. I scheduled an appt w/ a LC for tomorrow. Hopefully, she will identify a problem to correct.

opheliainwaders · June 2014

What about his diapers? Does he seem to have normal poop? I ask, because it sounds like he is transferring enough milk, but maybe he's having trouble digesting it?

I hope the LC can give you some answers!

hydrangeagirl · June 2014

gulickr said:

What about his diapers? Does he seem to have normal poop? I ask, because it sounds like he is transferring enough milk, but maybe he's having trouble digesting it?

I hope the LC can give you some answers!

He has at least 8 poppy diapers a day. His poops turned from yellow and seedy to different shades of green and seedy about 1.5 weeks ago. There is no blood or mucous. A few diapers turn more dark yellow w/ seeds on occasion. We showed one of the green diapers to the pedi today and he said that the color did not concern him at all since there was no blood.

I can't help but be worried about my little guy. I don't have a lot of confidence right now in my pedi and am concerned he might be overlooking a real problem.

Marick2 · June 2014

I agree that there might be a latch issue here. Can you tell whether he is swallowing or just sucking during these long nursing sessions?.

We had a very similar experience in the first month. My son gained weight slowly, would nurse for 1+ hours per session, and would generally transfer 2-4 oz per session (we bought a scale too). But, he was a happy baby with normal diapers and what looked like a good latch so I just could not figure it out. My LC had me do triple feeding starting at two weeks to try to help him gain weight (BF, offer a bottle of pumped milk from the previous nursing session - 1-2 oz, and then offer formula if he was still hungry - 1 oz). While I think this helped keep my supply up, it did not change my son's nursing behavior and was very time demanding so after 2 weeks we went back in and my LC confirmed tongue tie. As soon as we fixed his tongue tie, everything changed. He became a much more efficient nurser (much more swallowing than just sucking), and he got back to his growth curve. Good luck at your appointment with your LC!

hydrangeagirl · June 2014

@Amyg* thank you for your insights. DH bought a professional baby scale from a health department (the sliding weight kind, not digital) and we have found it to be very accurate.

I really like your suggestion to do weighted feedings for 24 hours and will do so starting today.

As far as pumping goes, should I pump after each nursing session and give LO the pumped milk as the LC suggested?

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