Weigh gain in 6 month old twins

I am posting here so more mom's (who aren't breastfeeding for related issues) will see it. Hope that is ok!

We just got home from the most upsetting doctor's appointment I have even been to. To make a really long story short, my boys are now 6.5 months old and weigh 13.2 and 13.4 pounds. Their growth curve has flatlined and they are not even on the chart at this point. They have only gained a couple ounces each in 2.5 months.

They were born at 38 weeks with good weights, 6.7 and 6.9. Their brain and height curve are still ok.

I have breastfed the boys from day 1, AND given them formula bottles from time to time (as little as 1-2 a week to 1-2 a day). We had a really rough month around 2-3 months, when they both had very bad reflux to my milk. During that month they got formula and I pumped and froze my milk. Magically they outgrew the issue at 3 months.

Now after making it through all of that, my doctor is saying I need to quite nursing (basically right now, cold turkey). He said they are not getting enough from my milk. It could be a supply issue or they just are lazy nursers. He said some babies will nurse to get satisfied only. Since the brain feeds first, there is nothing left for "storage". This is what we are assuming is the case and not a supply issue, since I nurse them on demand whenever they want, and they are not crying because they are hungry. Then seem satisfied after every feeding. I asked about the antibodies they are getting from my milk and he said that at this point their weight gain is more important. He continued that babies who continue on this type of curve (or lack there of) will see a hault in brain growth. WHAT?

We introduced solids 2 weeks ago to see if that would help, and obviously it didn't.

I am so overwhelemed right now. We got some other bad news that I wont even go into in this post. I was wondering if anyone has been in this situation before? I totally trust this doctor and we have been seeing him since my oldest was born (3 years ago). But, I can't help but wonder if there is another option? Why does it have to be all or nothing??

 

First off, I just want to say anything I am saying is just my own, and I think it always makes sense to check with a real medical professional before listening to some random person's advice online.

But with that disclaimer:

My girls who recently had their 9 months appointment, weigh just a bit more than ur guys, so I dont know if the weight per se is an issue, or the lack of weight gain is an issue.

my girls also didnt show that much gain in the last 3 months, since our last visit, but my doc said that the charts are based on formula fed babies and not nursing babies, and nursing babies dont always gain the same. He also said that sometimes they check the baby right before or after a growth spurt, so it could be last time the baby had a big growth spurt and just slowed down now, or the baby might be about to have a growth spurt.

My doc recommended me coming back in a months to do another weight/hight check to see how things were progressing, at no point did he suggest stopping to breast feed.


Do your babies seem satisfied? are they sleeping? peeing pooping? doing all the things that babies should be doing?

I would also check out www.kellymom.com or some other very pro breastfeeding site for more information about slow weight gain. and if your babies are enjoying solids I would add foods like avocado etc, that are high in good fats.

 

1. Formula is not poison.
2. Kids need to eat. In sufficient quantities. If they can't get enough from the pump, then it must come from a bottle.

One option might be for you to pump and fortify your breastmilk to 24 or 22 calories. This means they will drink from a bottle and may take in larger quantities.

Have you tried working with an LC?

 

I just wanted to address that I do not think formula is poison. Like I stated in my OP, they have gotten formula bottles as many as 2 times a day, as well as for a whole month while they were having reflux issues. I am asking for mom's who have BTDT that might have some advice, encouragement, or personal experiences that could help guide me if I have other options I could look into. Thanks

 

I agree with the things that kumphort said. I think I understand why the doctor is concerned (low weight is not necessarily a problem, but a child falling off *their own* growth curve is concerning). That being said, I don't think you should wean cold turkey. I would ask for a referral to a specialist, and in the meantime, perhaps you can supplement with 1 or 2 bottles of Neosure (or another high calorie formula) in the place of 1 or 2 nursing sessions.

You could also get a consult from an LC who can weigh your babies before and after nursing to see how much milk they're moving. She could help correct possible latching issues as well.

I think that doctors are very quick to blame any feeding problems on nursing. If I were you I'd see if you can have a nutritionist or some other specialist look to see if there is a deeper issue here.

Good luck and I'm so sorry things have been stressful for you. :hug:

 

I haven't been in your exact situation as far as slow weight gain at 6 months, but for the first month it took my 2 a long time to start gaining weight. By 6 wks old I was having to supplement both of them after every nursing session because they were not full, and this was with nursing them for 45 mins at a time. I just knew I didn't have enough milk to satisfy 2 babies growing needs.

As much as I hated to stop nursing, I knew it was for the benefit of my babies. It took several days of crying, of wavering, of going back and forth before I made my decision.

With all this being said, if it had come down to a situation like yours, where my babies were no longer gaining weight, I would have either increased my supplementing or possibly stopped nursing completely.

I know all babies grow differently, my kids are obvious examples of that, but even my smallest twin (6.4 lbs at birth) was at 16.12 lbs at 6 months. He's running about the 10% now at 1 yr old (19 lbs 15.5 oz).

I would first call my hospital I delivered at, or somewhere that has a lactation consultant, and talk to them. There may be some way to "beef up" your milk. I would also look into feeding them higher fat solids if you need to!

Good luck! :hug:

 

I have been in a similar situation. And some of the best advice I got was "formula is not poison" and that it is way more important for them to eat than to get antibodies from bm. This helped me mentally get to the point where I felt OK with formula. But if you aren't ready to go there yet, then I understand, having BTDT. So again, I would recommend looking into the other option of pumping & fortifying & feeding them from a bottle. It sounds like pumping worked for you before, and so you hopefully could pump again successfully. This would save your kids the trouble of having to suck hard when they are lazy eaters. And would give them extra calories to help them grow. And it avoids the "all of nothing." And again, I recommend working with a LC.

 

Hi,
I agree with a PP - kumphort. My twins did fine on their growth charts until 6 mos (even some slowing between the 4 mo and 6 mo check here), then they started slowing, and some drop on their curves (25 down to 10% and 60 down to 40%). I was really worried about it, but my pedi who is very pro-breast feeding, told me that the growth charts are based on formula babies and that the benefits of BF outweighed the drop on the growth chart...

Well, hearing that, and accepting that are two different things..... Momma wants big healthy babies, right? (Well, I want the healthy, and I think "society" thinks big is healthy....) I guess I just had to make some hard choices about what to do about it. So I'm still BF. They get one bottle of EBM at night, and we really try to pump it down them, and I do fortify it with some formula - increase calories per ounce. I give them a lot of high fat foods - full fat yogurt every am, avocado at least 2/3 times per week, cheese, butter!, olive oil on their pasta, egg yolks (add formula powder when scrambling)...

I can't say that I know for sure that this is working - haven't been in for a weight check yet, but it seems like it is helping.

 

just want to say hugs and that I relate in this situation. Have 6 month old twins (who we were elated, btw, to find weighing in at 12lbs and 12lbs 3oz at their recent 6 month apt!)

I understand you being cool with the combo feeding and alarmed at a dr. saying to quit nursing entirely. Obviously BFing is more than just about giving healthy BM, it is the bonding that goes on as well and it sounds as if you want to hold on to those nursing sessions. I can totally understand that and don't see why the doctor can just have you really work in some bottles and up the solids, etc. What I have been doing when I finally got fed up with predominately nursing on account to the slow gain was to focus on giving bottles at fixed time, basically a breakfast, lunch, dinner feeding of about 4-6 oz each of the enfancare which is like neosure, a 22oz formula, then BF on demand around that. Lately we are going through some challenges b/c I think they are just getting bottle preference, but I still get in a good 3-4 sessions a day which I am hoping to maintain to the year point. I also give 3 solids meals a day, but from what I have understood if you want to focus on weight gain, there tend to be more calories per oz in formula/BM rather than solids.

Although you like your ped, I think that it wouldn't hurt to inquire into a 2nd opinion about dropping nursing altogether if you don't feel that is something you want to do. I agree it is concerning if they have fallen off their established curve, but I have BTDT with erratic curve reports, both from my twin sons and from my DD and so far everything is pointing to three developmentally appropriate and perfect little beings, albeit petite ones. So again, hugs to you, I totally understand the stress you are feeling.

 

so sorry for the scare. from what I read on kellymom.com it seems that the breastfeeding growth curves are supposed to be a little higher for the 1st 6 months and then they taper off to be lower than FF babies over the next 6+ months. that's what my babies did, they actually
rose from 10% at birth
up to 50% by 4 months then
down to 30% at 6 mo
down to 10% at 9 mo
barely 7% at 12 mo-17 mo.
up to 10% at 18 mo and a little higher now.

all that is to say that babies do grow differently.
but... in your case, if they really have tapered off on their weight it would be concerning (not gaining any more than a few ounces in 2 months). I believe that the doctor has their best interest at heart, but from what I have also learned breastmilk and formula are more nutritious than most solids and I would think that you would do better to supplement with the higher calorie formula...

I totally recommend getting an LC's opinion and a referral for a nutritionist or something to help you out. as for antibodies... would it really hurt at all if you at least kept breastfeeding for at least 1 session a day? I don't think they need a whole lot of breastmilk to get the anti bodies.

one other thought... what if you totally quit breastfeeding and you don't see any increase? that would mean that you might have quit in vain. if the LC thinks its ok to keep breastfeeding I would rely on that and hope that they have a substantial plan/advice for you to increase the calories.

I hope you are able to get an appt. with an LC soon to get more sorted out. You have done an outstanding job to overcome all the issues in the first few months, they will be gaining good weight soon!

 

Here is the growth chart link for breastfed boys from Kelly mom
http://www.kellymom.com/babyconcerns/growth/chart2.html

Here is the link to the page about growth charts
http://www.kellymom.com/babyconcerns/growth/growthcharts.html

Here is a link with some good info a nutritionist gave to a member for when your guys are eating more table foods. http://www.twinstuff.com/forum/index.php?/topic/113555-going-to-see-a-nutritonist/page__p__1183828__hl__kix__fromsearch__1&#entry1183828

My twins were 38 weekers and 5.3 and 5.13 at birth - so kind of small. They gained slowly and had the same issues at 6-12 months as your guys. My pedi thought it was related to breastfeeding but did not push me to stop. It took my DD 20 months to get to 20 pounds and finally got back on the charts at 2. My DS2 is still very thin but both are thriving. I really used the developmental skills, being content i.e. thriving - more as a yard stick then the charts (though it was stressful for a long time to have underweight" kids)

I would chart each of your boys on the BF chart and see if they are staying consistently on his own chart across the months. I would also try to meet with an LC to discuss the best course of action. Did MD recommend how many calories/ounce he wanted?

Hang in there, I hope you get some answers soon on the best way to proceed.

 

that is a great chart. and at least they are still on the "chart" on the breastfeeding one. I do hope you get some answers for yourself soon. I would definitely chart your twins on this so that you can understand a bit more and take with you to any dr. or LC appointments.

 

I would get the opinion of a lactation consultant before I would do anything! Elizabeth only weighed 13 lbs at eight months old and my pedi never told me to stop BF. She was in the 5th percentile or less for the longest time for weight. She is just a skinny kid! My pedi does use a different growth chart for formula fed vs. breastfed babies. I would check to see that your pedi is as well!

:hug: to you!

 

Thanks for all the advice so far!!

I am going to look into a LC and talk to the ped some more. I am not giving up yet!!

THanks for that chart as well. I am glad to see the they would be at least in the 3rd percentile on that specific chart, however, the way the dr explained it to me is that they have "flatlined". Basically, when he showed me their curve, it was similar to the chart until about 3.5 months, they it goes straight. They have only gained 2 and 3 ounes each since December. I am trying be to positive though and looking into all my options before I give up!

THanks again ladies! You are great!

 

I'm so sorry you are dealing with this. You sound like a wonderful mother. My two were low weight and growers. Formula plus breast feeding. 10th and 5th percentile. One LC suggested I quit. Well, it didnt' change their weight one bit. Since then (they are now 2 years old) the one twin at about one year got more hungry. Her sister continues to be BELOW the 3rd percentile. FOLLOW YOUR GUTS. Likely if you are pumping or formula they are still just not drinking a ton.

I was a hard thing for me to go through but for me I think I was ready to stop bf at 5.5 months. If you want to continue ... YOU CONTINUE.

I'd recommend buying baby scales -- not to get too obsesses with their weight but different scales show different results. Plus please please please read "Child of mine: feeding with love and good sense" it will really put it all into perspective. An important book for parents with low growth weight.

Sometimes it is just them. At various stages they plateau and then 3 weeks later they eat like a horse. Try to get a Pedi you can work with. REally, all the best to you. It is hard. Focus on enjoying them, and not the number of their weights it can be overwhelming sometimes.

Heather

 

Great advice from PPs!

Yes, the slowdown in growth can be a concern. But I agree with PPs that weaning is not necessarily the answer. Pumping and fortifying is one great option if they need extra calories.

I totally second the PPs' advice to see a LC before you do anything else. She'll be able to evaluate whether they're moving milk efficiently, and if not, why not.

I'd also strongly recommend finding a GI specialist. There could be other reasons for this big slowdown in their growth that are unrelated to your milk.

Another thing I've heard of - falling off the charts can be due to hormonal reasons (growth hormones). Endocrinology could be another avenue to check out.

Oh, and one other thing - try not to push the solids too much. Solids are much, much, much less calorie-dense than breastmilk. (At least the kind of solids 6 mo olds should be trying - you definitely don't want to load up on butter yet.) At this age, even in babies without weight gain problems, solids can seriously cut into milk intake if you're not careful. I'd keep it to one solids "feeding" a day, and that should be no more than 30 min after a good nursing session.

Good luck! I hope you can get to the bottom of this soon. :hug:

 

I don't admit this to many people on the forum because I don't want a barrage of questions when I am trying to learn how to be a twin mommy myself, but I am a pediatrician. When I read that your pedi told you to stop nursing my jaw just dropped. I am not doubting he is a good doctor, but some docs go way too much by the numbers and don't look at the big picture. If your babies are developing, acting satisfied after feeds and growing height wise and head circumference-wise, I think my advice would have been to look for areas to fortify and then bring them back for a weight check. I have seen many babies who take a periodic lull in growth right around the 6 month mark and then shoot up in the next few months.

I also have BTDT experience, because my own DS is a peanut. At 6 months he weighed 13 lbs. Between 6 and 7 months, he only gained a few ounces as well, and now is gaining like crazy. Since yours are 6 mo, have you started introducing any solids yet? One of the things I did to help the weight gain was to make sure he got cereal made with BM twice a day and started yogurt for extra calories and fat. Avocado is also a good food to use in order to boost calories. If the problem was that your kids are really lazy nursers, you would think that they would chug the formula bottles they get and still gain weight...this tells me that they are just following the path that a lot of BF babies take with being smaller than what the charts tell us they should be. I think we get used to these giant formula fed babies whose rolls have rolls and we think all babies have to be in 12 month clothes by the time they are 6 mo old. My DS who is the smaller one is actually developmentally ahead of his sister, which goes to show that being small didn't halt his brain growth at all. If you enjoy nursing and don't want to stop, I would definitely get a second opinion. You could even have an LC weigh them pre and post feed to see how much they are getting and hopefully disprove the "lazy nurser" theory.

I can tell you that medical school and residency does not teach anything about breastfeeding and that many doctors are not very pro-nursing so their answer to everything is to switch to formula. My babies get mostly formula during the day because I can never pump enough and I am ok with that, but I think I would be angry and devastated if someone told me I had to stop nursing them! And even if you only nurse them a few times a day, yes the antibodies are important for immunity and the milk itself is important for brain growth and development.

 

I totally have to ditto the Avocado advice!!!!

Let me give you my sister's story on her 3rd child! She was ebfing her, and she grew fine until around 5-6 months old. At that point my sister started her on rice cereal and she began having problems. She stopped growing altogether until around 10-11 months old. She was vomitting a lot and it took my sister months to realize she was having a sensitivity to rice cereal and oatmeal. Anyway, the peditrician would never believe my sister on this topic. They brushed it off as regular spit up. In spite of this and the fact that the child was not putting on any weight they NEVER told her to stop bfing. Never! Looking back I'm surprised they didn't question whether the child was getting enough milk. But perhaps it was because my sister had a baby scale and weighed her child occasionally to see what she was getting, and she was getting plenty of milk. (So this would be a great option for you too! You can get one on-line for around $40 or so...or you can take them to an LC and get a before and after weight check!)

Anyway, once my sister determined for herself what the issue was she took her off anything with grain at all. And one of the foods she did put her on was avocado. She only started gaining weight after my sister started feeding her avocado...you just can't gain weight from fruits and veggies and no grains! But avocado has a ton of calories in it, and fat too. She's still a little peanut, turning 2 in April, and probably not yet 20lbs, but she is holding her own growth curve...it's just not on the growth charts!


If I were you I would not stop nursing. I would maybe get a baby scale or go to an LC for a weight check. I might pump after feeding them. If they still don't put on weight then I might consider offering a bottle once a day. If you really don't want to switch pediatricians then I would pre-empt any scolding you might get and go to an LC for a weight check so that you know whatever methods you are trying are working for weight gain.

 

P.S. My sister's little girl is smart as a whip... she is quite the stinker at not quite two. She is the most verbal of any of my sister's kids, she can open doors, climb on tables to get to cookies, tries to help my sister unpack the dishwasher by climbing on the open door to get to the second rack! No problems with any of her milestones! If anything my sister wishes she were a bit less mobile!! About the only issue my sister has faced is some occasional night waking even now for milk at night.

 

I know that I no longer breast feed (my boys were 29 weekers, never learned to latch, tried & tried, but never learned- ending up pumping till 4 months, then I quit for my own sanity)., but I wanted to maybe throw around a few ideas.

At my boys 6 month appointment (Feb 1, 2010) Wyatt weighed about 15lbs, 5oz and Riley weighed about 15lbs, 10oz. That's huge considering my boys were only born at 2,10 & 2,15 and dropped down to barely 2lbs. They also get rice cereal in their bottles (on top of prevacid) to help w/ their reflux, so I'm sure some of their weight gain is from rice cereal. ANYWAYS.

I weighed them this morning and Wyatt only weighed 15lbs (so he's LOST 5oz in about 6 weeks) and Riley was only 15lbs 3 oz (so he's LOST 7oz in about 6 weeks). At their 6 month appointment they were eating at 10am, 2pm, 6pm, and 10pm...All 5oz bottles w/ 2.5 scoops of rice cereal. Now they are eating at the same exact times but 6oz w/ 3 scoops of rice cereal each time. So they are eating more, but losing weight? I'm not too worried cause I know they are eating plenty. However, my idea that I wanted to throw around is that they are a lot more active. Sure they aren't crawling or walking, but they're rolling all of the time, jumping around in their exercauser, jumperoo, etc.

Is it possible that yours are exerting more energy so possibly burning more calories? I know I'm not a lot of help, but I don't think you should give up if you aren't ready. I've heard that you can get your breast milk tested and see how many calories it really is. I know most of the time it's only 20cal, but some women do produce 22, 24, 26, etc. You could try nursing, then offering 2 oz or so of neosure.

 

You've gotten great suggestions and I want to reiterate that meeting with an LC is a great idea, as well as weighing before and after a feeding (rent a scale for a week) to check what they are getting over the course of 24 hours. I also agree wholeheartedly with following other signs of development, not just weight! And, finally, I learned a great lesson on this forum when I was supplementing which is to do so at set times and continue to bf on demand around that. My LC said sometimes even an extra few ozs/day can make a difference in putting on weight. I supplemented both twins for 7 months, with 1-3 small bottles/day (2-4oz, going from 3 to 2 to 1/day in gradually smaller amounts by the end). This is a great strategy if you do decide or need to supplement. I dropped the supplements and was able to continue to bf for quite some time, and I would have been devastated if I had been forced to stop and it didn't make a difference in the weight gain.

I also have to add my two cents about food allergies/sensitivities. Do they have any GI issues (spitting, diarrhea)? Do they have eczema? I have two slow weight gainers and both have serious food allergies. With my older DD, we didn't know why she spit so much and wasn't gaining well, but she always gained and was a generally happy baby so we didn't investigate. It got worse when she started solids, and we finally had her tested at 14 mos. This was based on an article my mother read about food allergies and how my DD met a lot of the symptoms! My ped (nor my sister, who is a ped) ever thought of it. With my 2nd DD, I knew more what to look for and had her tested early and was able to adjust my diet and, eventually, hers. However, she is still a peanut...21 lbs at 27 months! It's just her. My ped did suggest (hestitantly) around 4 mos. that I try only formula for a week to see if that helped her gain weight... I agreed to do it for 2 days only b/c I was nursing her twin and pumping a lot anyway so I froze the milk. She was actually more sick those two days b/c, as it turned out, she is allergic to dairy and formula is dairy-based.

Good luck!