Babies falling off weight curve

We just got back from the pediatrician and got some upsetting news and I'm hoping for some advice and words of wisdom. My boys are 4 months old, but were born at 34 weeks and they have both fallen off their weight curves, both their weight for length and weight for age.

We worked VERY hard to establish exclusive breastfeeding and have been doing it for about 1.5 months. Due to the problems with their prematurity and my supply it took until about 11 weeks to get here, but we did. They currently breastfeed 6 times a day for about 30 minutes per session, though I'm thinking that the sessions don't have to be quite as long because they seem to be comfort nursing at the end. They seem content after they eat, and over all are happy babies. They sleep well and have over the last couple of nights done 10 and 9 hour stretches, up from 7 to 8 hour stretches. Daytime sleep is going pretty well too, they wake up from a nap of about 1.5 or 2 hours then they eat, we change diapers and play a bit and about 90 minutes from when they woke up, they go down for another nap. It really feels like things are going so well and that they are thriving, albeit as tall and thin babies, and them falling off their weight curves is pretty devastating.

Their pediatrician is concerned, and wants us to try and get more food into them, I'm planning on trying to get another feeding session in per day, but is there anything else I should be doing or thinking about? Have any of you been here and solved the problem? They are such happy and content babies that I'm surprised that they aren't getting enough food, you'd think they'd be cranky if they were hungry. Please help!

 

I don't know as I would try to get them to eat more, honestly. If they're not hungry they won't eat and it's just going to cause you and them more stress.

My boys fell off the weight curve around the 6 month mark and haven't seen it since. (They are 5 now.) Their doctor was never concerned much about their weight as long as they were developing physically and mentally as they should be. But then again, I'm 5'9" and 120 pounds so it's not a far stretch to think my kids are going to be tall and scrawny too!

 

My first question is to ask if it was just one appointment where they dropped off their curve or is it consecutive drops?

One drop means nothing. It could just be how they grow. The "standard growth curve" is just an average of kids those ages. Not following the curve is not concerning in and of itself and I would not change anything and not try to force extra food/feedings on your kids.

Now, if there have been several appts and they are not developing their own curve and continue to drop off, that is concerning.

My son dropped off not only his growth curve but the whole damn chart. The doctor was not concerned and just made sure he tracked him carefully. My doctor says their birth size and first few months of growth has to do more with uterine conditions and the drop is often them getting into their natural genetic growth pattern. My son just went up from there and began his own growth curve (below the chart mind you.) He finally got back on the chart at age 5 but there were no concerns for his eating or growth. He just had his own slower rate of growth is all. At 9 years old he is holding steady at about the 35th percentile.

 

I'm sorry your appointment was disappointing. It's hard work to breastfeed and you're exclusively breastfeeding two babies! I think it's great that the three of you have gotten into a nice routine and you're right, it is odd that things seem to be going so well, they're happy, sleeping well, etc. and falling off the growth chart. I know another twin mommy who's boys did the same thing around 9 months or a year old and they are still very, very slender kids. From what I understand it just happens. I agree with the pp - try to feed them more, but they'll let you know if they're still hungry or not. If their wet diaper counts are good each day and all else is well, it may just be how things are. I will say this - my DS was 5.4 at birth and I was convinced he was going to starve until he turned about a year old. We did a combo of bm and formula the first several months and "shoved" as much food into him as possible. The result? He still only drank what he wanted to and when we managed to get more into him than he obviously wanted, he just threw up. I think the only thing that really happened by us trying to "up his intake" was that we upped my stress level. Hang in there and GL!

 

i agree with everyone else - i don't think this is cause for concern because all other indicators are that they are happy & healthy. and i'm assuming from your post that they did but on weight & height, just not as much as the curve says they should have? i honestly wouldn't worry about it. you can definitely try offering the breast more during the day & see if that helps at all, but like others have said, you won't be able to force them to take more than they want/need. :hug:

 

Thank you all for your replies and for sharing your experiences. I'm trying not to worry as much. I expect these boys to be big, dad is 6'4" and I'm 5'8", so when there is a hiccup all of my insecurities about breastfeeding and the struggle we had to get here come on full force. We'll try to do an extra feeding, though I'm not confident they will eat much extra. We go back for a weight check in 3 weeks, so we'll see what happens.

To answer some of the questions raised about their other growth measurements (note: none of these measurements is adjusted for gestational age):
L (baby A) went from the 5th percentile in length to the 25th since their 2 month well baby visit
head circumference from between 8th to between 17th percentile
weight for age went from just below 4th to 0.1 percentile--there is a slight downward trend before this bigger jump down
weight for length went from 25th to below the 5th
He weighed in at 11 lbs 2 oz (birthweight: 4 lbs 14.5 oz)

O (baby B) went from the 9th to the 5th percentile for length
head circumference follows the curve very well, though it remains below the 5th% curve
weight for age went from 2% to 0.01%--there is a downward trend away from the the curve
weight for length went from 5% to well below the curve
He weighed in at 10 lbs 1 oz (birthweight: 5 lbs. 3 oz)

The babies were in the special care nursery and from day 1 I was not able to provide enough EBM for them, and what EBM I could provide was boosted to 22 calories with premie formula and the supplemental formula was also 22 calorie. Is it possible that the early points on their growth curves are artificially high, and what we are seeing is an adjustment to 'breastfeeding normal?' Has anyone seen this? I know that growth curves are different for formula and breastmilk, so it seems plausible to me...but I really don't know.

Thanks again, I appreciate any and all input!

Edited to add: Developmentally they seem fine, all of the milestones we talked with the ped are being met, in fact he was really surprised at how early they both rolled from tummy to back.

 

i definitely think that sounds plausible.

also, here's an overview from kellymom about growth charts. what's especially interesting to me is that breastfed babies' growth curves are much shallower than formula fed babies from 3 months on. also, i like the checklist of factors to help evaluate adequate growth in conjunction with the growth charts. i think it would be worth asking your doctor about these things to see what they say.

 

It makes sense to me- essentially when they were tiny they were medically porked up. Now they aren't get as many calories per feed- which is ok- it's what they are supposed to have.

I would watch the wet/poopy diapers and see if they maybe want an extra feed but not push anything.

Finally, how about a weight check before and after a feed by a LC? They can tell how much your babies are getting in a feed.

I'm sorry this is happening- you've done a fantastic job getting them to EBF and now this stinks!

 

All the pp's have very good points. I'd like to add 3 things:
1. Recently there has been a recommendation to use the WHO growth charts for 0-24 months but most peds have not switched over. The WHO charts are based on breastfed infants while the current CDC charts are based on formula fed babies who are often overfed and tend to be much bigger. I would look up the WHO charts and chart your babies on that to see the difference.
2. Pediatricians expect a term baby to triple birth weight at 1 year. Yours were early, but not THAT early since 37 weeks is term, so the fact that A went from 4 lb to 11 lb is phenomenal. Even B has doubled birthweight.

3. I am a pediatrician and what it sounds like from your numbers is that they each had a huge length growth spurt. It is hard for a baby to put lots of weight on when they are shooting up like that, so often the height goes first, then stalls and allows the weight to catch up.

You mention you expect them to be big but they may just be tall and lean as babies. My DH is also 6'5" and I am 5'7" so very similar. DD has always been >97th for height and only 25th for weight so wt for length is very low. DS is 50th for height and <3rd for weight. He was 5lb 6oz at birth and has made his own curve below the chart since he was 4 months old and we never stressed because he always gained some at every visit.

Honestly, I would just keep doing what you are doing and maybe try 1 additional feeding (maybe a dream feed a few hours after bedtime or cluster feeding before bedtime?). I think many docs look too much at the numbers and not enough at the whole picture. Also, there is no formal breastfeeding education in med school or residency so many peds don't really understand it fully when they are giving advice. Whatever happens, just follow their hunger cues. Studies have shown that breastfed babies have less obesity because they learn to stop when full.

 

I echo what everyone else said here! ours were term babies and started out gaining a lot of weight - even up to 50% on the formula fed chart, but slowed after 6 months and by a year were only closer to 5% or less... UGH! finally closer to 18-21 months they have gotten to a new growth curve for them, my ds is closer to 20% and my dd 10%. Height has stayed stable at 50% for both.

I only say this b/c some babies are just tall & skinny...

WOW congrats on the exclusive breastfeeding!!! by all means don't rush on adding solids - they aren't as high in calorie content as your bm and you'd be filling them up on lower calorie foods. I know you didn't mention starting solids, but your pedi may... some of my friends have said that their pedis did...

sounds like you are doing great! keep up the great work.

 

Given everything you suggested I wouldn't worry too much. Plus, as the previous poster mentioned, your babies have already doubled in weight--that's amazing. :clapping: I have a BF baby the same age, and she is gained a little less than 5lbs since birth, so the weight gain sounds quite reasonable to me.

I think 6 times a day is probably fewer than the average number of feedings for that age, but if they aren't hungry and they are sleeping good I wouldn't worry too much (I'm so freakin' jealous of you in the sleep dept. My child nurses like 10 time a day, and isn't sleeping more than 3 hours at a time.). I think you should probably try to focus more on comparing their weights to their previous weights rather than the percentiles. Moreover, you definitely should adjust for prematurity. Rather than comparing your twins to 4 month old full term babies. You should compare them to babies six weeks younger.

I think this is a very good point. Here we have a mulitple birth that was 6 weeks early, so they obviously are going to start out small, but over the first few months, and maybe even the first year, they will fall into a pattern. I've seen this with my daughter, who was born huge, but my DH and I are very average size people. She's 4 months and she went from the 96th% at birth to the 54th% at four months.

 

I wanted to post an update since it has been 2 weeks since we first discovered my babes fell off the weight curves, I so appreciate all of your posts and want to let you know what has happened.

I charted their weights on the WHO curves and actually asked the ped to as well, and it was apparent that even on those curves they had fallen off, though it wasn't as dramatic as the standard CDC charts. We tried getting an extra feeding into the boys each day, but all it ended up doing was making us stay up too late at night. I decided to rent a scale to do before and after breastfeeding weights to really see what was going on (as and aside, I'm a chemist and LIKE data). I determined that baby B, the one who had fallen off the curve was only getting around 17 ounces a day over a couple of days. From what I read on kellymom, the average BF baby takes 25 oz per day and range is 19-30 oz--so he obviously wasn't getting enough. His brother was getting about 20 or 22 oz.

When I analyzed the data througout the day, it became apparent that I have a supply issue. In the mornings when my breasts were the most full they were able to get 4-6 ounces no problem, throughout the day it would go down to 3, then 2, then 1. I am aware that breastmilk changes composition and increases in calories over the day, and they can't be expected to eat as much volume throughout the day, but it was enough data for me to start working on increasing my supply. I started domperidone again and began pumping after every feeding session. I also thawed some milk from my small freezer stash and offered a bottle after they were on the breast when they didn't get at least 3-3.5 ounces at a feeding (I still had the scale). When I took them off the breast, they seemed happy and content, then when I offered them the bottle, they were RAVENOUS, and very cranky when I took the bottle from them to see if they were done. We went through a couple of days of them being bottomless pits, but they have settled into a new norm at about 28 oz and 30 oz for baby B and baby A respectively.

My freezer stash is long gone, so we are supplementing with formula. I had some REALLY dark days where I couldn't get past the fact that I was no longer exclusively breastfeeding after all of that work. Every new formula related change really threw me for a loop, like yucky formula breath and formula poop, but seeing my kids actually growing before my eyes was positive. We are in a new stage where I am breastfeeding as much as I can and supplementing as much as is needed. I have the supply to tandem feed in the mornings and not need any supplement, then I think that for each feeding I will alternate one baby at the breast and the other with a bottle, so that the baby at the breast gets both breasts...then I will switch for the next feeding. From before I ever got pregnant I planned on breastfeeding, so having to supplement has been a blow, but ultimately by doing this I will have healthy growing babies who are still getting the benefit of breastmilk.

I think that all the problems I had developing a full supply on the pump alone in the beginning with them in the special care nursery meant that my breasts never got the message that I had 2 babies to feed. It isn't for lack of trying that I had these issues!

They each gained a pound in 10 days...I think most of that has gone into length, since there doesn't seem to be any more pudge than before. I think they will be fine on the growth chart now.

Thanks for all of the support and words of wisdom, I really appreciate this forum and you supportive and caring people!

 

Thank you so much for posting your story - I have no doubt that your struggles and successes will help other BFing mommies.

I'm so happy for you that you figured out what was going on and have been able to fix it! :clapping:

 

I'm very glad you were able to find out what's going on and your babies are thriving again.

Thanks for the update, too.

 

you're doing great, and your babies are thriving!! I know I had a small freezer stash at 6 months and that went in about 2 wks... (only 30+ bags)... I was able to add in a pumping session for me at 11pm when they were sleeping and though I never built up a freezer stash again, we kind of maintained a day to day bottle in the fridge for the next evening. I hope that with your new schedule of pumping and the meds you are taking etc. that you will get into a great new groove with feeding you babes! you're doing a great job!! way to go!

 

Data driven Mama--gotta love it. I'm a sociologist, so I understand where you're coming from.

I'm glad you are finding something that is working. A little formula won't hurt them, and who knows if you work it right, your body may still adjust to meet their needs, and if not, you're still doing good. :Clap:

You also may find their # of ounces decreasing back to around 25, as they could be compensating or going through a growth spurt.