Insufficient weight gain at 4 month checkup

Hi everyone,

I'm new to the boards but have been reading many of your posts and you all seem so friendly and helpful i thought i would ask for your advice.

I was tandem breastfeeding my twin boys (Saro & Ari) and they were gaining very well at first. however, at their 4-month checkup 2 weeks ago today, i was surprised to hear that they had NOT gained enough weight over the last month, nor had they grown enough in length or head circumference. This was very scary to me and my doctor recommended i try to supplement with a bottle after each feed. I had some EBM i used but i also used formula in order to be able to try to supplement. However, Saro absolutely refused the bottle and Ari was so-so with it. We had tried in the past to give them the bottle (just to give me a little freedom on occasion) and again, Saro would adamently refuse it while Ari was ok with it. So, i made what was a difficult decision for me but one i felt i had no choice but to do... i stopped breastfeeding and gave them only the bottle so that they would have to get used to it and we could better monitor their intake and encourage them to eat more.

Well, this backfired on me. At first, it seemed to be working. I could coax/force Ari to eat 5-6 oz per feeding and noticed his diapers did feel heavier and he did seem content. I started to think - wow, this kid really was starving himself. Saro started to take the bottle as well but you could not force him. He would eat what he wanted and that was that. But that wasn't so bad either... he would eat somewhere between 4-6 oz per feeding. But, as days went on, things got worse. Saro started to take less and less. Ari started to cry and protest more and more. I guess they were getting mad at the force-feeding? It came to the point that i just couldn't do it anymore. I was feeding all the time and each feeding would take forever and involved so much crying.

So on Monday night, i went to see the doctor and we are going to give bf'ing another shot. However, my supply has since gone down b/c i didn't pump that often (who had time? there was always someone who needed to be bottle-fed). I'm now taking Fenugreek and Blessed Thistle 3capsules, 3x a day and domperidone 10mg, 3x a day. I am pumping after every feed but am not getting much milk -- not sure if that is because there is no milk or because they are emptying me.

So long story to get to my question... I do believe that Ari was not eating well at the breast before we started the bottles, because i did notice a change in him when he started eating well from teh bottle. However, i don't know how to correct his problems. He only stays on for a few minutes and i can tell he is not just super-efficient... his sucks aren't that great... I can't get him back on, he arches his back and pushes away and cries if i try to force him. I paid $200 for a LC yesterday that was totally useless. I don't want to force him too much and then have him hate the breast... I still don't think my supply is back to where it should be, but i'm hoping that will soon correct itself...

I hope i haven't rambled on too much. Any ideas as to what i can do??
arda

 

:hi: Welcome to Twinstuff! I'm sorry you are having difficulty. Sorry about the lost $$$. That is always a bummer! Sounds like you need an old fashioned nursing marathon. I would suggest starting to pump when/if you have time. That should signal your body that it needs to produce more. Another thing you could do is start Saro on one side & then put Ari there.. Saro might start your let down so that when you put Ari there, he'd be getting more milk and wouldn't give up. Another thing you could do is to start to pump one side and then put Ari there and see what happens. I would spend a weekend on the couch. Have someone there who could help change diapers, get you food/drink, and nurse as much as possible. That should jumpstart your supply! Good luck! Keep us updated! :hug99: I'm sorry about the poor weight gain. I have to ask though... did they stay per their percentiles? My two are on the charts, just not that high early on. As long as they are sticking close to *their own* percentiles, they are growing fine. My *guess* is that they were fine and getting enough to eat.

Boy Growth Chart
This is a great breastfeeding chart. Maybe that will help.

 

Thanks for your reply. No, they weren't staying on their percentiles. Even when i plot them on the graph you gave me, i can see them fall off the curve. (Actually, i think my doc must use whatever you gave me because their percentiles look the same as what she told me.) Essentially, they didn't gain enough from month 3 to month 4... They expect a minimum of about 25 grams a day and my boys were more like 13 grams a day! Things have since gotten a bit better (i'm going for frequent check-ins now to ease my mind). I'm fine with them being low percentile... i get that i have small babies... i just want them to grow as per their low percentile curves!!

I am pumping after every feed, but i don't seem to get much of anything. Do you know if it is helpful to keep pumping even if it is dry just for stimulation? i let the pump keep going for 10 minutes even though nothing comes out. Once in a while, i might be able to have another letdown after about 5 minutes of pumping and i get a few ounces that way... but otherwise, i get close to nothing. i can see why the boys come off if they would have to suck for 5 minutes before MAYBE getting another letdown! I'm afraid to pump more often (between feeds) because i don't want to be completely dry when i go to feed them around every 3 hours. I did read someone's post that pumping in the middle of the night (between 1-4 am) is helpful so i did that last night...

i'm hoping my milk supply starts to get better after all these pills i'm taking. I just upped my dose of domperidone to 30mg, 3x a day as Dr. Newman recommended (and i got my family doc to give her ok before i changed the dose b/c i think Newman is a bit fanatical and don't entirely trust him... just my gut feeling...)

Thanks,
Arda

 

ok, my first suggestiong after noticing you were in toronto was to contact dr newman, but it looks like you already have! i took dom for a while when i needed to up my supply, and although i think it did help, i am postive that the increased nursing was what really did it. btw, i was taking 40 mg 3X day.

sorry about the worries. that is the worst, isn't it? i would like to recommend a book to read (maybe while you pump? ). its called 'my child won't eat'. the author is dr carlos gonzales? i am not 100% on that, but its published by LLLI. it talks about force feeding and normal intake and growth patterns for babies and children. really woth the time to read it. plus its a quick easy read. it talks specifically about slowed growth at 4 months, and how common it is for drs to suggest supplementing, when in fact it is totally normal behavior. i realize though that this may be a genuine problem that you are dealing with.

yes, continue to pump even if you are not getting any milk out. and please don't assume that just because you aren't not getting any out with the pump that there is not milk there. babies are able to get milk out much better than any pump can. and some women are just not able to pump "as well" as others.

i agree with jackie--nursing marathon. what that means is just nurse as much as you can. what i did was have my dh remind me if he saw me without a baby at the breast that i should be nursing! it worked! we were able to ditch formula supp, after using them for 5 months.

if you really think one of the babes is not nursing well maybe try contacting a LLL leader? can you go to dr newmans clinic? i don't know if your health system would pay for that? might be worth a shot though. yes, i agree, he's a bit enthusiastic, but the knowledge and experience he has to offer are vast. good luck mama, please, keep us posted. :hug99:

 

Not sure if i mentioned it but i have an appointment for Dr Newman's clinic on Tuesday. I was thinking of cancelling because i think it might be a waste of time/money but maybe i'll go just to see what he says.

I'm trying to pump more often (that's why i'm awake now) but i'm still not getting very much. I used to pump and get 8oz from each breast... now i'm not even getting 3. it is depressing, especially when i think that this is my fault.

My husband is currently trying to dream feed them and it seems they are rejecting the formula. They were taking it before but now don't seem to want it. I don't have very much EBM (since i am not getting much when i pump) so this is just adding to the problem... AAAAH!

i'll try and check out the book you mentioned and it to the pile of "must reads" on my bedside table.

 

this is not your fault. if i may say so, i think your dr is at fault. instead of trying to find out why they babies were not gaining, the first step was to supplement. that, IMO, should be the LAST step. you will get back on track, it will just take some dedication and a strong will! which you seem to have plenty of. definitely keep the appt, you will always wonder 'what if' if you don't. hugs mama, hang in there.

 

Things are just getting worse (imo)... Ari basically never comes onto the breast anymore. Maybe he'll come on for one minute (if he does come on at all) and then refuse to come back on. I think my supply being low has turned him off. I used to have a very fast flow, lots of supply... so now he is not liking having to work very hard for not much return... I'm having to give him bottles afterwards otherwise he'll starve to death which is just perpetuating the cycle.

Saro is still coming onto the breast but i don't know how much he's getting. I'm scared that i'm starving him... I'm still pumping after every feed and sometimes i get a few ounces but that is only after i pump for several minutes and then force another letdown. For the first several minutes, i get nothing whihc makes me feel like that's why he came off. He wasn't getting anything... not because he was full.

I'm still taking fenugreek, blessed thistle, and domperidone (30mg, 3x a day) but i don't know if they're helping... i don't feel like my supply has increased but i can't tell what Saro is getting. Sometimes he seems very frustrated at the breast and yesterday i offered him a bottle after a feed and he took it! i was so surprised because this is the guy that hated bottles. He must have been starving.

how long do i keep this up before i give up and declare a loss?

 

It is normal to not get anything when you pump after a feeding. I've NEVER gotten 2 ounces out after a feeding, actually. If I were you, I would consider supplementing with a supplemental nursing system from Medela. Then you don't have to use bottles and your babies will still get all their food at the breast. When you use those, it increases your supply, too. It's the only way I can think of where you really don't have to worry about them preferring a bottle, yet you make sure they're eating and give yourself a great shot of getting them off of supplements entirely. An LC can show you how to use them.

 

How much do they weigh if you dont mind me asking? x

 

QUOTE(Twinnylou @ Jul 30 2007, 11:09 AM) [snapback]349571[/snapback]
How much do they weigh if you dont mind me asking? x


At their last checkup on Friday morning, their weights were as follows ... (At the time of weighing, they were 4.5 months old.)

Ari - 12 lbs, 13 oz
Saro - 13lbs, 14 oz

The doc said we were making good progress from the 4-month checkup where things weren't looking hot. At that point, it was looking like they were gaining max 0.5oz/day. Now they are looking closer to 0.8 oz/day. I'm trying to stay positive and keep that in mind whenever i start to get frustrated...

Take luck - i'm not sure what teh medela supplemental nursing system is but i am assuming it is the feeding tubes that go from teh bottle to your breast and work like a straw? The LC that came tried that and they didn't like it. She said they shouldn't even feel that it is there but every time she tried putting it, Saro would come off or actually swipe at it with his hand. My boy is VERY picky. He wants ONLY boob and NO tricks. <sigh> hehe

I have all but given up on Ari breastfeeding. he won't come onto the boob now it's been almost 2 days. If he does come on, it lasts 30 seconds and then he refuses to come back on. He is eating better from the bottle now (compared to a week ago) so i think i'm just going to bottle feed him. So far, i've had enough EBM for most his feedings but i don't know how long i'll be able to keep that up. I'm not opposed to formula but i would feel bad if one is getting BM and the other isn't... Sort of like i'm giving Saro an advantage over Ari... guilty feelings creeping up but really i need to remember that the most important thing is to get them FED!

 

try not to despair. you don't need to make a final decision right now. do what you need to do, go see dr newman tomorrow and see how he can help you. go from there.

is it possible ari has a tooth coming in, or an ear infection? not very likely, but thought i'd throw that out there. update after your appt tomorrow. i'll be checking in. :love0028: :love0028:

 

i went to the newman clinic on Tuesday and did find it to be pretty useless. they spent a lot of time preaching instead of helping. they are too hard-core for my liking. in the end, i was asking them "SO am i doing the latching right? am i doing the compressions right? etc etc" to get them to actually provide hands on help after 2 hours of beign there already and just hearing how my milk supply was low and it wouldn't have been had i come earlier, how evil my doctor was for suggesting i supplement, etc etc.

At this point, I am considering Ari officially self-weaned. He did it in his own time and is very happy with the bottle. He gets mostly breast milk, some formula. I have some guilt over the fact that i'm not giving him the same as Saro (who refuses a bottle so is exclusively breastfed for now) but he is getting the advantage of lots of time to bond with dad and is a very happy baby. I am not going to let the guilt live in me, even if he gets formula more than breastmilk in the end since i can't find enough time to pump for him.

Saro i still worry about a little but i do believe my supply is getting better and he is drinking better. I am paying more attention to the "gulps" vs. just "sucking" and am able to use the tricks people have for singletons like going from one breast to the other to make sure he gets that fast flow at the start which he likes.

we have our next appointment on Tuesday so i will hopefully see that my slowly-building confidence is not ill-placed.

Thanks for your support!
arda