Poor Weight Gain - Confused & Frustrated

I was at the doctors today for the boys 4 month shots. I was shocked as they had only gained 6 and 7 oz. since their last weigh in over a month ago. They are only 11 lb 5oz and 11 lb 9oz. I'm really sad. They seem to be eating well and seem satisfied after. They also seem healthy and thought they were heavier... everyone comments on how well they are doing. The only conclusion is that there must be something going on with my milk supply. I have had some stress lately but overall feel quite good, eat and drink lots, take time for myself, get lots of sleep (they STTN) etc... and the really confusing part is that the boys seem satisfied so I wasn't concerned. The doctor suggested supplementing with formula a few times a day to see if they are actually still hungry after breastfeeding. I don't know what else to do because obviously they need to be gaining way more weight than they are. I worked so hard to breastfeed (and tandem at that!) and am frustrated to have to add in bottles, formula etc., but guess it's what I have to do.

Did anyone have issues with weight gain, needing to supplement eventually (I was fine for 3 months), or anything similar. Advice? I'm so discouraged.

 

:hug: i'm sorry you're feeling upset & frustrated. if i were you, i would get a second opinion. i am always extremely suspicious when the first solution offered to low weight gain (or any feeding issue) is supplementing. supplementing should be the last resort. have you talked to an LC? they are quite likely more qualified to help in a situation like this than your doc. also, do you know if your doc is charting the babies growth on charts for breastfed babies or formula fed babies? the two are very different. it's possible that the slower growth isn't as concerning when charted on the breastfed chart.

here's an overview from kellymom on low weight gain.

the fact that your babies are otherwise healthy & happy suggests to me that they're doing just fine - the key is that they ARE growing. have a think about how important continuing with exclusive BFing is to you & decide how you would like to proceed from there. supplementing can often be a slippery slope to the end of the BFing relationship, and while there are certainly times & situations in which it is needed & necessary, it should be used with caution.

 

Oh I'm so sorry you are dealing with this! I was there about 1.5 months ago, my guys had fallen off the weight curve at their 4 month visit, particularly baby B. My pedi didn't immediately suggest supplementing, but he did want us to try and get an additional feeding in. I like you was so confused because my guys always seemed so satisfied and happy, they slept 7-9 hours in a stretch at night, napped well, and all in all we were feeling like life was going really well, particularly after all of the problems we had with establishing exclusive breastfeeding. I decided to get data (I'm a chemist and DH is an oceanographer...we like data). I rented a breastfeeding scale and for 2 days fed as usual with trying to get an extra breastfeeding session per day in while weighing before and after each feeding. Baby B was only getting 17 ounces and Baby A was getting 20-22 ounces, Kelly mom says the average is 25 ounces for a breastfed baby and the range is 19-30. Looking at the data throughout the day, it was obvious that I had enough milk for them in the first 2 feedings of the day because they would take 5-6 ounces from the breast, but then after that they were only getting 1-3 ounces in the subsquent feedings. Looking at the data, it became obvious that I had a supply issue. Only after we had that data and I had talked to an LC did we start offering a bottle after feeding (at first it was EBM from my small stash for going back to work) and they were obviously ravenous (the LC warned that they would probably be bottomless pits with the bottles afterwards for a few days, and she was right!). We used preemie flow nipples and held the bottles almost horizontal so that it wasn't significantly easier than the breast to try and avoid them developing a bottle preference. I've done everything I can to increase my supply (domperidone, pumping after each feeding, oatmeal and lots of water) and through continued use of the scale, I saw no increase in what they were getting from the breast...and they are still very happy to eat at the breast, it's not like they were just waiting for the bottle. It took some time, but we have settled into a routine where they eat at the breast for the two first feedings of the day, they alternate for each feeding since lefty just doesn't produce as much as righty, then for the next feedings I feed one from the breast and give him both breasts and the other baby I give a bottle (I do this in tandem using the EZ to nurse pillow, the baby with the bottle sits with his back against me and I give him the bottle). The boys both get about 10 ounces of formula a day and it works out that they get about 2/3 of their intake from the breast (or EBM if I'm at work, I work 3 days a week).

I still don't understand how they could be so happy if they were not getting enough to eat, it completely baffles me. I struggled and struggled with giving my boys formula and still hate that I have to do it, but I do. It is really gratifying to see them growing and gaining weight before my eyes, it takes some of the sting out when I look at it from their point of view, not as a personal failing. I think I've mostly accepted that they aren't getting breastmilk exclusively, but it has been a process. They came at 34 weeks and I had to bring my milk in with a pump since I couldn't get them to the breast for about 3 weeks, and I think that my body just didn't get the message that there are 2 babies to feed. I keep telling myself that there were many things about their conception and birth that didn't happen as I wanted, but in the end I have the ultimate prize--2 healthy babies who I still do have that breastfeeding relationship with. I intend to do extended breastfeeding and I think my guys will do it...they like the boob. Their weight gain is right on track now, there is just a dip at 4 months.

I hope that you have a case of just needing to up your supply and that your body will respond...by no means do I think that you have the same issues as I do, but I wanted to share my story in case it helps. I've been there and it is SO hard, I can't tell you how many tears I shed. Since your babes are happy, I would suggest you take a couple of days to determine your plan of action so that you can act logically and not too emotionally, that was important for me. I wish you the best of luck and please PM me if you want to talk more offline. Take care.

 

Rather than formula, you can try pumping after feedings, particularly in the late afternoon/evening, to increase your production at that time of day. Then you can offer the EBM the next day in a bottle. 3-5 days of that should be enough to indicate whether you actually have a supply problem or not. But I second the suggestion to talk to a LC or La Leche leader and get some personalized assistance.

If they're teething, another trick which worked for me is the refrigerated teething toy about 10 min before feedings, it really helped soothe her gums so she stayed on longer.

 

I went through something similar. My little ones are failing to thrive though, still at 3 1/2. I would definitely make an appt with a LC. Some are worth their weight in gold. I had plenty of milk for the twins, but they still didn't gain properly. But it isn't an issue with me, it's an issue with them. Mine also had reflux which inhibited the volume they could take in at one time. Meds helped, but they still would take in less than 4 oz at once (even at a year) and slept through the night very early on. We were told to wake them to feed them, to get an extra feeding in.
At the very beginning we were also supplementing with expressed BM with extra calories added to make it higher calorie. If I could have kept up with that, I think it probably would have helped. But they didn't want a bottle as much as the breast, so we fairly quickly went to exclusively BF'ding.
I think with things like this you just have to figure out what's right for you. We were immediately told to STOP breast feeding and start formula. Well, there was NO WAY I was going to do that. We did try to go back to pumped milk with added calories.
I hope you can figure out why the gaining has slowed. It could just be that you need to up your supply.

 

I definitely agree that supplementing should be the last thing you do! Definitely see a LC so you can get pre/post feeding weights and evaluate latch, etc. Also, were your babies premature? What was their birthweight? It could be that the weight they are at is completely normal. It is also important to look up the WHO growth charts which are based on breastfed babies. Most pedis use the CDC charts which are based on formula fed babies. On the CDC charts my DS is <3rd percentile, and on the WHO he is 15th. That's a big difference!

Also, how are you and DH built? My DH was always skinny and tall as a child, so no surprise that my DS is 50th for ht and <3rd for weight. He was only 18 lbs at a year, but he started at 5 lbs 6oz, so he more than tripled his birthweight. I have realized that he is just built small (in contrast to his sister who is a good pound heavier and 2 inches taller) and no amount I feed him is going to change that. I think pedis get so used to those sumo babies out there that they think it is the norm, when actually it sets kids up for weight problems later in life.

 

think I would first try nursing more often. Even nursing on an "empty breast" will yield the higher fattier milk for them even if it is low in volume.
If I did decide to suppplement, I think I would supplement AT the breast (with a SNS, or a 5 french tube taped to your breast and the other end in a bottle of your milk) so that the babies do ALL their sucking at your breast and your breast still get all that extra stimulation to make more milk.

other things to do would be meet with an LC, and take the babies in for weekly weight checks to see how they are progressing...

 

I think you've been given some excellent advice, and I agree I'd try other things before supplementing. I'd check with a lactation consultant who can evaluate your supply and give you some direction from there. It could be a supply issue, it could be milk composition and it could be no problem at all when you compare their weight to bf baby growth charts. Do some investigating! And if it comes to you feeling that supplementing is the best option for your family don't feel guilty about it, because all you're doing is making sure your baby has calories.

 

ITA with this.

 

Thanks for your support everyone. I went to a lactation consultant and they gained 5 and 6 ounces in 6 days so she was really happy about that. She said it could be a number of things... we've all had colds, developmental (I guess a plateau is normal at this time), teething, my milk supply changing. She suggested fenugreek and pumping once or twice a day after a feed, but said I don't need to supplement. I hope my doctor is okay with that by I feel good about it. Thanks for your support. I was pretty stressed!

 

that's so great to hear! thank you for the update. and honestly, as long as you feel good about it, that's what matters. i mean, certainly listen to what your doctor says, but remember that what a doctor says is a recommendation - it's not the be all & end all. if your doc does get ornery about it, ask what training exactly they've had in BFing & lactation.

 

great news on the LC consult! and them gaining 5+oz in almost a week! sounds like its getting better.

the whole weight slowing down when you've had colds happened to us at 15 mo. and my pedi wanted me to give them pediasure... I didn't... their weight wasn't that low... and I just started giving them more healthy snacks to get more nutrition in them. when we went for their 18 mo. visit you could see that they were back up on the scale where they'd been at 12 mo. so we finally realized that they were sick that month that we'd gone in for their 15 mo. visit.

all the advice you've been given was great! I hope they continue to gain weight!