They're not growing.

I have been taking the boys for bi-weekly weight checks the past month and they have not gained the right amount of weight. I thought it was because I moved them to a 4 hour schedule, so I went back to a 3 hour schedule and they still didn't gain. (They actually gained less on the 3 hour then the 4 hour).

The first 2 weeks (four hour schedule) Michael gained 3 ounces and Jeremiah gained 6 (they should have gained 8)
Then the second 2 weeks (three hour) Michael gained 3 ounces and Jeremiah gained nothing.

The doctor said they look perfectly healthy. They never act hungry or anything. They are so content!
She said they are just not getting enough to eat. Right now, supplementing with formula isn't an option for us. I am wondering if they might be ready for foods. Or if they are just are just getting more and more active and not gaining.

What do you guys think?

Any suggestions?

 

If the doctor told you they are not getting enough to eat what did s/he suggest that you do so that they are getting enough?

Between 6 and 9 months my girls only gained 1 pound total! When they became mobile but I hadn't started table foods they just didn't gain any weight. If they are healthy and content I wouldn't be worried unless you have some underlying medical issues and that's why they are going for bi-weekly weight checks in the first place.

 

QUOTE(aimeethomp @ Sep 26 2008, 05:20 PM) [snapback]998962[/snapback]
If the doctor told you they are not getting enough to eat what did s/he suggest that you do so that they are getting enough?

Between 6 and 9 months my girls only gained 1 pound total! When they became mobile but I hadn't started table foods they just didn't gain any weight. If they are healthy and content I wouldn't be worried unless you have some underlying medical issues and that's why they are going for bi-weekly weight checks in the first place.


I echo Aimee's post. What do they want you to do if you dont want to supplement? Did the Ped say to try and start cereal? Why are they going for bi-weekly weight checks...have they not been gaining for awhile?

 

I'd think if they were not getting enough to eat they would let you know... Mine definitely do and if they're not hungry, they will not eat more.

And I know that my babies seem to gain weight in spurts. They won't gain anything for two weeks then I'll check a week later and bam, they gained half a pound. I think it's normal for it to slow down at some point too...

 

I'm not sure about the reasoning behind the bi-weekly weight checks but that seems way to frequent at their age. Babies don't always gain consistently from week to week and I think it's a more accurate picture if you look over a period of at least a month to every 3 months. In one month they gained almost a half pound...I don't think that's terrible at all (going with the theory that babies should gain approximately double their weight by 6 months and triple by 9-12 months...yours seem right on track). Of course, you should do what the ped recommends but I'm not sure what that is if you're not supplementing with anything.

 

I know it's worrisome. Is there any possibility of getting some formula samples from the pediatrician?

What about checking your milk supply? If you were feeding every four hours (which seems kind of far apart for feedings with breastfeeding, just with the supply/demand principle), it may be that your supply went down some, or just hasn't caught up with their growing needs. Have you checked on the bfing forum for suggestions? Maybe pumping after each feeding (if you aren't doing that already) to increase your supply. Or feeding-on-demand closer than every three hours for a few days.

I started solids (plus supplementing with formula all along) at 5 months because ours weren't growing enough. I think they're doing okay now. It just gets harder to get them enough food as they get more and more mobile.

Mine didn't act hungry, but I don't think they were getting all the food they needed all the same.

:hug: I went home and cried the first time my kiddos were diagnosed with failure to thrive.

 

the doctor just suggested trying to get my supply up - rest, water.. but I really don't think it is a supply issue anymore. the boys will take themselves off after 15 minutes or so - and I CANNOT get them to go back on.. they are just full. and like i said, they never act hungry.

i was going for the bi-weekly checks for myslef... the doctor didnt tell me to. just to see if the gained ok when i switched to four hours.

 

I would nurse MORE often, if they will nurse every 2.5hours nurse them that often, they have got to be fast nursers by now

as pp's said, babies gain at varying rates, they don't gain 4oz's every week, they can gain 2 this week and then 3 the next, then 6 the following week.

 

Nursing marathon, ASAP!

BFing on a schedule is proven to be risky for mom's milk supply and babies' weight gain. Sometimes everything seems to work fine for a while, but then it catches up. Unfortunately, you're seeing that the hard way now. :hug: They probably gained less when you went back to the 3 hr schedule because your supply already took a huge blow from the 4 hr schedule.

The good news is that it is reversible. If you want to get your supply and their weights back up, spend at least a weekend doing nothing but nursing. Offer the breast at least every hour. Nurse them as often as they'll take it. Frequent nursing will really send your body the right message, and should also help the babies get richer milk. The more often you nurse, the more you produce, and the fattier the milk is. And once you get your supply back up, you may want to consider still offering to nurse at least every 2.5 hrs for a while, and if you must go back to a strict schedule, try not to let more than 3 hrs go from the beginning of one feeding to the beginning of the next.

Also, starting solids probably wouldn't help at this point. Your babies are only a little over 4 mo adjusted, and the AAP Policy Statement on Breastfeeding states:

QUOTE
Introduction of complementary feedings before 6 months of age generally does not increase total caloric intake or rate of growth and only substitutes foods that lack the protective components of human milk.


So in other words, you'd only be replacing high-cal, antibody-rich milk with stuff they can't even digest yet. (Those enzymes won't be there until ~6-8 mo adjusted.)

 

I agree w/ nursing more often. Why can't you supplement w/ formula? Not that I am pushing it, but I know their lack of gain would worry me. If you can't afford it, you can always use WIC. But definitely try nursing more often. Do you pump? It may be worth it just to see how much they are actually eating at a meal.

 

QUOTE
Do you pump? It may be worth it just to see how much they are actually eating at a meal.


Actually, pumping doesn't give a very accurate picture of milk supply, because the pump never gets as much as a baby. Giving a baby a bottle also doesn't tell you much about a typical feeding, since many babies will guzzle down a bottle even if they're not hungry just because they like to suck.

I totally agree with your post, though, that it would be good to find out how much they're eating at a sitting. The best way to do that is to make an appointment with an LC and have her do a pre-/post-feed weigh. That way you know exactly how much they've taken.

Anyway, to the OP - please keep us posted on how your babies are doing!

 

I would also try to nurse them more frequently - first the nursing marathon and then once your supply is back, going no more than 3 hours between feedings until they are older. I know my older DS nursed every 2-3 hours for the majority of his first year. At your babies' ages he was still going every 2 hours and a few times at night, too. I bf him on demand - and sometimes it was just for 5 or so minutes - but he did that off and on every 2-3 hours during the day and then I would always get nice, long sessions first thing in the morning, during the night, and right before bed.

I pump for my twin boys b/c they have pretty significant latching issues so I can't offer advice re: bfing twins - but I bf my older DS past his 2nd b-day - and it was a long time until he was going 4 hours between bfing sessions.

:hug: I'm sorry you are dealing with this now - after months of hard work and worry! Hang in there - and don't get too frustrated. You'll get it figured out!

 

One more for the "nurse more" vote. I can relate to wanting to be on a schedule....boy did I want some rhyme or reason to my day in those first 8 months of life. However, it doesn't really work that way with BF. It's supply and demand. I did nurse on demand and slowly they worked themselves into a 3 hour schedule. A four hour schedule is too infrequent for their age and weight. It can quickly slip into failure-to-thrive. The easiest fix for supply and growth is to breastfeed more often. Your milk is high in calories and the fat and nutrients they need. They need to be getting it more often. Solids will also cut into your supply. If you want to continue to BF I would strongly suggest that you do it more often. For a week or so, double up. Nurse every 2 hours instead of every 4 and watch how things go. They may not want it always, but it will help your supply. Also, tandem nursing will help your supply.

I know it's a lot of work and you feel like a one-woman dairy farm at times nursing so often, but it's a very short time in their (and your) lives and it will be the very best that you can offer your kidlets.

Great job on the nursing and keeping a close eye on their weights. It's a good way to be armed with knowledge and information and now that you have the info...you can take action to help them grow and stay healthy little buggers. You're a great mom!!

Of course you can always visit us in the BF forum (I know you've been there before) we all have been or are in the same boat.

 

QUOTE(Fran27 @ Sep 26 2008, 01:33 PM) [snapback]999134[/snapback]
I'd think if they were not getting enough to eat they would let you know... Mine definitely do and if they're not hungry, they will not eat more.



This is generally true except in cases of FTT or when a child is headed in that direction. A child who does not eat enough or not fed enough can get "lethargic" about asking to eat. Not saying that's the case with the OP, but with such a long feeding schedule (4 hours at such a young age) I'd be very mindful of that.

 

When I brought Evan home from the hospital, he slept a lot. He also didn't gain weight like he should have. He was minimizing his activities because he wasn't getting enough to eat. He wasn't fussy or anything. He was just not expending the energy so that he could conserve what he was getting. I had to wake him up more and make sure he was eating. I agree with others who have said to nurse more often. I don't understand what you mean when you say you cannot suppliment. I don't think you need to, but you do need to nurse more often. If you don't nurse more often, then supplimenting would be the only sane alternative IMO! It SOUNDS as if they need more milk!

 

How many wet diapers do they have a day?

 

Did the doctor give you any direction on how to get the babies to eat more, if they're not eating enough?

In your shoes, I might try nursing every 2 or 2.5 hours....try it temporarily, at least, and see if it helps their weight gain.

I followed the Babywise principles with my older DD, and nursed her every 3 hours, and it worked pretty well for us. (She always drained both breasts.) But, I was never able to go for longer intervals, because I found she was *hungry* every 3 hours.

But when I had my twins, I quickly realized that they wouldn't be able to go even 3 hours on breastmilk alone, because boobs can only hold so much, you know? I actually did supplement from the beginning because I ran into all kinds of nursing problems, so I pumped and offered bottles. But even with bottles of half breastmilk/half formula (which stays in the stomach longer), I still never went beyond a 3-hour stretch. (We fell into a natural pattern of eat, wake, sleep, but they always woke like clockwork for the next 3-hour feeding....)

Anyhow. I would be somewhat worried if your munchkins are not crying out of hunger at all, and not gaining weight, either -- please try feeding them more often, and see what happens.

How long do they go at night without a feeding? I know 12 hours is ideal, but maybe you could wake them after 8 hours, feed them, and then put them back down and see if they'll sleep another 4. My older DD was on that schedule until we started solids at 6 months.

Oh, and about solids -- breastmilk has a lot more calories per ounce, so I don't think solids are going to help with weight gain at this point.

Good luck! Check back and let us know how you're doing.

 

When I was nursing my twins they nursed every 3 hours until they were 8 months old or so. I would definitely stick to a 3 hour schedule or feed on demand if they seem hungry earlier than 3 hours. My concern would be that when you switched to the 4 hour schedule that your supply took a hit and is still catching up. What you might want to do is try a nursing marathon and nurse them as often as they seem interested over a 2 day period or so. Get your DH to do all the diaper changes, burping, etc. so that you can just focus on nursing them. That will give your supply a boost and may help with their weight gain. Then I would stick with the 3 hour schedule (or on demand) for a few more months. I wouldn't start solids until 6 months due to allergies and even then it's mostly just for practice and not actual weight gain for another few months. I hope that helps! Please continue to see the pediatrician for weight checks to make sure that they are gaining appropriately!

 

QUOTE(fuchsiagroan @ Sep 27 2008, 11:22 AM) [snapback]1000369[/snapback]
Actually, pumping doesn't give a very accurate picture of milk supply, because the pump never gets as much as a baby. Giving a baby a bottle also doesn't tell you much about a typical feeding, since many babies will guzzle down a bottle even if they're not hungry just because they like to suck.

I totally agree with your post, though, that it would be good to find out how much they're eating at a sitting. The best way to do that is to make an appointment with an LC and have her do a pre-/post-feed weigh. That way you know exactly how much they've taken.

Anyway, to the OP - please keep us posted on how your babies are doing!


Oh, I didn't mean pump to get a picture of supply I meant that you can measure it in a bottle and see how much babies are eating.


And just as an aside- babies don't always get more than the pump. When I was BFing when they were newborn I thought they were getting more, but then I weighed them before and after and they were getting nothing So in my case I got more with the pump. But I think this happens more with newborns.

 

I got told that aslong as they are staying on their growth curve then they should be absolutley fine. Sophie was really small to begin with and hardly gained any weight but is perfectly healthy. Even now she only weighs just over 24lbs and is a lot smaller than her brother. I would suggest giving them baby rice or cereal and seeing if that helps them gain some weight. Keep us posted with any news x

 

I know the nursing is important to you but if they are not gaining weight, I would supplement with formula - the most important thing is that the babies are gaining and eating the right amount for them. You are still doing mostlu BM, a little bit of supplement is OK if it means your babies will gain. Don't feel guilty about it-

 

I have kept a chart over the last week of their wet/dirty diapers - they have a wet at every feeding and at least one or two dirty diapers a day. So I know they are not dehydrated.

And as for being lethargic - they are no way lethargic. They are so happy ALL the time! and very content!
If I fed on demand, they would be waking up at the same times as their feedings. If they wake up sooner, I will feed them, but they RARELY wake up before the 3 hour mark. Often, once they wake up and are waiting for me to get feeding they cry wanting to eat. But they rarely wake up prior to 3 hours hungry!

They sleep 12 hours a night and wake up so happy every morning.

I think that answered all the questions!

I might take them to get weighed today - like I said - if you look at their growth from beginning they are right on, but it was those weeks that they didn't gain as much.

I just don't think that they are failure to thrive - they are so happy!

Thanks for all the help guys!

 

QUOTE
Oh, I didn't mean pump to get a picture of supply I meant that you can measure it in a bottle and see how much babies are eating.


Oh, gotcha! I'm still not sure if that would give the OP an accurate picture. It sounds like there are some supply issues, so what the babies take from the bottle would probably be more than is available at the breast right now. (Plus some babies will really pig out at the bottle - they use it as a pacifier, and take a lot of extra milk because they just like to suck.)

QUOTE
I would suggest giving them baby rice or cereal and seeing if that helps them gain some weight.


Actually, solid foods have far fewer calories and less fat per ounce than breastmilk or formula, and they also take up room in the babies' stomachs and keep them from taking in the good stuff, so they are not recommended where there's a weight gain problem.

Sorry, I'm not trying to pick on either of you! I'm just very concerned about the babies' sudden decline in weight gain. Sounds like they've really plummeted off their growth curves lately.

 

My hospital has a lactation class that's free. You might be able to get some hands-on-input from something like that.

My boy was very energetic during his failure-to-thrive episode. He appeared very healthy and energetic, but his head growth had leveled out.

The problem, according to my pediatrician, is that the body automatically saves nutrition for brain growth, even when the baby isn't getting enough food. When their head isn't growing proportionally (staying on line with their own charts), if nutrition isn't increased, it can lead to lack of growth in the brain, and it also is a clear sign that the body isn't getting what it needs (because now, not only is the body not growing, the "last thing to go" has gone, too, if that makes sense).

You may just want to ask your pediatrician to look at that section of the charts.

I'm just concerned because I had to work through the same issues. It gets much harder as they get more mobile--they burn off so many more calories. That has been one of the biggest struggles with my son. We feed him more than his sister, we feed him all day long, but he's so incredibly busy (never still if he's awake) that he burns it right off. If you can get them back on track now, it'll be so much better in the long run.

:hug:

 

It's great that your babies seem cheerful and active. But regardless of their behavior, there is obviously a serious problem with their weight gain.

Over 4 weeks, they have each gained only 6 ounces. They should have gained 16 ounces at the very LEAST. Some fluctuation in weight gain from week to week is normal, but their growth has slowed almost to a halt for a whole MONTH. This is not normal.

Unless there's some exotic cause like a metabolic disorder, they are simply not getting enough to eat. That seems like the most likely explanation, since this period of almost zero growth coincides with a decrease in their feedings. Since they are not asking for the nutrition they need, you may need to take charge and give them a little nudge in the right direction and offer more often than currently, at least until their weights get back on track.

If you are convinced that they are getting enough to eat despite their almost total lack of growth, it might be a good idea to ask your pedi to refer you to a GI specialist to see if you can find out what else might be causing their problems.

What's your plan of action right now?

 

Energy and mood is not the way to evaluate if they are getting enough to eat. The only way to evaluate that is growth. Breast milk is the best thing for their growth at this time. Maybe feed them every 2 hours while they are awake and then every 3 if they take longer naps. I hope the LC can help. Joannabug, thank you for sharing your experience. It's nice to hear from someone whose been through it. It's interesting that your DS seemed just fine and it was only an indicator because of growth.