50 answers

3 Wk Old Slow Weight Gain (Caught in Breast/formula Conundrum)

*Long request

My 3 week old daughter was born at 7.11 and with weight checks every 4 days or so has lost weight (normal, I know) to 6.14 and then gained (7.2) then down(?!) to 6.14 again and then up to 7.4 and after 7 days has only gained an ounce (7.5)!

The post partum weight drop can safely be attributed to her sleeping well, she would go from midnight to almost 5:30 at 10 days old, so I've started waking her to feed every three hrs (daytime) and every four hours at night. Beyond that, my milk supply seems adequate but I'm taking fenugreek to be sure, her latch is good and I'll pump when I can to continue to stimulate milk production.

She was exclusively breast fed until last week and now I'm supplementing her with formula because her pedi is concerned and wants her back up to birth weight by her 1 mon check up next week or we'll have to start doing "tests" to see what's wrong.

Pedi says to "wake every 3 hrs (day and night)offer formula as primary and breast as secondary. Pump when you can to keep up supply."

Lactation consultant says "wake ever 2 hrs (day and night) offer breast as primary,skin to skin contact, allow for 2 "last calls per breast" where if she falls asleep, put her away from you and give her the chance to rouse and continue eating, and then offer formula as secondary." (And with that, we're 90 mins into our every 2 hr schedule but that's a whole other issue ...) After 24 hrs of that schedule, she is so sleepy at the breast she is aspirating the milk when I wake her and is dozy all day long vs having her normal quiet alert times.

She looks healthy (not skinny or dehydrated), and has ample wet and dirty diapers. She gets a good latch at the breast and it appears she's swallowing mouthfuls and I'm not taking any other meds besides the fenugreek.

Normally a decisive person, I'm really caught up about what to do. I want to breast feed, but it is apparently not enough or her weight would show more steady gains. The formula causes much more gas/discomfort for her and according to what I've read, doesn't have as many calories/fats as the breast milk, so I'm not sure what I'm gaining by using formula as primary source of food.

My goal is to get weight on her period and avoid potentially unnecessary "testing."

Has anyone else been in this situation and how did you resolve it?

What can I do next?

So What Happened?™

Whew! What a lot of great help/advice/support! Thank you!

When I wrote that post I was 24 hrs into what became sinusitis/bronchitis (my 3.5yo dd was kind enough to share with all of us), and the idea of keeping my already tired, now gunk-filled head upright for a few extra hours was unbearable!

The good news is that when I took the baby in on Tues 4/15 (5 days after the post), she had gained to 8 lbs 2oz - a gain of 3 oz/day! We were feeding her at the breast and then supplementing with either breast milk or formula, depending on how much breast milk I had pumped.

NOW, however, she's a bit lackluster on the nursing b/c she figures a bottle is coming and she'll take easy street. So, I'll be posting a question about how to retrain her to the breast a bit later... someone is calling for a meal!
C.

Featured Answers

I have worked( in this area)for many year. you always offer the breast first and once you have fed for the allotted time then offer the bottle. Not the other way around! Sounds like you may have a dr. who prefers bottle over breast.Good luck.

I would breastfeed primary. I did - both two skinny babies, despite being born big (9#4 and 8#11). They started truly packing the weight on at 3 months, and my 4 year old (lactose and gluten intolerant - formula would have made him worse) is wearing a size 6 (usually slim) and my 2 year old is in a 3T.

More Answers

Wow. My DD was the same. She was born at 7 lb 14 oz. For me I had issues that whole first week trying to figure out the breast feeding. She was opposite of your daughter. I had soft nipples, so it was hard for her to latch on. Ultimately after a week, I started pumping only. And by her 2 week check-up she weighed 7 lbs 2 oz. So I can only imagine what she was weighing before. I pumped until she was 11 months. Hard work at times. But I was able to regulate how much she was getting. She was eating probably every 2-2.5 hours. We let her sleep through the night. And if not awake by 6 hours we woke her. We had to do weight checks every fews days and by the time she was 5 weeks she weighed 7 lbs 14 oz again. She gained slowly but steadily. I liked the pumping idea. I really wanted to nurse from the breast. But with pumping she's still getting all the good stuff! We only did formula when traveling. I really think relaxing a little too. Which is super hard I KNOW. But I know even now DD will react to me and how I feel. Best wishes!

Just a couple of ideas... you could try pumping and feeding from a bottle so that she is getting your breast milk AND you can see how much she is eating, you could also try giving her some poly vi sol infant vitamin drops daily to supplement the breast milk, or you could try mixing your breast milk half and half with forumula.

My daughter was born 3 weeks early weighing in at a whopping 5 lbs 16 oz. She didn't have trouble gaining weight but the dr had her on infant vitamin drops starting the day she came home. We also had to add a small amount of rice cereal to her bottles because she had reflux so bad, this may have helped with the weight gain too.

DON'T STOP BREASTFEEDING!! :D
Ok. That said. I had the same issue with my son. Some babies just gain slowly. If your pediatrician isn't concerned, don't worry yourself, either. Also, usually drs are just happy that the baby is at their birth weight around 2 weeks, so it sounds like your babe is doing great. I think you may just be causing your self excess worry with weighing her so often. Also, She's only 3 weeks old. She doesn't need to have gained much weight by now. As long as she's healthy, that's all you need to be concerned over. It sounds like you're doing a great job. Stick to it, don't give up. I think many breastfeeding moms get caught in wanting to meet all the expectations set forth for formula fed babies, when you really don't need to worry about them. Just focus on keeping her healthy and happy and the weight gain will take care of itself.
(some background info)-- I nursed 2 kids past 1 yr and am wanting to become a lactation consultant in the near future...

C., If you want to continue breastfeeding always offer the breast first. And I would reccomend "block feeding" that is where you offer the same breast all day and pump from the other one so it does not dry up. Offering the same breast will allow your baby to get the hind milk (the fatty milk). All 4 of my children struggled to get back to their birth weight the first few weeks, but I never gave up and had a wonderful nursing relationship with them. Follow your instincts and keep an eye on the diapers. Good Luck, P.

I have a 3 week old baby also who weighed 7 lbs. 15 oz. when born. She lost weight in the hospital and then had already gained weight before we left. We didn't even have to go in for the 48 hr appointment. She went in at two weeks and weighs 8 lbs. 9 oz. She eats 4-6 ozs at every feeding. She is formula feed and I catch grief over that all the time. People need to realize that breastfeed babies are always going to be smarter or healthier... especially if a breastfeed babies is undernourished. If you want to keep breastfeeding, that is great. But don't be afraid of the formula. Your baby will survive if you have to feed her through a bottle.

Hmmm... I think the best advice I can offer would be to wait a couple more weeks and see. My lactation specialist said (and was right) that babies often hit little growth spurts where they would "cluster feed" (want to nurse many times close together) and then in a few days grow.

My daughter is a petite girl (15mo) but developing rapidly and is very healthy despite her little size. I would encourage you to continue to breast feed and make sure that you are encourage your babe to nurse a good while on each side (fore-milk and hinds-milk are different - the latter comes out second and is much more dense/fatty). For a while, I would only do one side at a feeding (so she could get a good dose of the second kind of milk) and alternate the next feeding (now I do both). Make sure your diet is full of good fats and nutritious food (avocados, fish, nuts, etc).

In my experience, breast milk has kept my daughter very healthy; she rarely gets sick or has tummy trouble. Hope that helps! I did have a friend who needed to supplement with formula when her baby got older (4months and still very little weight gain). But, give it time and do check with your doctor or, preferably, a midwife/lactation consultant.

This site is a valuable resource: http://askdrsears.com/html/2/T020100.asp

D.

I would get a second opinion from another pediatrician. If I had done that with my first son, we wouldn't have gone through 2 years of senseless testing to find out what I was insisting all along-he is perfectly healthy! My son is now 3 1/2 and still very small for his age, but very smart, active, and happy. Weight/height gain is obviously not the only indicator of a healthy baby, but unfortunately it's about the only measureable indicator that pediatricians can rely on. You can refuse testing if you feel there's really nothing wrong. However, I would ask the pediatrician for detailed information on what the testing would consist of. For my son the first round was just blood work, which was not a big deal at all (as long as you get a phlebotomist who has experience with infants!). But if it's something more invasive, I would definitely get a second opinion before consenting. And if the feeding every 2 hours schedule isn't working due to the baby being too tired, try every 3 hours as the pedi suggested. The professionals may know babies in general, but they do not know your child like you do. Try their suggestions, but if it's not working for your baby, tweak it to fit her needs.

Trust your mama instincts. And pray!

C.,
I would continue to wake her every 3 hours and offer the breast first, once she has emptied the breast, offer formula. 90 minutes is way to long to be going through a feeding and you are both getting exhausted. I would say 30 minutes at the breast should be enough at this point and then formula. One way you can make sure how much she is getting is to pump a couple of feedings and bottle feed what you pump. I think if you are more rested and relaxed at feeding time, baby will be too!!!
Good luck with your feedings!!
N.

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