8 poopy and pee diapers a day, yet minimal weight gain with BF?

[jerseygirl07067]

DD #3 was born early, 35 1/2 weeks and "appears" to be doing well with nursing. She gets about 8 good feeds a day, has a lot of poop and pee every time I change her diaper.

To be specific, her weight at birth was 5lbs 8 oz, and she dropped to 5 lbs even, two days later. We stayed in the hospital for one more day, and she was 5 lbs 1 oz then we got discharged. The next day at the ped she was 5 lbs 1 oz but it's a different scale so hard to compare. Two days later at the peds she was 4 lbs 15oz. I nearly died since she's been nursing vigorously, with all of the pees and poops to go along with it. I kid you not, there is a good amt of pee in her diaper, and she poops after every feeding - a decent amount too.

I am concerned because she is already small. Our ped doesn't seem worried 'yet" and wants us back for another visit next thursday. I honestly credit him for not just telling us to give formula and waiting it out another week, but frankly I am concerned and puzzled. And I do know that weights can be influenced by many factors, ie. just having had a bowel movement, just being fed etc. I think this was his mindset too, so he's not concerned yet.

Some other details, she was a c-section baby; I was given IV fluids a few hours prior to delivery, since we didn't now what was going on yet, she developed jaundice and peaked at 13.5 before coming down. They did send us home on bili lights which we used for a few days. She's now at 11.7 and dropping, since her color is getting better each day.

My only thoughts here are that I have A LOT of milk, and it was even worse during engorgement. I'm thinking DD may be getting too much foremilk and not enough hindmilk, since she likes to switch sides before completely emptying the first side. . I am now keeping her on one side only, and pumping a bit at the end and giving it to her, to ensure she's getting the fatty hindmilk.

I'd like to know if I'm on track here. I did call a LC and they agreed with my approach. I have noticed more of those seedy fat granules in her poop since I started doing this, and it's now turning from military green to more yellowish green, a good thing. The bilirubin still may be keeping it darker, thus the green color, but I know too much foremilk can do the same thing.

Any other tips or advice? This is driving me nuts and I want to make sure she's gaining by her next weigh in!

[Momof3Labs]

Congratulations on your new arrival!! It sounds like you are on the right track, and the weight differences aren't alarming IMO. Can you go to a LC and do a weight check before and after nursing her? If her weight is still hovering around 5lbs, I'd consider renting a scale from the LC just to keep a closer eye on things (and get rid of it once she's turned this corner).

[chozen]

because that is what we had to do with our daughter, my lc let me borrow a scale for about a month. maybe you know someone with one. it is a good sign that her stool is changing color.

[jerseygirl07067]

Thanks. You know I was thinking of renting one, but then thought I'd drive myself nuts with it and get obsessed over each feeding. I actually had the Baby Weigh scale on reserve at the hospital LC office and then changed my mind. Last time I rented a scale, it was for Julia (also born at 35 weeks) because she went on a nursing strike when she hit 4 months, so I used it until we got things back on track. I ws a tad nutty over it then too, but it did give me peace of mind. :)

I think I'll have DH go ahead and pick one up on monday.

[jren]

DS did this, too. His was due to a milk allergy and probably some fluid retention. He was just so puffy and swollen, even a week after birth still.

He was on formula from day 1 but still lost weight. At about 2 1/2 weeks we discovered a milk allergy. He'd always have lots of poopy diapers, more than one per feeding, and eventually blood in the stools as his intake of formula increased. Once we switched to hypoallergenic formula, he started gaining. If I had been breastfeeding, I would've just had to cut out dairy.

I don't think my doctor would've been concerned at 1 week, but by 2 weeks she expected to see an increase in weight. Especially on formula.

[WatchingThemGrow]

I'd get the scale to keep at home. We keep track of weight gain with our slow-to-no gainers on trixietracker.com, just because it gives us a little bit of data and some charts to see the progress. Wonder if you could do what we did a little bit with one of ours... after nursing, pump the hindmilk and feed it back to her by bottle after the (next) feeding. So, you won't be able to do it for the first feeding, but for every subsequent feeding, you'll have a couple ounces of hindmilk to supplement her with. Does that make sense or sound logical? That's what my LC had us doing for a bit.

[jerseygirl07067]

Thanks everyone! WatchingthemGrow, I have a question about what your LC recommended. How come it was recommended to use the pumped hindmilk for the next feeding, as opposed to the current feeding? Just curious.

I've been pumping the hindmilk and then offering it at the end of the feeding. I can usually tell when she will take it, depending on the quality of her nursing session and how tired out she is.

Another thing I've been doing for the night feedings, just to save time, is to pump off some of the foremilk so when she nurses she's getting mostly hindmilk. It's a quicker way to do the nighttime feedings. The LC gave me that option to try as well.

So far things seem to be working out...she's gained an ounce every day since last friday. :)

[DrSally]

My DD's birth and first few days were almost EXACTLY like yours. I think your on the right track and agree it's a good sign her poop is changing colors. In our case, the jaundice/prematurity made her too tired to finish a nursing session. So, for the first 2 weeks, I'd give her an ounce of pumped BM or Alimentum to get her going (otherwise she'd get too frustrated), breastfeed until she tuckered out, offer a few ounces of pumped BM or Alimentum, and then pump myself. At 2 weeks exactly, she stopped needing the supplement and was able to get what she needed solely nursing on demand. I think the Jaundice really makes them tire out, and I suspect her weight gain will get better with each day her bili improves.

ETA: with a toddler to look after as well, I didn't always pump, maybe like 3 times a day, which really isn't enough. But, luckily, my supply didn't suffer. I had to pump and supplement with DS as well due to jaundice and was able to regain my supply over the period of a month (after pumping for a month).

[WatchingThemGrow]

Thanks everyone! WatchingthemGrow, I have a question about what your LC recommended. How come it was recommended to use the pumped hindmilk for the next feeding, as opposed to the current feeding? Just curious.
In my case, the logistics and timing (slow nursing and pumping) meant that she'd start nursing in the first hour, finish after 25 min each side, then I'd set up and pump for another 15, so it would be into the 2nd hour (like 1:20 with the transition time) before the bottle would be ready. So...the plan was nurse, supplement (while pumping if possible), then pump and store it for the next feeding, giving some space in between each feeding for me to pee or eat or stand up.

Sounds like the immediate pump/feed or pumping off the foremilk is working. My experiences were like a trainwreck, so don't take much nursing advice from me.

[jerseygirl07067]

Watchingthemgrow, that makes total sense. I know what you mean....by the time you nurse, then pump, they're off to sleep already!

Dr. Sally thanks for your post too. :)

I have good news....it seems we've turned the corner. I've not had to pump a bottle for her now in two days, she seems to be nursing more vigorously and for much longer periods of time. She gained 7 oz in the past 6 days, so at this pace she should hit her birth weight tomorrow, right at 2 weeks! The pediatrician seemed really pleased with her progress. Just wanted to update. :)

[WatchingThemGrow]

That's awesome! Congrats on getting things going! I'm praying we'll be much better this time -and able to reach birthweight by the 2 week visit. We've only ever done it by the 3rd week :(

[DrSally]

Great news! I think w/jaundice, once they stop needing that supplement and are able to stay alert and active for a whole feeding, there's really no need for pumping. At the time it feels like it will last forever, but it's so great when it's done!