WWYD- low weight gain

[JTsMom]

Zachary is doing well- his reflux has gotten much better, and the rashiness is pretty well under control with the elimination of dairy from my diet, but he is gaining REALLY slowly.

At birth, he was 8 lbs,4 oz. He gained like crazy early on, but by 3 months, the weight gain slowed dramatically. 4 mos- still slow. Now at almost 5 mos (he'll be 5 mos on the 31st), he's stuck at 14 lbs 12 oz. He's only ut on 2 oz in the past 16 days.

He nurses well (on demand), and has a good number of wet diapers. He's right on track developmentally, but is a lousy sleeper. He barely naps. He's also teething.

At our 4 mo well check, the ped suggested considering starting some oatmeal cereal. I've always been in the no solids until 6 mos camp, but i'm starting to kick around the idea. I'm very concerned about FA's though.

Also, Jason had this exact same pattern, but we chalked it up to his surgery at 3 mos. He started gaing well again at 6 mos when we started solids with safflower oil added (on the advice of a nutritionist). So, WWYD?

[SnuggleBuggles]

I'd probably for formula instead of cereal. You won't have the same FA worries and I think it is more easily digestible and likely to provide better nutrition than cereal. ((((hugs))))

Beth

[brgnmom]

I supplemented with formula at night, and noticed that my DS would sleep for longer periods. I would also go for the formula first. I'm planning on nursing mostly this time around, and supplementing with formula again at night.

[Cuckoomamma]

Your bm has all that he needs. Any chance you're using a pacifier? If so, I'd use it less and nurse more. We always recommend that babies don't start solids until the second half of the first year. Babies with the potential for FAs we definitely suggest waiting longer, more along 9 months.

Breastfed babies always slow down with their weight gain around 5-6 months. Has anything changed recently in terms of his nursing?

If you really want to supplement with something, I might tend more towards a really low allergy solid as opposed to formula. There are a lot of ingredients in formula and I'd hesitate to introduce any extra ingredients if it wasn't necessary.

[ThreeofUs]

Have you talked to a LC? LCs have a lot of good strategies you might use.

The only thing I can think of is that you might want to start wearing him (if you aren't already, lol) and nursing a LOT - like offering every (insert short time period here), as you would a newborn.

I'm sure you're trying everything! Hugs and good luck to you both.

[egoldber]

FWIW, I think this pattern is relatively common with reflux babies. My younger DD was exactly like this. She gained well for about 2-3 months, then she slowed down a LOT. I think she gained maybe 3-4 ounces from 4-6 months.

We did start her on Reglan (which is controversial I know) in addition to the Zantac and that helped. We also gave her a bottle with cereal once a day, but she was 6 months, so I was OK with that. But she did not start to gain more rapidly until she started eating a lot of solids at 7 months.

I never supplemented, because I was stubborn that way. :p But my peds never suggested it either. She was just on that hairy edge of gaining slowly, but still gaining, so they were fine with EBF. I :heartbeat: my peds.

ETA: And DD just had her 4 year appt. She is barely 31 pounds. But ahead in all milestones. She's just thin.

[KpbS]

I remember reading that reflux can peak at 4 mo. So while his is under control, it could still be affecting his appetite, kwim? I would give him a few more weeks and then make a decision. If I were you I would supplement with a hypoallergenic formula (Nutramigen or Alimentum) since he has had such a dramatic improvement when you removed milk from your diet. These formulas can be rejected by ebf babies b/c of their strong taste but if you keep offering, most of the time they will drink the formula in increasing amounts.

[JTsMom]

I really want to avoid formula if at all possible, and I definitely will not give a cow's milk based one. I also suspect he's sensitive to soy, so that doesn't sound like a great option either.

My ped's office actually has 2 docs- our regular one is an IBCLC. The other isn't I don't believe, and she's the one I saw last time (I saw our regular one at 3 mos). Neither seemed especially alarmed about his weight gain, although the said that they'd like to see it go up by the next apt. At the 3 mo check, she said it was probably b/c he' had such a HUGE gain the month before, in fact. (He'd actually gone up to somewhere around the 86th percentile).

Here's the thing with the nursing- he really and truly seems to get plenty. He nurses frequently. I don't think he ever goes longer than 3 hours. He doesn't always stay on long though. When he goes for a marathon session- which happens at night sometimes- he tends to spit up, so I don't think it's a supply thing. He has at least 7 really wet disposable dipes a day. He seems well hydrated, has a ton of energy, etc.

I don't use pacis or artificial nipples, and I think I'd have a hell of a time trying to get him to take a bottle.

He seems satisfied after meals 95% of the time.

He has been extra fussy lately, but I think a lot of that had to do with the tooth he just cut. Right before that, he did have a little cold, and he's been making some big developmental leaps too.

The reflux- it's not totally gone, but is much better. I did try Zantac, but couldn't get him to swallow it, so I gave up on that pretty quickly. He seemed to do pretty well without it anyway, but maybe we should re-visit the meds. He still spits up maybe 3 times a day or so-sometimes it's quite a bit. (This is down from 12X or so with dairy). He's not waking up screaming nearly as often, but still does on ocassion.

Honestly, I don't think he's ready for solids, but think he could be in another few weeks.

ETA: I have been wearing him some, but he's in arms almost constantly, and we co-sleep.

[ThreeofUs]

Lori, I honestly think you're on the right track. Honestly, he sounds like he's doing well, so maybe this isn't such a big deal.

FWIW:
-My DS1 needed prevacid, which we gave him in breast milk from a tiny appetizer/espresso spoon. Maybe your little guy could use some help with the reflux and getting a little meds in him would help.
-And just on the principle that more of your milk would probably be better for him than supplementing (kwim?), maybe he should nurse more often. If he can't hold down a lot of milk at once, maybe getting more milk by nursing more often would give him the nutrition he needs to grow. Just a thought....

GL!

[elephantmeg]

is he outgrowing the dose of reflux meds? That might explain the poor sleeping too.

DD was on prevacid solutabs and they were a miracle (and strawberry flavored IIRC). We stuck the part of the pill in her mouth and syringed water over it-much easier than making it into a solution, trying to get it in etc.

[Indianamom2]

I might be remember incorrectly, but I thought that prevacid tabs had some trace milk in them. We tried them for a while, and they didn't hurt (maybe helped) but if they do have milk in them, that wouldn't be a good fit.

Just something to double check. Ds loved the prevacid tabs. They smelled like candy to me!

[Dr C]

What is his height percentile? Often breastfed babies go through a "chunky" phase around 2-4 months and then the slim out and their weight percentile drops towards their height percentile. If that's the case then I'd just watch his weight but not do anything other than offer breastmilk.

Offering cereal could boost his calories but mainly if you're concerned about supply. Does he take expressed milk in a bottle? If he does you may be able to do that to get a sense of whether your supply is appropriate for his demand. If he takes more than you are able to pump, you may want to consider offering a supplement (elemental formula). If you can pump more than he will take (and he takes a bottle well), then inadequate calories is unlikely to be the answer.

If your peds are not worried (and it sounds like they are VERY breasfeeding friendly so I would be inclined to trust their advice), I would just keep nursing him, and bring him in around 5 months or so for a weight/length check and see where he is at that point. My guess is he's fine. Some kids are skinny, and that's ok. You would not be wrong to offer some cereal (rice or oatmeal) and see what happens--if he devours it, you may have your answer. But I totally get your concern about allergies. It's a tough call.

[mamicka]

I know that you always worry more when it's your own child, but I don't think this sounds like a problem. If he's not spitting-up a ton & he's eating a lot then if he's still hungry, just nurse him more. If he isn't hungry then supplementing with anything won't make that much difference, you know? As an outsider looking at your situation, I'd say ride it out. Easier said than done, I know.

[Indianamom2]

I know that you always worry more when it's your own child, but I don't think this sounds like a problem. If he's not spitting-up a ton & he's eating a lot then if he's still hungry, just nurse him more. If he isn't hungry then supplementing with anything won't make that much difference, you know? As an outsider looking at your situation, I'd say ride it out. Easier said than done, I know.

I think this is my inclination as well, especially since he's had issues with milk and reflux. Once he gets all this sorted out, he'll likely start gaining well again.

It is very hard not to worry about it though. My ds gave us fits, but he actually dropped dramatically and stayed very low around this time, so we had some reasons to be really concerned....and yet he still ended up being just fine.

Hang in there and just keep an eye on things.

[California]

This is minor, but one thing I noticed is that you said he prefers shorter nursing sessions, right? If you are really concerned you might consider nursing all on one side during each nursing session. That was the suggestion given to me by my LC and it did seem to help. You might be able to get a similar result by pumping first to get the initial letdown out of the way. Either way the goal is to make sure baby is getting more of the hind milk that comes later in a nursing session.

If you go the one-side route, you might want to talk to an LC first to be prepared for the adjustment period your body will go through. I remember it didn't take long at all, but the first few times I nursed only on one side I did feel a little uncomfortable.

[niccig]

FWIW, I think this pattern is relatively common with reflux babies. My younger DD was exactly like this. She gained well for about 2-3 months, then she slowed down a LOT. I think she gained maybe 3-4 ounces from 4-6 months.



We were the same. The Dr. swapped us to prevacid and DS started to gain a bit better. At 6 months, I started to give one bottle of formula instead of pumping when DH had him. I loathed pumping, and he was already on solids, and wasn't just EBF anymore as a friend point out.

DS still didn't gain a lot, it really didn't matter what we did he only put on about 1/2 what was expected. He still doesn't gain a lot now. He's nearly 6 yo and just 40lbs. He's always stuck to his own curve that was set around 4-8 months old.

[brittone2]

I'll echo several PPs. I would not decide to supplement based off of one 2ish week period of time. I would give it more time and see if he continues to gain.

If he's peeing, pooping, reasonably content and continuing to move in a positive direction...I'd skip supplementing for now if your peds are okay with that too.

Hang in there!

[brittone2]

Does he take expressed milk in a bottle? If he does you may be able to do that to get a sense of whether your supply is appropriate for his demand. If he takes more than you are able to pump, you may want to consider offering a supplement (elemental formula). If you can pump more than he will take (and he takes a bottle well), then inadequate calories is unlikely to be the answer.



I don't think pumping tells most women much about their supply, to be honest. I have oversupply issues if anything and I rarely pump...if I pumped I don't think it would look like I make a lot of milk (once I get past the initial major engorgement phase in the first month or two). And I've EBF'd 3 babies now, and they have been on the chunkier side.

Some babies will also just continue to suck, suck, suck at a bottle until it is gone because it will sort of dribble into their mouth anyway. Kellymom, etc. always mentions baby taking a bottle after BFing, etc. should not be used in and of itself to judge whether mom is making enough milk. Many babies, even those getting enough milk will just continue sucking if offered a bottle post nursing. Doesn't mean mom isn't making enough.

Maybe I am misunderstanding what you meant, however.

eta: Kellymom's site discusses babies sucking down a bottle after mom nurses, and why pumping output is not a great predictor of "adequate" supply. etc. on this page:
http://www.kellymom.com/bf/supply/low-supply.html#supply

[mamicka]

This is minor, but one thing I noticed is that you said he prefers shorter nursing sessions, right? If you are really concerned you might consider nursing all on one side during each nursing session. That was the suggestion given to me by my LC and it did seem to help. You might be able to get a similar result by pumping first to get the initial letdown out of the way. Either way the goal is to make sure baby is getting more of the hind milk that comes later in a nursing session.

If you go the one-side route, you might want to talk to an LC first to be prepared for the adjustment period your body will go through. I remember it didn't take long at all, but the first few times I nursed only on one side I did feel a little uncomfortable.

:yeahthat: I actually nurse the same side for 2-3 nursing sessions in a row.

[brittone2]

One other thought, Lori. If you are cutting out a lot of allergens, how is your own nutrition? I doubt that's the cause, but I know you are restricting your diet due to concerns over allergens. I'm wondering if bumping up your own calories and fats could help a little bit. Again, that's probably an unlikely scenario but something that came to mind.

[daniele_ut]

If your peds are not worried (and it sounds like they are VERY breasfeeding friendly so I would be inclined to trust their advice), I would just keep nursing him, and bring him in around 5 months or so for a weight/length check and see where he is at that point. My guess is he's fine. Some kids are skinny, and that's ok. You would not be wrong to offer some cereal (rice or oatmeal) and see what happens--if he devours it, you may have your answer. But I totally get your concern about allergies. It's a tough call.


I know that you always worry more when it's your own child, but I don't think this sounds like a problem. If he's not spitting-up a ton & he's eating a lot then if he's still hungry, just nurse him more. If he isn't hungry then supplementing with anything won't make that much difference, you know? As an outsider looking at your situation, I'd say ride it out. Easier said than done, I know.

ITA with both of these posts. From what you posted, I think it sounds like you are doing fine. I'm the mom of two VERY slow gainers. DS dropped off the charts at around 3 months and didn't even get back on until he was 2. He was born at 36 weeks weighing 6 lbs and had reflux so it wasn't entirely unexpected that he would be a slow gainer, but it still rattled me at first. My ped wasn't worried about it so I made myself stop worrying as much. He never once suggested supplementing, but I was EP'ing so I knew how much he was eating. He wouldn't take more than 24 oz in a day, ever. He didn't start solids until he was 6 months and we never gave him rice cereal or baby oatmeal, only real oatmeal. He wighed 17lbs at a year. Eventually from age 2-4 he moved from the 10th to the 50th percentile for weight.

DD was born full term weighing 7.5lbs and I nursed her exclusively until she was 9 months old. She looked totally average at birth, but her curve has been very slow for both height and weight. She only weighed 16lbs at a year. She is just a tiny kid and my ped (a different one now) was always fine with her weight gain and never suggested formula. Even now, she's 3 months away from turning 3 and she weighs less than 26 lbs.

As pp have said, it is hard not to worry, but it sounds to me that you have good support from your doc.

[JTsMom]

Here's some more detailed info:

Birth 8lbs 4 oz 66% 20" 62%
1 day 8lbs 1 oz 57%
2 days 7lbs 10 oz 42% 20 57%
8 days 8lbs 41% 20.3 57%
23 days 9lbs 9 oz 57% 21 50%
8w 2d 12lbs 13 oz 80% 22 21%
3m 6d 14lbs 2 oz 60%
4m 4d 14lbs 8 oz 39% 24.3 22%

I weighed him about a week (or maybe 10 days) after that last appointment, and he was up another 2 oz. Weighed him again about a week later, and he was up another 2, so 14 lbs, 12 oz. (My scale is within an oz of the ped's). So his weight % has ranged from 39% to 80%, and height from 22-62%.

I can't pump much ever, with any pump, even when my 2 were at their chunkiest.

I was wondering about my diet as well- I didn't think that was likely to be a problem, but I diid cut out a lot of fat, and I've dropped about 1 size. I have a lot of extra weight though, so it's not like I'm dangerously thin or anything.

The only other relevant factors I can think of are that I'm on synthroid for hypothyroidism (dose adjusted and re-checked around 10 weeks pp) and DS is easily distracted when nursing.