Almost 5 mo on 4 hr schedule and not gaining enough

[sunny90]

My first two sons were big, fat babies, who were on a 3 hr schedule and then a 4 hr schedule by 4-5 months. My third baby boy was born average size but was "skinny" and very clingy and cried a lot so the doc recommended solids around 5 months and then I sleep trained him and he was much happier and put on weight very quickly.
Now my baby boy #4 at almost 5 months is exactly the same, born average size and was on a 3 hr schedule but when I saw it was interfering with his naps I put him on a 4 hr schedule, his naps still aren't great but his wake time is 2 hrs-2.15, and he has fallen off the weight curve completely. The doctor recommended starting him on solids, nursing him more, giving him a feed around 5 pm etc, but how do I feed him more and keep him on 4 hrs? He doesn't take a bottle, and frankly I don't want him to. I nursed my other kids totally fine, what can I do to keep breastfeeding and keep on an age appropriate EASY?

[michaeljacknnugg]

You don't keep on a 4hr schedule, not if your baby needs to eat more frequently. You can have age-appropriate A times and nurse more often, it's just a bit of a jigsaw and you may end up with two feeds in an A time.

My second baby has only just made it to four day feeds, and that's because he's taken well to BLW and is eating lots. We finally made it to 4 hours between feeds at 6 months! My first was a much chunkier baby and went longer in between feeds much earlier.

[becj86]

You can do a topup feed around 45min-1hr after the WU feed. Your routine would then look a bit more like this:
7 - WU, feed
7:45 - feed
9:15 - nap
10:45 - WU, feed
11:30 - feed
1 - nap
2:30 - WU, feed
3:15 - feed
4:45 - nap
5:30 - WU, feed
7 - asleep in bed

FWIW, I wonder if he's pretty active compared with other babies his age? If so, he can look like he's not gaining because his weight gain pattern will be a bit different from his peers. I certainly had weight gain concerns raised with DS at 5months and again at 10 months when he started crawling and walking earlier than his peers and so was using the energy for moving rather than putting on more fat, yk?

I see you have a post regarding your routine too.

[sunny90]

Would the topup feed be on the other side? I do single  side feeding.
Also, how can I add feedings without messing up his naps? He does tend to drift off on the breast.

[becj86]

I think its worth trying offering both sides at a single feed before you go doing topups, etc. unless he's truly done and not interested in further milk after one side. In my case when I was doing single side feeding due to oversupply, yes, the topup was from the same side to make sure DS got sufficient fat content as he wasn't gaining bue to my copious quantities of milk and suffered dreadfully from foremilk/hindmilk imbalance related gut pain.

[zissi]

if a baby is not gaining well one should absolutely offer both breasts and also feed on demand not on a schedule. as others have said you can still have a good nap routine just make sure a feed is not right before nap which would interfere with independent sleep if thats your concern. definitely 2feeds per A time I would say...

[Martini~]

I also second both-sides feeding. DS was younger when not gaining weight or gaining slowly and both-sides feeds made our problem non-existing. It may not be enough for him - but worth trying as it is the quickest way of helping him. DS was on 3,5h EASY at 3mo and approaching 4h around 4/5mo, but we were doing cluster feeding in the evening (additional feed at 5pm) until we introduced solids and feeding both sides. I don't think he could go 4h without both sides and sometimes three sides:)

[sunny90]

Thanks for all your advice! I will try double side feeding. How long are you supposed to feed on each side? I've always done single side so I have no idea!
Also I've added a solids meal at 5/530 so not going to add that feed.

[becj86]

Feed on one side til its drained - LO presumably detaches? Its not a time thing, its a matter of how long it takes him to take his fill from the breast, then switch to the other.

[sunny90]

Sometimes he detaches sometimes he just chills til I take him off. And the next feed you start on the last breast?

[becj86]

And the next feed you start on the last breast?

Yep

[sunny90]

Will I ever be able to go back to single side feeding?

[sunny90]

I'm worried that then I'll have less milk on each side.

[Martini~]

You may have slightly less at the beginning but it's not a problem as breasts will adjust quickly. And no matter how you calculate, the LO will get more milk overall. And that's what matters. I never managed to get back to single side feeding as such but LO had different appetite and sometimes one side was enough for him. However from some moment I always offered both sides and he just refused if not interested.

According to my knowledge for some women it can be very difficult to achieve 3.5-4h feeding routine with only one sided breast feeding. For some even two sides feeding is not enough:).

If you want to boost your supply more - remember that more often you attach you LO, the more milk you have. After couple of days of more frequent feeds you will probably be producing more milk so sometimes you can get to a normal feeding routine. This what you usually do during growth spurts.

[becj86]

I did single side feeding til L weaned at 2.5yo, except in growth spurts - it really depends upon you and your baby - it will probably be different for another baby should you have one. I know a lady who EBF her baby totally on one breast - she was a bit lopsided but it worked for her.