Need advice please

[ericapt]

Hi all.  I have some questions and I'm hoping someone can give me some advice.  I realize that every LO is different and one LO can't really be compared to other LO's, but maybe some of you have been through a similar experience and could give me some support.  I'm feeling pretty low right now.  To make a long story short DD is 5.5 months old now and we've been dealing with horrible reflux since she was 4 weeks old.  We do have the reflux under control (being managed with meds by a pediatric GI doc), but here is our current issue.  DD is EBF and we went to the GI doc yesterday for check up/ medication adjustment and it was discovered that she has not gained any weight since her 4 month check up.  That means she hasn't gained any weight in 1.5 months! (Prior to this she had been gaining weight really well.  She weighed 6 lbs. 10 oz. at birth and, as I said, was 14 lbs. 7 oz at 4 months!)  I FEEL AWFUL!!!!  Maybe I shouldn't feel this way, but I feel like it is TOTALLY my fault because she is EBF!  I feel like I should have noticed something was wrong and gone to the doctor sooner.  DD is much different than my DS was at this age, but as I said, I realize every LO is different and I just thought this was how she was.  She nurses at about 7 am, 11 am, 2:30 pm, 5 pm and 6:45 pm every day and then wakes usually 1-2 times during the night to nurse.  It was getting pretty exhausting for me because she was often waking as early as 10 or 11 pm to nurse and then again around 2 or 3 am, so I was only getting about 2.5-3 hours of continuous sleep twice a night.  That's fine at the newborn stage, but after 5.5 months it gets pretty tiring and frustrating.  (DS was sleeping 11-12 hours straight around 4-5 months old without a DF, so this waking every few hours wasn't what I was used to, but thought it was just how DD was.)  So, I feel like things are just really bad right now.  I feel like my DD isn't getting the nourishment she needs and my body isn't doing the job it was meant to do.  I am dairy and soy-free due to intolerance in DD, so I keep thinking maybe the lack of dairy and fat in my diet has affected the quality of my milk.  DD did go through a brief period about 1.5-2 months ago when she was sleeping 8-12 hours straight at night, but that ended and never returned.  I just thought GS at first, but when it continued I just assumed this was how it would be with her until she was eating solids.  Which brings me to my next concern.  The GI doc recommended that I start DD on solids immediately 1-2 times per day.  This is fine (although I waited until 6.5 months with DS) because obviously she needs more than she's getting, but I'm concerned that by giving solids my milk supply/quality will go down even more since she will be taking in some of her calories through cereal.  I've read a lot of the research about feeding solids to EBF babies too early and they say that at this age LO's don't just add to their daily calorie intake, but actually start to replace BM with solids.  I don't want this to happen!!!!  What can I do to avoid it and how do I know how much cereal/solids she needs while still taking in the necessary amount of BM.  I gave her oatmeal with EBM yesterday evening and she gobbled it up!  She took 2 T. of oatmeal with 2-3 oz. of EBM and then STTN 12 hours!!! Obviously, this is fabulous, but my main concern isn't her STTN, it's her getting the nutrition she needs to be healthy and grow and meet all of her milestones.  The STTN is just a bonus once her health needs are met!!  So, I guess I'm asking what other mom's have done in similar situations?  How do I make sure she takes in the amount of BM she needs when she's already nursing 5 times during the day and 1-2 times during the night?  I NEVER had milk supply issues with my DS (I was a milk machine!) and I'm not sure I have issues now, but for some reason she isn't gaining weight!  I hope that someone can offer me some positive info.  Like maybe this is normal (wishful thinking) and things are going to get better and she won't stop taking in BM and my supply won't be affected and she'll start gaining weight like she's supposed to.  Anyway, just really need to hear something good now because all I can think about is that my baby is going hungry.  I'm second guessing myself about everything.  When she starts fussing now I worry that she didn't nurse enough or that my breast milk isn't good enough for her.  I know this will pass, but as I said, I just want to know that my LO is healthy, happy and gaining weight!  Sorry for the pity party, just need some support.  Thank you all in advance for reading through this mess!!!!

Erica

[anna*]

((((hugs)))) I don't know much about reflux so I can't speak to that at all. 5.5 months isn't so early to be weaning, so I wouldn't worry about that. I do want to reassure you that she is NOT going hungry! Being hungry and not gaining weight do not equate to the same thing - she would let you know for sure if she was hungry!!

The best thing you can do to ensure she is still getting the milk she needs is to always BF before solids. So BF, and then do solids like an hour after the start of the BF. Also you can do breast compressions while she is actively BF'ing, to make sure she is really draining the breast as much as possible. Pumping after a BF (or any time you can) will help your supply, and so will Fenugreek capsules, if you feel like trying a supplement. Oats are a great galactogogue and will help keep your supply good. I know you are dairy free but are you getting plenty of other fats? Olive oil, avocado, oily fish, hemp seed/flax seed/cod liver oil, meat?

In the west, we are obsessed with weighing babies and for sure it is a useful measure, but it is not the whole story. If she is happy, healthy, meeting milestones, bright eyed, rosy cheeked, smiling - those are important measures too.

((((hugs)))) I don't wish to try to belittle your experience AT ALL, it is a fundamental and instinctive concern for mothers that we can properly nourish our little ones. You are doing an amazing job under difficult circumstances, and I don't think ANYONE (except maybe you ) thnks you are doing anything but the very, very best for your little girl.

[ericapt]

anna- *Sigh*.  Thank you very much.  I really needed that.  Your words were very helpful and soothing to my nerves.  I do need to stop and realize that if DD were really hungry she would let me know.  I guess I just keep second-guessing myself about everything, especially since she is waking 1-2 (occasionally 3) times a night and the only way to get her back to bed is nurse her.  He naps were all very short today (this can happen a few days a week), so I was concerned that maybe she has been waking early from naps because of hunger and I've just been trying to extend her naps and make her wait longer.  I'd much rather have a chubby, happy baby who isn't sleeping that well than a skinny, hungry baby that sleeps better!   I just don't understand how she could be gaining weight so well and suddenly stop.  It just seems like something is wrong.  As for your question about me getting enough fat in my diet.  I would say probably not.  I have a somewhat limited diet anyway (I don't eat red meat or pork), plus DD is sensitive to nuts, beans, many veggies (which I LOVE) in addition to the MSPI.  I need to figure out more ways to get good fats into my body so that my milk supply is rich with fats/carbs for DD.  I do love fish, chicken and pastas and veggies, but anything can get pretty boring after eating a limited diet of very few items for 4+ months.  Today DD seemed extra hungry at her 3rd and 4th feeding of the day which isn't typical.  I'm not sure why or if I'm imagining things, but I suddenly feel like my supply has decreased.  (Hopefully it's just in my head!)  She seemed unsatiated (sp?) after the 4th feeding and it wasn't until I gave her the oatmeal and EBM that she was happier.  (She took 2 T. of oatmeal with 2.5 oz of breast milk.  Does that sound normal for this early on?)  I pray that DD starts to gain weight and seem satisfied again.  I have never experienced her being hungry AFTER nursing.  Maybe I should just start nursing more frequently for several days to help with the supply, if it is a supply issue.  Ok, off to pump before bed (could be bad if she ends up waking in the next hour or 2), but need to build up supply and stored milk to have enough to put in her oatmeal twice a day.  Thank you again for listening!  It truly helps.

Erica

[anna*]

Remember this is an incredibly hungry age, along with the six month growth spurt, and it's VERY common for breastfed babies to still be feeding overnight until they are well established on solids.

It's age- and developmentally appropriate that she should be hungrier than you can provide for - that's why we start solids, because mums can't keep up with demand! It doesn't mean that there is anything wrong with either your milk or your supply - it's what happens to most babies at this age, and for millennia, BFing mums have started to give their babies 'real' food because we can no longer satisfy our ravenous little offspring!

Fenugreek really does help with supply, if you are concerned, although I understand that you may be cautious to try it given the food sensitivities.

If you want to try nursing more frequently, you could do, say BF at 7am, solids at 8am and then another BF immediately afterwards. There won't be much milk, but the extra feed will stimulate your supply. I would be looking to phase this out pretty quickly though - in a few weeks time you really won't want to be tied to doing 7 x BFs and 3 x solids, or you'll never get out of the house! Once you feel like your supply is healthy, doing breast compressions while she's feeding will help make sure she's getting the maximum amount per swallow.

((((hugs))))

[Vicku]

Hi Erica!

You've had fantastic advice from Anna already but wanted to jump on with my support. I can relate to how you're feeling as I've had some weight gaining issues with DD2. It is awful to think that you may not be providing all that your child needs usually they are absolutely fine though, and as anna said we are obsessed about weighing babies these days. One important thing to keep a look out for is if she's haing plenty of wet nappies and some dirty ones? Is she happy, alert and meeting milestones etc?

I just don't understand how she could be gaining weight so well and suddenly stop.

You said she'd not gained for 1.5 months right? And is 5.5 months now... It is actually VERY common for EBF babies to hit a plateau around 4mos where the weight gain slows down. Sure most don't stay the exact same weight for this long, but it is a big time for weight gain to slow. Might be worth keeping in mind.

With her reflux, is she spitting up a lot?

{{{more hugs}}}

[ericapt]

anna- Thank you again!  It's so helpful to hear advice from someone on the outside (meaning not my doctor or my husband!    Of course, I truly value their opinions, but my doctor's main concern isn't the breastfeeding, it's the weight gain.  I want to have both, continued successful breastfeeding and a healthy baby that's gaining weight.  I was a little frustrated today because I spoke with a LC at the hospital where I delivered DD.  They will answer any questions over the phone for free.  The lady I spoke with today is particularly conservative and said I should be nursing DD at least 8 times a day!  OMG, I would NEVER get her off the boob, much less leave the house!!!!   This just seems completely insane to me.  How can I force more feedings when DD isn't acting hungry between feeds?!?  This just seems counterproductive to taking in more food.  Wouldn't she just start snacking and taking in less at each feeding?  Also, I was thinking about her weight and the 2 weights were done at different doctors offices on different scales.  I'm really wondering if there is a difference between the 2 scales.  I'm actually going to take DD to both offices on Monday (if permitted) to weigh her for my own peace of mind.  This could be a HUGE factor.  Also, DD had a stomach virus about 1.5 weeks ago and was vomiting.  It didn't last long, but this could also have resulted in a little weight loss which could be another issue.  I like your suggestion about trying to nurse at 7 am, feed solids at 8 am and then nurse again right after solids to help with milk supply.  I was also wondering if I should start doing a DF.  I know that they aren't commonly started at this age, but her 6-7 feeds per day has turned into 5 feeds per day since starting solids, so I'm worried that she is just replacing a breastfeeding with the solids.  I want the solids to be IN ADDITION to her 6 feeds a day, not replacing a feeding, right?  Last thing.  When do I pump to get enough breast milk to add to her cereal?  I work 2 days/week and only pump twice while I'm gone (she takes 3 bottles), so I have to find extra time to pump enough milk for the days I'm at work.  This is without needing extra milk for cereal.  Ugh!  My least favorite thing about breastfeeding is the pumping.  It's a lot of work, especially with a 3 year old running around the house!  Ok, done with questions for now.  Thank you thank you!

Vicku-  THANK YOU!  That is good to know that it's common for EBF babies to hit a plateau around this age.  I realize that some weight gain is necessary, but maybe she has just hit a lull and will bounce back again very soon.  I have been doing a lot of praying and hoping that things change very quickly.  I tend to be quite the worrier and this is definitely stressing me out!  As for the reflux, she really doesn't spit up too much.  It's much better than it was when she was younger; it's more the silent reflux/acid that is the issue.  I will keep you all posted as to what I find out next week.  Again, thank you for all of your support and encouragement.  It is GREATLY appreciated!

Erica

[LizzieN]

Erica sweetie, I have been EXACTLY where you are.  My DD stopped gaining (and was a very slow gainer before this) at around 5 months, I mean she dropped from the 25th percentile to the 3rd...I had started solids with her at 6 months but she wasn't gaining even with the extra solids, was getting severely constipated to the point we had her at the doctors and on suppositories, it was a HUGE mess.  I took her to clinic and they gave me two weeks to get her at least following the 3rd percentile or they were going to suggest formula supplementation.

In two weeks she gained 400g which was more weight than she had gained in those 1.5-2 months....this is what I did.

I changed her to basically finger foods, lots of protein (chicken, fish, beans), good fats sa canola oil and avocados added to her food, legumes and stone fruits, quinoa, some rice cereal in case her iron was low etc.

I also went off all gluten in my diet (I"m already soy and dairy free) and suddenly she started pooping normally (we have always had issues with her poop frequency).

When I got her weighed she had gone back up to the 10th percentile and she has continued to do well.  She is eating like a horse....seriously I'm not exaggerating when I say she is eating like a 1 year old now, and she is still feeding off me every 4-4.5 hours and once or twice a night, so I know she is still getting the milk she needs.

Just wanted to let you know I have totally been where you are, I have felt the worry and guilt and more worry....I have felt like I should be supplementing, been angry at my body for not doing what it's supposed to.  Been on fenugreek and blessed thistle for ages.  It is SO hard.  But I do believe that your LO hasn't been unwell or hungry, mine was the same, she is just mellow and she takes what she needs but no more, she is incredibly active and bright (like your LO no doubt) and she has reflux issues.....

Huge hugs sweetheart, keep feeding that little girl, LOTS of good proteins and good fats for her and I recon you will find she comes ahead leaps and bounds again

Good luck sweetie
xx

Oh here is my post of BF too if you are interested:

http://babywhispererforums.com/index.php?topic=183095.0

[anna*]

Lactation consultants are so valuable but I have found some to be a little... overzealous maybe? Definitely think it would be a good idea to get her weighed again on the same scales, and agree that her tummy bug may have set her back in weight gain over the last month. A dreamfeed will be a great idea too - be prepared that she may not take a feed - but is definitely worth a try and as you say will help with the overall qty of BF she is getting (and again with your supply too).

Pumping is hard work, no doubt about it, and (for me at least) it gets harder as they get older. Doing it with a 3-y-o running around too? Well, I can't really imagine. Does she feed both sides, or single sided? If she feeds single sided you could pump from side 2 while she feeds from side 1. Another idea (and I know this is brutal and not really seriously expecting you to go for it) is to pump in the middle of the night. I used to do this just once or twice a week. It was REALLY good for my supply, and I could yield more milk at that time than pumping at any other. I couldn't maintain it every night, but maybe once or twice a week? When I did it, I found that my breasts were super-full at the morning feed on the nights when I didn't pump, so I could feed him from one side and pump from the other.

[*Liz*]

Another thing that may have happened is that your LO gained great with comfort feeding with the reflux, and now the reflux is controlled they are returning to baseline.

My DS did this - born on the 2nd centile, gained up to the 25th by 4 mths, and tumbled back to the 0.4th by 7ish mths. At age 2 he is still a 0.4 th centile baby so I guess that is where he belongs. DS used to feed all night long as a teeny.

Just another possible explanation 

[ericapt]

LizzieN, anna* and *Liz*-  I can not thank you all enough for your wonderful support and suggestions.  It is a tremendous relief/comfort to hear about other situations that have been similar to ours and made it through on the positive side!  I am so grateful for all of the information and encouragement.  I will look into the high protein in DD's diet and mine (although in the US they recommend no meat until 8+ months and she is so sensitive to things in my diet I'm concerned about what will will affect her).  Agreed that some LC's, while incredibly helpful/knowledgeable can be a little too overzealous.  I just can't imagine a 5+ month old nursing 8 or more times a day!!!  No way women would continue nursing if it was always that time-consuming!  As for the pumping, I've decided to pump around 9:30 pm (last feeding is around 6:30 or 7 pm).  I don't get much, but I guess if I continue to do it my supply will increase (?).  DD has woken to nurse the past 2 nights (last night around 1:30 am, the night before around 4 am), so I'm hesitant to pump in the middle of the night when she may be waking up to nurse.  For now I'll just stick to pumping after her first feeding and then 9:30 at night on my days off.  (anna*-I do 2-sided feedings every time now.  We used to do single sided, but that changed around 3 months old.  She doesn't seem satisfied on just one side anymore.  Any suggestions to return to it? Or just stick with 2-sided?)  I'll keep you all posted as to what we find out this week.  Praying that she is ok and growth will continue as before.  Thanks!

Erica

[LizzieN]

Good luck sweetie,  you are right about being cautious of protein at your LOs age...mine was about 7 months by the time that was suggested.
Just keep in mind you are doing great and she is well and happy...when I spoke to my doctor about my DD his comment (word for word) was"

"in such cases we look at the baby, she is thriving, active and happy, that is all we need to know"

hugs to you
xx

[ericapt]

  Thank you again, LizzieN.  I plan on calling the pediatrician tomorrow just to discuss the weight issue and see what he thinks.  I'm hoping that will give me a little peace of mind and relieve some of my worries/stress as well.