4 mos old not following growth curve, worried sick

[natashalil]

hi everyone

went for my ds 4 mos appointment today. he weighed in at 12lbs 10oz, which is in the 5th percentile.

Here are his weights over time -

born - 7 lbs 13oz (50th percentile, was a c-section baby)
1 mos - 8lbs 12 oz
2 mos - 10lbs 14oz
3 mos - 12 lbs 1oz
4 mos - 12lbs 10oz

I have been breastfeeding him exclusively since about 3 weeks in, had some supply issues at first and was pumping and taking motilium. Weaned off the motilium over christmas slowly, didnt notice a difference in supply.

I feed DS at 7am, 10:30, 2:00, 5:00, 7:00, and when he wakes up at night, sometimes once more at 3-4am, sometimes he wakes up twice. So he is being fed 6-7 times a day. The nurses told me that isnt enough and I should feed him 8 times a day, and that he shouldnt be sleeping 7-8 hours at night when he is that little.

We started sleep training around the 3 month mark for night time sleep, 3.5 month for nap sleeps too. Is it possible he is crying too much and burning up all his calories? How much crying is too much for 4 months old?  Should I feed him more often, or wake him to feed?

Please help 

[natashalil]

Also how do I not fall back to AP? I feel like I dont want him to cry at all now so he can gain weight. He still puts up a fuss at night time (last night was 30min of p/u p/d, i think we are in a sleep regression because it use to be 5 min of fussing and he would put him to sleep).

Same question on naps, sometimes he falls asleep after 3 mins of fussing, other times it takes longer?

[MasynSpencerElliotte]

Do you know if they are using charts meant for bf babies? It is actually quite normal for an ebf baby to gain weight fast at first and then slow down - also they tend to take after their parents (my DD3 is around 5-10th centile but dh and I are small!). She actually was sleeping long stretches at night until she hit the 4 months growth spurt.  Two of my three were able to do long stretches quite young.

Also pu/pd can be too stimulating for some babies...have you tried shh/pat? At 4 months old he could be going through a growth spurt and also need a routine tweak as he may be ready for more A time.

[Erin M]

Also, did you receive any fluids during labor?  Birth weight is sometimes artificially inflated because of that.  Is your baby soaking enough diapers during the day?  That's honestly the best indication of supply.  I'd say that at 4 months old, all of mine had 4-5 day feeds (depending on where we were on the 4 hour transition), a dream feed, and either no night feeds (dd1), one night feed (dd2), or two night feeds (ds). 

There is some good information here: Slow weight gain in breastfed babies that may help.

[natashalil]

he has a dirty diaper after every feed, and it is wet too, and maybe 1 or 2 additional diapers that are just wet. So i guess by that standard it is ok? Going to go to a lactation consultant in a couple of days, see if there is something wrong with my supply.

[MasynSpencerElliotte]

This is a good read too:
I'm worried I may have low milk supply

[C_mother]

Can you weigh him over the next few weeks? He may have his 4 mth growth spurt a bit late. I think it is actually fairly common to move around the curves a bit, especially if you are only weighing in every couple of months

[*Ali*]

Can you put him to the breast again an hour after his usual feeds to get some more calories in him?
What about doing a DF before you go to bed?

[eva026]

If it makes you feel better, DD was born in the 50th centile and dropped significantly in mo 3-4.
Drs freaked me out too but when I looked things up online it turned out they had not been checking her on the BF charts and she was in fact on the 15th. Even so, she dropped a lot but has since then hovered around the 15th-20th.
I finally stopped worrying. She had plenty of wet nappies, met her milestones and not matter how hard I tried she wouldn't feed more, so I guess she just wasn't hungry.

[lauradj]

HUGS!  This is super stressful and I know from experience. 
My DS was in the 50th percentile for weight at 2 months but had dropped to 5th by 4 months.  The doctor had us come in every two weeks for weigh-ins, which was a nuisance but I understand why.  I was super stressed too and I hopped on here and found that lots of babies go through this.  Even my doctor acknowledged that the growth/weight charts aren't completely accurate because they're meant for all babies, formula fed and EBF which my DS was.  In addition, my DS is a little sting bean. He's 90th percentile for height!
What I did end up doing was giving him one bottle of formula/BM at bedtime and that seemed to give him a boost.  I wrestled with that decision for a solid two weeks before doing it but I'm glad I did.  He's still only in the 25th percentile but because the numbers continue to rise and he's alert, content and happy, the doctor has said he should be just fine. 

[*Ali*]

The WHO charts since 2006 have been based on EBF babies and those are the ones the drs should be using but some probably aren't. These are the current ones. Growth Charts for EBF babies announced by the WHO

I did check your measurements against them though and it looks like your health professional is using the correct charts and your LO is on the 5th centile line.

[clazzat]

My ds fell from the 92nd percentile at birth to the 8th by about 4 months (and fell off the chart completely for height!). I was really lucky in that I had a hv who looked at him and could see that he was happy, thriving, meeting his milestones and so he just kept an eye on us (we had to go in for weighing a bit more frequently) but otherwise left us to get on with it. As pps have said, nappies are the best indicator for whether they are getting enough, and I think that you are able to tell whether he is satisfied with the amount he is eating.

It can be very worrying, but it is very common, and weight is not the only indicator of well-being. Trust your mummy instinct, and if you are happy that he is doing alright then ignore the numbers. Fwiw, my ds climbed back up the charts from about 18 months and is now on about the 70th (although he is still down in the 20s for height!).

[natashalil]

Thanks everyone, I will update you after the appointment tomorrow (Thursday), see what the LC says.

In the meantime I have been trying to add more feeds (like one poster mentioned, putting him back on after an hour), we will see if that works. Today he spit up a bit (maybe 2-3 tablespoons) of breastmilk, which isnt typical for him, but I will keep at it.

I also tried giving him a bottle after I fed him (once with formula, the next time with expressed breastmilk), and he refused both times. Another time I had DH try to give him a bottle to start the feed (I hid in the basement), and he cried and pushed away the bottle. So I REALLY hope that I can get my supply up if that is the problem. DS hasnt had a bottle since maybe 6 weeks old, I was planning on just weaning from breast to cup, now I wish I had given him the occasional bottle so I can get some more into him.

[natashalil]

OK, saw the LC yesterday, she reassured me that he is fine, healthy, just probably a small guy like me and my husband. She advised to put him on the breast a couple more times during the day and try a DF, but other than that nothing to worry about. Will be going back in 3 weeks for a weigh-in.

[eva026]

Great news:)

[*Ali*]

I'm glad she has put your mind at rest.

[shannoncorrin]

I completely know what you are going thru- I just posted almost the same question yesterday!  I started to supplement with formula.  My doctor TOTALLY freaked me out as well.  My LO was8 lbs 2 oz at birth , 11lb 4oz at 2 mo and then only 12lbs 5 oz at 4 mo. 

I thought I was happy with this decision to give formula, but now I'm not so sure.  I just don't want it to affect my supply.  I have been giving him more in his bottle on days that gets bottles.  He is such a hard guy to read.  He's laid back so it's hard for me to tell if he is still hunge or full or what!  I'm having a difficult time with my motherly instinct i guess! 

Anyway,  I just wanted to tell you that I'm right there with you! 

[clazzat]

Glad that the LC put your mind at rest, and I hope you can relax now and not worry.

[natashalil]

ok so now i have increased the number of daytime feeds and introduced solids (on family dr recommendation, since DS is showing interest in food), and he is getting up at night like he hasnt in months!!!  For two nights he woke up at 9:30, 12:30 and 4:30 (bedtime is 7:30), and last night he woke up at 10:30, 12:30, 2, 3, 4,5 ?!??!?!

Does feeding more often in the day make them wake up more often at night looking for food?

[clazzat]

If you are feeding too often during the day he might not be hungry enough to take a full feed and then he will end up hungry sooner which might in turn lead to him waking up at night looking for food. He does seem a bit young for solids - they will not fill him up as effectively as milk, so don't rush it. At this stage I would have thought that just giving him something to hold and suck on for interest is as far as you should go - how much have you given him in the way of solids?

[MasynSpencerElliotte]

What and how much food did you start him on? Tbh showing an interest in food would not be enough to get me to start solids that early - DD3 has been eyeing up our food and drinks for ages but she only learned to sit up and lost her tongue thrust a few weeks ago.

[*Ali*]

It could be that the solids are causing digestive discomfort or they are displacing the milk feeds by filling him up with calorie deficient food which is then meaning he doesn't have room for the more calorie dense milk in his tummy. So he may be waking at night to make up the lost calories.

Unfortunately some doctors do give outdated info on starting solids but it is now known that babies' digestive systems are generally not mature enough to handle solids until around 6mo. Showing interest in food is no reason to give it IMO. Babies who do that early still have immature digestive systems regardless. I imagine he is showing interest in many things like phones and toys to hold and put in his mouth but that doesn't mean he should be allowed to eat them, yk?

The World Health Organisation alongside UNICEF have developed guidelines for introducing solids based on extensive research and they recommend babies wait to start solids until they can sit unaided and hold their head steady, have the hand eye coordination to pick up and put food in their mouths themselves and also to swallow food rather than push it back out with their tongue. All three of these criteria should be met before starting solids and it is rare for them to appear together much before 6mo.
http://www.unicef.org.uk/Documents/Baby_Friendly/Leaflets/3/introducing-solid-foods.pdf

It is also recommended to start with one meal a day and build up gradually to two meals before adding a third meal between 8-9mo.

[natashalil]

I started w rice cereal at breakfast just a few teaspoons not much is actually making it in

[natashalil]

I'm really confused now both the lc and my family Dr said it was OK should I back off? I think they told me it was ok with the hopes it would help his wright gain

[MasynSpencerElliotte]

Not sure where you are in the world but here they definitely do not recommend solids before 6 months and they don't even recommend starting with cereal anymore - meats and meat alternates are supposed to be first foods for iron. Up until one year old bm or formula needs to be the basis of their nutrition - solid food is about new textures/tastes and fun!

[*Ali*]

I would do your own research and make up your own mind rather than just follow what your dr says. So surprised a LC would recommend rice cereal tbh. Do you think it is causing constipation btw?

Can you have a chat with your dr and say you have done the research and are wondering why he is advising you to go against the WHO and UNICEF guidelines?

[natashalil]

OK i have stopped the solids, no solids the past two days, but DS is still waking up every 1-3 hours at night. Some of those wakings he is taking in a good feed, some of those he feeds a little then falls right asleep (but then wakes up when i put him in the crib, then wakes and we need to do pupd).  Last night I got so exhausted that I put him in bed with me around 3-4am I cant remember which.

I really need some help, here was the EASY I was trying to follow, I have been throwing in more feeds willy nilly I need to know where I should put them so as not to disrupt night time sleep!

E - 7am
A - 7:30
S - 9  (usually a short nap, 30-45 min)
A - till next feed
E - 10:30
A - 11
S - 12:30 (this nap can be 1-2 hrs)
a till next E, if nap is short
E -2:00
A - 2:30
S - 4 (catnap, sometimes)
E - 5 (to tank up)
A till bed time routine starts at 6:30 (bath, massage, pjs, feed, then bed at 7:30)

[MasynSpencerElliotte]

Do you think it could be the 4 month growth spurt? DD3 just came through the six month one and fed like a newborn for a couple of days. Your middle A time seems a bit long...if you thinknit is down to routine (the 4 month gs often brings sleep challenges!) it is probably a good idea to start a post in the EASY forum for help!

[*Ali*]

I'd bring that second nap much earlier like 11.00 or 11.30 at the latest. The NWs could be caused by OT.