Author Topic: 4 month old poor weight gain  (Read 5835 times)

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Offline SukieCat

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4 month old poor weight gain
« on: June 21, 2015, 01:54:11 am »
Hey all,

My 4 month old DD is EBF and she is gaining weight very very slowly.  The same thing happened with my older son, and I ended up supplementing him with formula at about this age.  I was really hoping not to do that with DD.  I thought nursing was going really well with her.  She's content between feedings, takes decent naps and sleeps pretty well at night.  Diaper output is good.  Meeting milestones.  She is gaining in length and head circumference.  The only indication that things aren't going well is her poor weight gain, and I'm not sure what to do about it.  I had her assessed and treated for upper lip and posterior tongue tie at 10 weeks.  We saw a LC early on who said latch looked good and she was able to take about 3 oz at a feeding at that time.  She currently eats every 2.5-3 hrs during the day and once or twice overnight.  Here's what her weight has looked like with WHO growth chart percentiles:

Birth 9 lbs = 90%
lowest weight 8.4lb = 82nd%
2w 9lbs = 73rd%
1m  10 lbs = 72nd%
2m 11.2 lbs = 46%
3m + 1w 12.6 lbs = 35%
4m 12.8 lbs = 20%

All same scale (except birth), all nude.  She was an unmedicated VBAC baby, so no IV fluids at birth.  Ped says we can wait and weigh her again in a month, or I could start supplementing her with formula, expressed milk, or solids.  My supply isn't really robust enough to support a lot of pumping to supplement, so it would probably be formula.  I'm just feeling really discouraged and I'm not sure what the best course of action is.  Does anyone have any thoughts, advice, or words of encouragement?  TIA.

Offline SukieCat

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Re: 4 month old poor weight gain
« Reply #1 on: June 24, 2015, 02:45:21 am »
Can anyone help me?  Do y'all think I need to start supplementing? So far I've just been trying to nurse as much as possible, but I think she's just snacking all day long instead of eating bigger meals, and she's probably getting the same amount of food either way.  Plus it's exhausting nursing all the time, not to mention I have my son to take care of too.  Should I be worried that she's gone down so many percentiles?  ???

Offline MasynSpencerElliotte

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Re: 4 month old poor weight gain
« Reply #2 on: June 24, 2015, 04:36:36 am »
Honestly I don't know much about percentiles! I personally would not do solids this early as that will leave her less room for nutrient dense milk (whether breastmilk or formula). Has she hit the 4 month growth spurt yet? Any chance the tongue tie could still be an issue (I have read that they can re adhere, not sure how likely that is). 
Heidi




Offline *Ali*

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Re: 4 month old poor weight gain
« Reply #3 on: June 24, 2015, 21:42:08 pm »
I'd just keep feeding her directly from the breast. Don't worry about snacking. Getting those feeds in is more important, have you tried putting her back on the first breast after she eats the second? Or are you only feeding from one side at each feed? You could also try to pump after she feeds at times when it is convenient like the evening when your son is in bed. Those things should all increase your supply in line with her new demand.

Was she born much after her due date?

I'd also check the tie again in case there was another that was missed or it re-adhered. We're you given exercises to do to prevent that?
Cadan Dec 2009 and Colby Aug 2011


Offline SukieCat

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Re: 4 month old poor weight gain
« Reply #4 on: June 25, 2015, 02:03:20 am »
Thanks for your replies.  I'm not sure if she's hit her 4 month growth spurt, but the past few days she's been getting up 2x per night instead of 1, and she's been napping poorly.  It would be nice if it were a growth spurt but I can't say for sure.

Regarding the ties - our symptoms were pretty minor, mostly her poor weight gain and me feeling like her latch wasn't great even though we'd seen LCs who said it was good.  The dentist we took her to is a highly recommended expert in ULT and PTT, and she confirmed the presence of the ties.  However, I didn't see a lot of improvement directly following the procedure, like some people describe.  It was a laser cut, and we did exercises for 4 weeks post-op, so it seems unlikely that it would re-adhere.  The dentist we took her to is 2 hours away, so that's why I'm a bit hesitant to take her back.  :-\

We feed both sides, unless she falls deeply asleep after the first side.  She's more likely to fall asleep nursing when I try to nurse her more frequently.  I haven't tried switching back to the first breast.  She would hang out at the breast all day if I let her, she's never really "come off" the breast like I sometimes hear people talk about.  So I don't know how much nutrition she's really getting after the first few minutes of vigorous nursing, but I let her stay on 15-20 min per side sometimes.  She never would take a pacifier, so I think she uses me for comfort.

She was born a day before her due date!  I make big babies.  :P

Offline *Ali*

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Re: 4 month old poor weight gain
« Reply #5 on: June 25, 2015, 09:00:32 am »
So do you have other kids who were big at birth? How did they follow the graph? If it is similar to your  littlest DD then it could just be how they are made.

At the end of the feeds does she stop swallowing regularly? That is what I would look for to stop a feed or switch sides. If she is still following a kind of suck, suck, swallow rhythm then I'd let her carry on until that changes.

Have you tried any measures like supplements or foods to increase your supply at all? There are some good ideas here. I'm worried I may have low milk supply

How do you feel about pumping? I've been giving my DD a bottle of expressed milk at bedtime and she takes 6-7oz. I know she wouldn't get that from me at BT as supply is typically lower then. I wait until 10pm to pump as I have filled up enough by then. Even if you didn't get a whole feed (some ladies just don't respond well to pumping even with great supply) you could use it to top her up and increase supply.
Cadan Dec 2009 and Colby Aug 2011


Offline becj86

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Re: 4 month old poor weight gain
« Reply #6 on: June 25, 2015, 09:43:19 am »
When you supplemented DS, did he climb back up the centiles to his birth centile or stay where he was when you started supplementing?

How's her length going along the centiles?

Her weight gain is slower than following the centiles but it looks reasonable at least initially. Does she have reflux? Just wondering as that can affect weight gain and can have LO wanting to hang out at the breast all day for the comfort.

Is she an active kid for her age? I know that's an odd question at 4 months but it can make a difference to weight gain - DS dropped down centiles the month or so before most gross motor milestones because he met them early and once all the other babies were moving too, he moved up the centiles again.

Hugs xx It can be so devastating when LO is not gaining along a centile. 

Offline SukieCat

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Re: 4 month old poor weight gain
« Reply #7 on: June 25, 2015, 15:00:16 pm »
My DS (who is now 3yo) was 10lb 10oz at birth - something like 98%.  He was 10 days late, failed induction turned eCS.  Lots of fluids, lots of difficulty getting BFing established, but his lowest weight was still something like 9.5lb.  He did ok at first but then started falling off the centiles.  At 4m he was 25th% for weight, but long.  His weight-for-length was something like the 0.8 percentile.  (DD is sitting at 3% weight-for-length).  Started supplementing DS with formula at 4m and he right away shot back up to 90th percentile and is still there today for both weight and length.

DD is following the 75th percentile pretty well for length, not dropping centiles there.

She spit up a lot in the beginning, but didn't have any other symptoms that suggested GERD to me (or her doc).  In the last week or so her spit up has gotten a lot better.

I would say she is somewhat active.  In the week before her last check up she'd just learned to roll back to tummy, so she was practicing that every chance she got.  People always comment that she's very alert, and she's very engaged with the world.  I still swaddle her to sleep, but she's started busting out of those pretty regularly - she is strong.  I also find myself frequently saying to her "You're so wiggly today!" So I guess she is active, haha.

I've been eating more oatmeal and drinking the Mother's Milk Tea.  I can't really tell if it's helping.  When I pump at night, I only get about 2oz total, so it would take a few days just to get enough for one bottle.  If I pump during the day I always feel like DD is fussy at the next feed because there's not as much there as she wants.  I've been pumping somewhat regularly before I go to bed at night, but last night DD woke up at about 10 so I had to nurse her instead.

Another couple things I've forgotten to mention - she hasn't pooped in about a week.  Normally she goes 3-4 days, but this time is much longer and I have no idea why.  I know it can be normal for BF babies but it certainly wasn't my experience with DS.  When she does go it's usually an epic explosion.  She has plenty of wet diapers though.  Also, lately (past few days) she's been really trying to adjust her latch to be very shallow.  I have to really put pressure on her back when she eats or she'll purposefully move back on the breast.  It's not so shallow that it hurts, it's just not as deep as she starts out.  Not sure what that is about.  ???

Offline *Ali*

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Re: 4 month old poor weight gain
« Reply #8 on: June 25, 2015, 19:45:58 pm »
Teething?
Cadan Dec 2009 and Colby Aug 2011


Offline SukieCat

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Re: 4 month old poor weight gain
« Reply #9 on: June 25, 2015, 20:38:02 pm »
No visible signs of teething, although I guess it's possible...

Offline becj86

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Re: 4 month old poor weight gain
« Reply #10 on: June 25, 2015, 23:45:57 pm »
Is that shallow latch since you've tried anything new to increase your supply? Sounds like what DS did with over active letdown. Our issue with slow weight gain was down to oversupply, counterintuitive as that seems.

What are her poos like?

I presume you've upped your good fats and protein intake?

Offline SukieCat

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Re: 4 month old poor weight gain
« Reply #11 on: June 26, 2015, 00:45:45 am »
I'd say the shallow latch started around the time I started trying to up my supply, but I just don't feel like I could have oversupply. I feel very empty after feeds and like I mentioned, I don't seem to have extra to pump. I may have overactive let down though. Could I have overactive let down with low supply?

Her poop, when she finally goes, is usually bright orange to brownish yellow with some seedy looking bits.

I could probably do better on the good fats and protein. Any suggestions for good sources of good fats?

Offline becj86

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Re: 4 month old poor weight gain
« Reply #12 on: June 26, 2015, 02:20:14 am »
Yes, OALD and OS are different.

Unless insufficient, your diet actually doesn't have a big effect on the amount of fat in your milk. Have a read here:
http://kellymom.com/nutrition/milk/change-milkfat/
http://kellymom.com/nutrition/mothers-diet/mom-diet/

It seems it comes down to getting out the fat that's there. Odd as it may seem, massaging the breasts near the chest wall can help liberate the fats from the walls of the milk glands/ducts.

Does her tummy gurgle at feeds?

Offline SukieCat

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Re: 4 month old poor weight gain
« Reply #13 on: June 26, 2015, 02:43:06 am »
I haven't noticed any obvious gurgling.  I'll have to pay closer attention.  Is it something I'd notice while she's eating or right after?  Sound or just feel?  What might that mean if it did?

Offline becj86

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Re: 4 month old poor weight gain
« Reply #14 on: June 26, 2015, 08:21:57 am »
For us, it was both during and after eating and it was loud enough to hear. For DS, it was when my milk was just too much for him and there wasn't much requirement to swallow - its just squirted out with some velocity that it must have bounced, yk?

Offline SukieCat

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Re: 4 month old poor weight gain
« Reply #15 on: June 26, 2015, 12:46:51 pm »
Well, DD was up 4 times overnight, which she hasn't done in ages.  4 month sleep regression? growth spurt?  uncomfortable from not pooping for 8 days? teething? something else...?

I felt some gurgling overnight, but it's not loud or anything.  She's always been one to eat vigorously during and shortly after let down, and then kind of give up.  I try breast compression and it kind of helps.  I'm not sure what else I can do to "make" her eat more. She'll hang out on the breast for a long time, but not really eat much.  But I'm afraid to take her off since she has poor weight gain and I don't want to cut her off early in case she is actually eating more.

Is there anything I can do about OALD? I hesitate to take her off during LD bc that's when she takes the bulk of her feed, I think.

Offline *Ali*

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Re: 4 month old poor weight gain
« Reply #16 on: June 26, 2015, 18:45:41 pm »
Cadan Dec 2009 and Colby Aug 2011


Offline clazzat

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Re: 4 month old poor weight gain
« Reply #17 on: June 26, 2015, 18:56:26 pm »
My ds was 90th percentile at birth and down to 8th by about 5 months.  He fed well, met milestones, was bright and alert and happy etc and when I took him to the health visitor I was lucky enough to get a guy who looked at him, said "he looks pretty well to me, don't worry about it" and we carried on as we were.  We had him weighed more often to keep an eye on things, but other than that we didn't change a thing.  He did really well, thrived, and stayed pretty tiny until he was about 18 months when he started to climb back up the charts again.

It sounds to me like your dd is doing fine and in your position I would be waiting another month before jumping to formula (unless you want to supplement).  I think that if she was really not getting enough from you then she would spend all her time at the breast sucking to try to get milk out, but you say that she feeds greedily to start with and then stop - that sounds to me like she is full.  I can totally understand why you don't want to cut short feeds, but if you don't think that she is actually feeding then it is okay to stop her unless you want to give her the comfort.

Offline SukieCat

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Re: 4 month old poor weight gain
« Reply #18 on: June 27, 2015, 03:06:35 am »
She has some of the OS/OALD symptoms, but not all.  Sometimes she'll cough while nursing (not as much recently), but never pull off or clamp down (but she does go shallow).  She used to make a clicking sound when nursing sometimes, but she hasn't done that lately.  She loves comfort nursing.  She spits up some.  I don't know, it's a mixed bag.  That's part of what makes it hard to decide what to try to do to help her!

We are going out of town for a week, then we're going to have another weight check done when we get back.  While we're gone I'm just going to focus on eating healthy, drinking lots of water, and nursing frequently.  I'll check in when I have another data point. :)

Thanks for your replies!

PS - still no poop today.  I think it's day 9...

Offline becj86

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Re: 4 month old poor weight gain
« Reply #19 on: June 27, 2015, 22:46:45 pm »
It might be worth trying to relatch after LD? Then her sucking can be more effective and give her a better chance at getting the hindmilk.

WRT poo - that can be normal thought its getting to the long end of the normal range. Might be worth a tummy massage (gently sweep hands from right hip, around the bottom of her ribs and down to the left hip and/or gently push her legs up into her tummy) to get that moving. 

Offline weaver

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Re: 4 month old poor weight gain
« Reply #20 on: June 28, 2015, 19:37:40 pm »
Just to say if she is small and hitting a GS (hence getting up lots to eat at night), the no poop may be to do with her absorbing everything she's taking in. Mine were both small, I'm a small person, was a tiny baby, it's just the way they were/are.  I would keep feeding lots, make sure to take care of yourself and see how you go. 
*Anne*, loving mama to a honeybee (2010) and a sweetpea (2012).  BF for 4 proud years.


Offline SukieCat

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Re: 4 month old poor weight gain
« Reply #21 on: July 08, 2015, 13:39:06 pm »
We are back from our week out of town.  DD had a weight check two days ago and she's gained a pound since her last weigh-in (which was 2ish weeks ago)!  She's 13.8lb and back up to 30th%.  We have been nursing pretty intensely to try to get more calories in her, and I guess it's working.  She also finally pooped last week on day 10, then she went another 7 days before pooping again.  And somehow they are not epic explosions, just kinda big poops (sorry, TMI). 

We're going to try to keep doing what we're doing but it's kind of challenging now that we're back to the real world, hubby's at work, and no one's around to help me with my toddler while I nurse all day long.  Do you think we need to keep up nursing all the time (we are talking every 1.5-2 hrs during the day), or at some point will my supply be built up and we can go longer stretches?  We're also having the problem that we recently stopped swaddling her for sleeps and she's not napping well at all anymore, so I've been nursing her to sleep a lot.  We've pretty much given up EAS for EAES, which I know is just setting me up for trouble, but that's where we're at.   :-\

Offline *Ali*

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Re: 4 month old poor weight gain
« Reply #22 on: July 09, 2015, 22:15:35 pm »
Glad her weight is increasing. The extra feeds seem to be working so I would try to keep them up as much as you can if she is demanding them. Hopefully as she starts sleeping better as she gets used to sleeping without the swaddle she will need feeding a little less often.
Cadan Dec 2009 and Colby Aug 2011


Offline SukieCat

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Re: 4 month old poor weight gain
« Reply #23 on: July 10, 2015, 13:55:51 pm »
She doesn't demand feeds so much as she never refuses feeds if I offer.  So it's hard for me to tell if she's really hungry or just comfort nursing.  I think she'd nurse all day long if I let her.  She also takes a long time to nurse, and never comes off on her own.  She either falls asleep or I pop her off when I think she's just comfort sucking.  I don't think she's taken a nap longer than 35 min since we stopped swaddling 2 weeks ago.  :-\

Offline *Ali*

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Re: 4 month old poor weight gain
« Reply #24 on: July 10, 2015, 19:46:54 pm »
Could it be a routine issue do you think? Might she need more or less A time?

Feel free to post your EASY if you want us to take a look.
Cadan Dec 2009 and Colby Aug 2011


Offline SukieCat

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Re: 4 month old poor weight gain
« Reply #25 on: July 11, 2015, 01:09:58 am »
I think it's a combination routine and sleep prop addiction problem.  I just started a thread in the Naps forum to try to get advice on our EASY.  Basically we were doing 2 hr A time, now we're trying closer to 2.5 hr A time.  Transferring her from nursing asleep to her crib has been very challenging recently.

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Re: 4 month old poor weight gain
« Reply #26 on: July 11, 2015, 15:18:15 pm »
Why did you wean the swaddling btw? Do you think she still needs it?
Cadan Dec 2009 and Colby Aug 2011


Offline SukieCat

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Re: 4 month old poor weight gain
« Reply #27 on: July 11, 2015, 19:03:11 pm »
I stopped swaddling because she seemed like she was really fighting it and she seemed mad when she'd wake up and couldn't use her hands. I've also read conflicting advice about stopping once they can roll back to belly, and she's been able to do that for awhile now. The first time I tried arms out overnight she did great, so I thought she was ready.

However. I read your question in the middle of an awful morning. I had nursed or rocked her to sleep 4 or 5 times and failed to transfer every. single. time. She was crying, I was crying, we'd been trying for a nap for almost two hours and I thought of your post and decided to try swaddling her. She slept for 3 hours!!! Best decision EVER. Thank you for putting the idea in my head.

 So does that mean she's not ready to give up the swaddle? What about the risk of rolling? Should I just swaddle naps and not over night?

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Re: 4 month old poor weight gain
« Reply #28 on: July 11, 2015, 21:09:35 pm »
Is she rolling in the swaddle? What sort of bed does she sleep in? My DD is swaddled in a Moses basket and cannot roll in it. You are right that if she can roll it is not safe to keep swaddling her. You could try propping her in position with a rolled up towel or sleep positioner if she hasn't ever rolled in the swaddle but they aren't really recommended JIC, yk?

You have to do what you're comfortable with. If you feel better just swaddling for naps when you can watch her then maybe try that. Or did you try swaddling with just one arm out? What do you use to swaddle her? I'm just wondering if you could swaddle her with a hand up by her face so she can suck on it through the swaddle.

I never swaddled DS1 but I kept DS2 in a Woombie until he was 8mo and then he chose to go straight to sleeping on his side in a kind of recovery position almost. I hope to keep DD swaddled until she can comfortably choose her own position. After 6mo the SIDS advice is that you can leave them on their front or side if they roll there by themselves as long as you put them down to sleep on their backs on the first place.
Cadan Dec 2009 and Colby Aug 2011


Offline SukieCat

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Re: 4 month old poor weight gain
« Reply #29 on: July 11, 2015, 22:11:37 pm »
No, she has never rolled in the swaddle.  Even when she is in regular sleep blankets with her arms out, she rarely rolls in her sleep.  She doesn't really like to sleep on her tummy, so I usually hear about it if she ends up that way, haha.  I use the velcro SwaddleMes, although she's sort of in between sizes - small is too small, big is a bit too big.  I've used the big one twice today and she does end up with her hands up by her mouth, sucking on them. She was so happy after her 3 hr nap. She sleeps in a regular crib.

I think I will swaddle her for naps for now, and go back to using the sleep blankets at night.  I have been checking on her frequently when she's swaddled during the day. 

Offline SukieCat

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Re: 4 month old poor weight gain
« Reply #30 on: July 12, 2015, 03:18:03 am »
Had a weird experience tonight.  DD refused to nurse at bedtime, despite being hungry.  I have no idea what was going on, she normally never refuses to nurse.  I tried nursing at bedtime - she would latch, suck a couple of times, then get very sad and just cry.  I'd take her off, try the other side, same thing.   ???  As soon as she was off she'd be sucking her hands or trying to latch onto my arm.  So I gave her a bottle of pumped milk, just 2 oz to see if she was hungry.  She got SO excited when she saw it and gulped it down.  She was mad when it was gone.  Waited a little bit, tried nursing again, same thing as before.  So I gave her another 2.5oz and she gulped all of that down too!  She probably would have taken more but I didn't have any more fresh in the fridge (she doesn't normally eat very many bottles).  I'm so confused by her behavior!  Any idea what it could mean?  I hope it doesn't continue tomorrow.  :(

Offline weaver

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Re: 4 month old poor weight gain
« Reply #31 on: July 12, 2015, 15:44:53 pm »
Sore mouth? Teeth?
*Anne*, loving mama to a honeybee (2010) and a sweetpea (2012).  BF for 4 proud years.


Offline SukieCat

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Re: 4 month old poor weight gain
« Reply #32 on: July 12, 2015, 16:06:32 pm »
I keep feeling her gums but I don't feel any bumps or teeth poking through.  She nursed fine overnight and this morning, so I really have no idea what was going on.  Maybe my milk tasted funny from something I ate?  Or it wasn't coming out fast enough for her? That's all I can think of. I hope it doesn't turn into a trend, I can't usually pump that much milk every day.

Offline *Ali*

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Re: 4 month old poor weight gain
« Reply #33 on: July 12, 2015, 20:15:17 pm »
My DD does that when OT or if she had a cold making in uncomfortable to create the suction used for nursing.

Or is it very hot where you are? My DD is finding it difficult to nurse when we are so hot and sweating on each other.

FX it is better tomorrow.
Cadan Dec 2009 and Colby Aug 2011


Offline SukieCat

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Re: 4 month old poor weight gain
« Reply #34 on: July 13, 2015, 00:44:25 am »
She could very well be OT since naps have been so rough. It is hot, but we mostly nurse indoors in AC, so probably not that. I'm also thinking maybe it was due to gas? She started doing it again this afternoon, and really wiggling her legs, then she'd pass some gas and seem a bit better. So I gave her some gas drops and she was passing lots and lots of gas, and now she is nursing like normal.  Now if only I knew what was making her so gassy.   :-\

Also recently she likes to touch everything and she likes to hold my thumb or shirt while she nurses. Sometimes she kind of kneads the boppy pillow. Anyway, I'm thinking of getting her a breathable lovey blanket so she can hold onto that after I transfer her. Do they make such a thing, and do you think it might help?

Offline becj86

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Re: 4 month old poor weight gain
« Reply #35 on: July 13, 2015, 08:14:35 am »
Just a little square of muslin could do the trick.

Are you still lying back for feeds?

Offline SukieCat

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Re: 4 month old poor weight gain
« Reply #36 on: July 13, 2015, 14:27:38 pm »
We mostly do cross-cradle for feeds.  We have a hard time getting comfortable in any other position - ie, she squirms all over the place.  I think she's used to resting her head on the boppy and expects that now.