Weight gain concerns - 4 month old

[Kirsty in Aus]

I visited the child health nurse at our local pharmacy, who I've been seeing since DD was 2 weeks old (and having her weighed there, so it's a consistent set of scales). Last time I saw her was 4 weeks ago, when DD was 13wks. In the past 4 weeks, DD has put on a total of 240gm, maybe grown 1cm longer, and head circumference is 1cm more. Between 10-13 weeks, she put on approx. 200gm/week, grew a few centimetres, can't remember head measurements for that time. I was sure she was growing more in the past few weeks, but it must be because I'm using bigger nappies that her clothes aren't fitting so well anymore!!

Breastfeeding has been a big struggle for us from the start, with horrid pain and nipple thrush until she was about 6 weeks old, extreme fussiness, I've comp fed on occasions (EBM or formula if no EBM) and used a supplementary line for a few weeks in December when her fussiness was crazy. I thought she was settling into a 4-hour routine in the past week and a half, she's not sleeping through (6 feeds a day), and is getting to be fairly fussy during feeds again (pulling on and off, not particularly happy when the feed's over - which is when my breast feels soft and she keeps on pulling off after one or two sucks).  I'm going nuts and feeling guilty about her not gaining enough, and in my heart I don't believe she's a petite baby (3.58kg and 51cm at birth / 7lb14oz) who would only be gaining a small amount. She's now 17 weeks/4 months old, and not even 6kg!! I've been taking prescription medication as well as Blessed Thistle for the past two months to increase my milk supply. Even though she's been on a roughly 4-hour schedule, I still pretty much feed on demand, sometimes there are three hour gaps, and she's hungry, so I'll feed her.
In my head I know not to compare to other babies or trust what other mothers say, but someone saw her at the pharmacy today and thought she was a 4 week old, not a 4 month old!
I'm wondering whether formula might be a better option for her and/or starting on some solids in the very near future (as recommended by the paediatrician when she was 10-12 weeks old).

[deenz]

Hi there,
I wanted to post since you sound so worried, but I am not an 'expert' by any means... I'm sure one of those will step in soon!  Firstly, have you seen the new growth charts put out by WHO (there is a sticky about them at the top of this board I believe).  Those are based on bf babies, and I seem to recall that bf babies do slow their growth down around this time.  I think it's expected for bf babies to double their birthweight by 6m, so it sounds like your dd is on track to do that.  Also, don't base everything on one weight - I'm guessing they were electronic scales, which do get 'stuck' etc at times.  Does your dd have enough wet nappies (not less than before)?  Is she developing as expected?  Sounds like those earlier weight gains were great.  Solids most probably would not do anything to 'improve' weight gain, as those first foods have far less calories than milk.  And they are usually only little 'tastes' to begin with anyway.  There is a lot of good 'new' evidence to hold off on starting solids until 6m (unless special circumstances such as reflux sometimes etc).   Some (a lot?) of bf babies don't make it to a 4hr schedule, and stay at 3hrs.  Although sometimes they need a 'push' to get there so that they take proper feeds at each feed, rather than 'snacking'.  Therefore they get more of the fattier hindmilk when drinking more at each feed. 

Also, it is common for your breasts to stop feeling full now, and that doesn't usually mean you're making less milk etc.

Anyway, just a few thoughts from me.  I'm sure someone else will chime in too, but I wanted to answer since I know the worries of weight 'issues' - both my dd's had times of not putting on weight 'as they should', but my dd2 just naturally is petite and has never gained heaps of weight, and dd1 is just a bit smaller than average (3.4kg at birth).  Both my girls had doubled their birthweight by around 6m or just after.

Sounds like you've done well to get through your starting-out issues. 

[Erin (redstarfalling)]

Denise is completely right - weight gain does tend to slow down about now.
http://www.kellymom.com/babyconcerns/growth/weight-gain-metric.html

Nurses also tend to go by averages and not every baby fits in exactly.  Was it your doctor who put you on the medication for supply or a lactation consultant?  Any change you could see an LC?  They tend to know a bit more about breastfeeding and might be more reassuring to you...

I also agree that starting solids isn't the answer - she's really too young, and she'll get more calories from the breastmilk than she could possibly get from a small amount of solids at this age - and it may well upset her tummy.

If she's otherwise healthy, having lots of wet and dirty diapers and happy when she's awake, then I would try not to worry too much.  She might be going through another growth spurt, and her sleep might also be disrupted by the usual 4 month stuff  - developmental changes and so on.

You've been doing so well - I really hope things settle down soon! HUGS!

[Kirsty in Aus]

I understand that the charts and averages are based on formula fed babies. I'm just really concerned that between 3-4 months (not after 4 months like the Kellysmom site suggests), DD's weight gain has been what it was in a single week between 2-3 months.
I do have an LC that I've seen many times about DD's feeding. She's the one who put me on Blessed Thistle, and although it was the paediatrician who put me on the medication for my milk supply, my LC knows about me being on the meds.
I think the quantity of nappies is OK (and all pooey ones are browny-yellow, not green, so shouldn't be a foremilk imbalance), but feeds are a very distressing time and the time when DD cries the most during the day. There's even crying during the dreamfeed! She is becoming more grizzly during the day, which so far I've been putting down to her teeth moving around, but as I think about it, she was very upset during feeds in December, which is why we started using the supply line - her mood during feeds eventually improved, as did her weight gain. At least at that stage she was sleeping through the night and I had a chance to get some decent expressing done in the middle of the night. I'd find it very difficult with her current schedule.

Even if I look at the revised WHO charts, then she was between the 50th and 85th percentiles at birth, and now she's between the 15th and 50th. I've had friends with babies who've had such small weight gains that they didn't even make the charts, so I know bf babies and small babies who are healthy and happy with small gains, I just don't believe in my heart of hearts she is happy.

In a nutshell, if she was happier during feeds, then I wouldn't be as worried and I'd be happy to write off this month as a "light" month. But her unhappiness and pulling on and off during feeds is really frustrating the both of us, and indicates to me that she's not getting enough

[deenz]

My dd2 was also a very unhappy feeder from around 3wks to around 4m of age.  She was put on medication for reflux, which made some difference, but not a huge amount.  I don't know if it ever was reflux, but boy was it horrible to experience!  In any case, if it was reflux, then I know that formula does not help that. 

When does your dd do the pulling on and off at the feeds?  Is it near the start of the feed (when you let-down)?  Or later?  Maybe if it's later she's trying to tell you she's had enough.  Babies do get very efficient at feeding, and can drink quite an amount in a short time by that age.

How is her sleeping?  Could she be too tired to feed properly?  Is she getting good naps?  DD1 stopped sleeping through the night about 3m, (growth spurt initially) but then ended up having too much milk at night that she was not interested during the day! 

Sometimes babies can feed 'funny' if they're not truely hungry or more tired than hungry, and would be better to carry on sleeping for another hour, and to be well-rested and really hungry and take a good feed.

Both my dd's have not stayed on the percentile line that they were born on, and I have never been told that's a problem (and dd2 has seen plenty of dr's and paediatrician and LC etc).  So I'm not sure that's necessarily a concern.  If your dd is generally following a line that goes up, then that's a good sign, and if she's got enough wet nappies, then that's a good sign too.

Anyway, that's just a few more thoughts for you.  Sounds like you are doing everything you can to keep bf'ing!  Well done!

[daisymelan]

I would like to add that I don't think there is anything wrong with your breast milk that formula would fix. 

Also, a big applause for sticking in there bfing as long as you have.

I just don't believe in my heart of hearts she is happy.

If you really feel this, the I suggest you go to your ped and express your concerns with your doctor.  you know your lo best.

HUGS!

BTW, ignore the age ppl think your lo is.  Someone thought my son was 4 the other day and he's 1.5 years old!  LOL  Ppl just don't know sometimes.

[Kirsty in Aus]

For the past week and half, I've been feeding DD approx. 3 hourly, which is driving me a bit bonkers after that short amount of time on the 4 hourly routine! She's also been waking up before we can get her up for a dream feed (have still been aiming for 11, she'll wake up about 3-4 hours after her dinner), and twice through the night - although I think this is becoming a routine, as for the past three nights, she's woken up at 2:15 and 5:45. I'm going to start trying to move her towards a 4 hour routine, as I know she can handle it, and I'm hoping the extra feeds of the past week + will have increased my supply.
She put on 190 gms this week, but feeds aren't really any happier. I'm getting very cranky and she's just crying so much during the feeds. I don't think it's reflux or anything like that, the crying and fussing is either for too fast or slow flow, waiting for the let down, or being done. With the lack of sleeping for more than 3.5 hours at a time, my patience is worn thin and I don't want to be getting so cranky with DD. I know it's nothing she's doing deliberately, but I'm too tired to be able to rationalise anything!

Thanks for your thoughts and support.

[deenz]

Hi again,
Glad to hear that the weight gain was good, and nothing to worry about, although I know that the crying while feeding is very difficult to deal with.  I used to feed dd2 in all sorts of positions, and the one that worked most frequently was walking around and feeding at the same time (gets a bit sore on the back after a while).  Somehow that feeding while in motion seems to calm a lot of babies.

I think you are right in saying that the night wakings are becoming a routine - I have read a lot on these boards that if they are waking from hunger, then the times will be random, but if waking from habit, then the times will be the same.  Might pay to go and have a look at the sleep boards for ways to work through this.

[daisymelan]

All I can offer is hugs.... 

[Samuel's mum]

You've been given lots of good advice so far so I really wanted to just add more hugs. Also to add I found this checklist really useful when considering why a baby might be crying during feeds:


http://www.kellymom.com/bf/concerns/baby/fussy-while-nursing.html

There are obviously lots of different possibilities but something might click. A common problem around 4 months is a baby getting much more efficient a feeder (and wanting shorter feeds) and a mother becoming anxious that baby isn't feeding for as long and 'encouraging' the baby to feed more. This often combines with the fact the baby is reluctant to 'say goodbye to the world' during a feed. That's why feeding in motion is sometimes popular.

It might also have been that the last week or so was a growth spurt - they can last as long as that in some cases. Hopefully things will begin to settle. I would agree with Deenz in that a very precise waking time is normally thought not to be solely hunger related. Perhaps you could express one bottle for a night feed so you could at least get a block of sleep to try and refresh.

[Kirsty in Aus]

Thank you all for your thoughts and the different ideas. The 2:15 and 5:45am waking routine has been broken, and DD pretty much did it by herself. And last night for the first time since before Christmas, she slept through - from 11pm until 5:15 am! I think I still woke up, but I must've dreamed that she was awake, because she wasn't.
Feeds are still a bit fussy. I think as well as all of the reasons I've listed before, I can't adjust to feeds now only lasting for 10 mins or less - I'm so worried about her getting enough food, I keep on wanting her to stay there. Unless I know there's got to be another let down coming, I'll swap sides (I'm a two-side feeder) or stop the feed.

Thanks again for all the suggestions and hugs 

[Samuel's mum]

Glad you had a good night - hopefully that gives you some reassurance. I know it's hard but please try not to panic about shorter feeds. Some babies can honestly truly get full feeds in not a lot more than 5 minutes - there's such a huge range of normal. My own son rarely fed for anything like 10 minutes and steadily moved from the 2nd percentile to the 75th. I'm not mentioning his weight gain to say 'oooh- aren't -we -fabulous' but to show how irrelevant length of feed is. As I mentioned before fussiness in feeds can often come when a mother feels a feed should last longer and baby is finished.

[daisymelan]

YEAH!!!!!!!!!!!!!!!!


 

[mysterymia]

Kirsty in Aus, I can't comment on changes in weight gain as my LO has always been on a slow weight gain path. She is 8 mths old and still wears 000 (aust sizing) mostly. We are forever protesting that she is fine. Our MCH Nurse is stressing again as she is off the chart still so I am taking her to the paediatrician to get everyone off our back. (we have already seen her when LO was 4 months). I'm sure that she will say that she is okay. Developmentally she is doing fine.

Also, she has been a terrible breastfeeder all the time but on the occasions when she had EBM from a bottle she was just as fussy. She is too busy looking around and getting annoyed with having to stay in one spot!!!

Also I had concerns about the 4 months stage about my supply but persevered and when I was chatting to someone from the Aust B/F Assoc they said that that's a common time that people get concerned and then feel that they have to give up.  Of course it's your choice but I'd say hang in there! 

[fitfamily]

I just met with a LC because I was having feeding probs with my 4mos DS.  She discovered he had a tight frenula (tissue that connects tongue to the bottom of the mouth.  It wasn't bad enough to have in clipped.  But that is something you can check yourself.  It does cause LOs to pull off and on because they can't extend their tongue enough to get a good latch that will draw out the milk.   You will notice your nipple creased and sore when she's finished nursing.  The LC showed me that with your little finger and fleshy pad facing upwards - sweep your finger under the tongue.  You should be able to sweep it without interference.  My DS was having a definite latch problem.  I figured it out.  He does fidget a lot when he's tire and did so during his 4 mo growth spurt because of his silent reflux which peaks at 4mos.  I wouldn't worry about the weight gain.  If she's not crying in between feeds then she isn't hungry.   Hunger is a base need and she would let you know.  I know it's stressful.  I hope it improves for you both