Weight gain issues

[teresamac]

I saw a similar post to my dilemma that has encouraged me as well, but I have a few more questions.  My 6 month only gained 2 ounces in 2 months and my pediatrician has me paniced.  My daughter has slept through the night and dropped the dream feed around 2 1/2 months.  I tried to get her to at least do the dream feed, but she wouldn't.  Anyway, I feel like I am on operation bulk.  I am pumping after each feed, and getting nothing but a drop.  Should I be concerned?  We gave her extra pumped milk and it took her FOREVER to drink it.  She is on some solids.  She is having wet and dirty diapers.  She is mostly happy and easy going.  They want me to take her for blood tests even though the doctor said she looks perfectly healthy.  Wouldn't a hungry baby be unhappy and waking all the time?  They want me back in the office in two weeks.  They also want me to give her formula.  Any advice or thoughts?  I feel paralyzed.

[Samuel's mum]

Teresa - I'm sorry it feels tough. As you can see from the other post weight gain varies enormously for each child and it's not the only information that should be used to judge whether a baby is healthy.

Can you post your daily schedule with particular emphasis obviously on where you schedule the feeds and how they are scheduled around the solid meals? Are you single or double-sided feeding and how do you finish a side or a feed?

You are doing the right thing by pumping - it's not uncommon to get barely more than a trickle after a feed but you are sending signals to make more milk. You might have more luck pumping after a short gap - like 30 minutes or so.

You might also think about taking a galactalogue like fenugreek/blessed thistle which are available from your health food store. This is a natural way to boost your milk supply.

I think you are right that hungry babies would usually seem more restless (especially directly after a feed) and wake for feeds in the night but it can vary.

When you've posted the schedule we can have another think.

[teresamac]

Our schedule basically goes like this...

E - 7:00/7:30

she gets solids for breakfast when we all eat breakfast about 30 minutes when her feed is finished

A - plays with toys

S - back down between 9/9:30

Wakes about 11:00/11:30

E - 11:00/11:30

She has solids when we have lunch.

A - plays with me and her brother (22 months old)

Goes down around 1:00

S - 1:00/1:30

Wakes at 3:00/3:30

A - I tutor during this time so she has more alone time and her brother is still napping

She takes a quick cat nap around 5:00 if it should be later I might feed her before her nap, but usually solids after cat nap around 5:45

usually outside (weather permitting) from 6:00-7:00

Last nursing at 7:15/7:30  and off to bed.


Now that is normal until all this happened (over the weekend) and now she is waking at 12 and 6:30 and I am wondering if she is really hungry or if I have accidentally taught her that I will come because I have been paniced.

She does bob off and on at at times, but is happy during that time.  Usually at the end of a feed she is trying to suck her fingers, blowing bubbles while still on the breast.

I do double side feeding, and we sometimes switch twice.  She likes one better than the other.

Thank you!!

[RachelC]

That looks like a great routine... she's a great sleeper! 

How much solids are you offering at a sitting?

The waking overnight could be due to a growth spurt (6 months is a very common time frame for one).

[Samuel's mum]

It looks like you are putting bf first in the priority which is important and as Tylersmommy pointed out on the other thread too much emphasis on solids can sometimes lead to weight gain problems.
So I guess I'd just reiterate what Rachel said about quantity of solids?

If you're feeling more anxious she may well have picked up on that vibe and that might account for more wakings. And as Rachel said it's growth spurt time too. Have you felt growth spurts were obvious in the past?

You could think about using some breast compression to make sure that hindmilk is being reached. There's an FAQ to describe the method. I would also suggest staying on the preferred side as long as possible and make sure that is being completely 'finished'. What do you think causes the preference? Does one side have a slower letdown? You could think about trying focused pumping on the less preferred side (although babies are usually pretty determined on this one.)

I'm not sure why formula is the next step for your doctor? Are they saying they suspect your milk supply is insufficient? What is their evidence for that? If they felt that was the case supporting you to increase your supply e.g. through using galactalogues, suggesting a pumping regime, referring to an LC would be a first step.

[malialeanne]

Hi Teresamac,

Not sure I can be of any help, but have you checked the World Health Organization's weight-gain charts for exclusively bf babies? Many pediatricians use charts based on weight gain for ff infants. Many bf babies have weight gain that slows down after 3 months, this is normal but can cause concern when their weights are compared to ff infants. Here is a link to these charts: http://www.who.int/childgrowth/standards/en/

My mother bf all of her children, and we were "slow gainers". My sister was born at 8.5 lbs and weighed 13 lbs at her 9 month appt. Everyone was a bit concerned, but fortunately the ped supported breastfeeding w/o supplements and just kept a close watch on her weight gain. She was happy and healthy and extremely bright (she's now an architect), just a slow grower. My dd seems to be headed this way as well--born at 7 lbs 5 oz and gained 2 lbs her first month, but her weight gain has slowed WAY down.

I have had good luck with fenugreek. You have to take a bunch (I take 9-10 pills spread throughout the day) but it does help along with drinking LOTS of water.

Good luck and congrats on your good sleeper!

Malia

[teresamac]

Thank you for your care and concern.  It is nice to have people who understand and care although I do have a very supportive husband.
I am not ruling out a growth spurt, as I do know that they occur around 6 months.  We have never had one quite like this with the night wakings.  Obviously you feed them, but how do help them sleep or will it just work itself our in a couple of days?  I was unable to bf my son so this is new to me.
I have consulted a lactation consultant, but they have been slow in their response.  As for the formula, they feel that since she isn't gaining weight we must make sure she is getting something in her.  Like I said, they said she looks good minus no weight gain.
As for solids, we do cereal in the morning and maybe some fruit.  She has a cube, maybe a cube and a half, at both lunch and dinner..your basic pears, prunes, sweet potatoes etc.
I feel like they are asking me to do a lot of things at once instead of taking one step at a time.  I am trying to stay relaxed so she won't pick up on my uneasiness, but it is hard when outside factors are trying to create doubt. 
I am very blessed in the sleep department thanks to the baby whisperer's ways.  Thank you again for helping me through this. 

[Samuel's mum]

Growth spurts can mean restlessness generally and disturbed sleep but obviously extra feeding too. They usually only last 2-3 days but occasionally longer.
There are stages to go through before using formula. If they suspect your supply is the issue then formula is an alternative road but not a solution and it might mean the end of breastfeeding if you do already have supply issues. With less stimulation your supply may slip further. I'm not saying supply is your issue but it sounds as though they might be.
Maybe you need a different lactation consultant . You could also think about getting in touch with the la leche league. If you post on their mother-to-mother forums you often get a response from a trained 'leader';
http://forums.llli.org/