Do you have a baby who isn't gaining weight well or who falls asleep easily at the breast? Is your baby fussy or does he pull off the breast often? Does your baby spend what seems like hours at the breast only to seem hungry five minutes later? Even if you think you have a lot of milk, it may be that your baby is just not able to get what's there. And if he's not getting enough, your supply can falter and his weight gain may slow or stall altogether.
Newborn babies typically nurse eight to twelve times per 24 hours ” or every couple of hours during the day, sometimes with longer stretches at night and sometimes with clusters of more frequent feeds (see BellyBelly’s article on cluster feeding). Typically, it takes about 20 minutes per side for a baby to complete a feeding. Remember, this is just the average and your baby will have his own individual pattern, feeding more or less than this norm. A baby's hunger is much like your own ” sometimes baby just wants a snack, other times he wants a big meal. The most important thing is to watch your baby for hunger cues rather than scheduling feedings by the clock. The best way to know if a baby is getting enough is to count wet and dirty nappies (diapers in the US) ” a minimum of at least 6-8 really wet cloth nappies every day, and 3 or more bowel movements each day.
The other way to know if baby is getting enough is by tracking weight gain. Babies typically regain their birthweight by 10-14 days post birth, and then gain around 170 grams (or 4-8 ounces) per week. Breastfed babies tend to grow rapidly in the first six months, and then more slowly in the second half of the first year of life. When you are tracking weight gain, it can be helpful to use charts specifically designed for breastfed babies (see here). Be sure your baby is being weighed on the same scale every time ” when we're talking grams and ounces, different scales can be hugely off. The scale should also be sensitive enough to detect these small changes.
If your baby's healthcare provider has suggested that your baby is not gaining weight well, don't panic. Weight gain is only one assessment ” you want to look at the whole picture. Is your baby having plenty of wet and dirty nappies? Is he feeding often, day and night? Do you hear swallows as he feeds? Is he active, alert, and meeting developmental milestones? Is he growing in length and head circumference? Is he still on his own growth curve? If your baby seems to be doing well in all these areas, it could be that he is just a slow gainer.
If you are concerned about weight gain, the following tips may get you back on the right path:
#1: Let Baby Set The Pattern
Slow weight gain is often a breastfeeding management issue. Feed your baby as soon as he shows signs of hunger rather than on a schedule, being sure he eats at least every two hours during the day and at least once at night. Allow him to finish the first side before switching sides after a certain number of minutes. Be sure your baby is positioned and latched well, and is actively transferring milk during a feed. Get help from an international board certified lactation consultant (IBCLC) or breastfeeding counsellor if you're not sure.
#2: Try Breast Compressions
Breast compressions keep baby drinking at the breast, and provide extra milk-making stimulation at the same time.
To do breast compressions, get your baby latched and feeding normally. When the milk flow slows and he goes back to the quick sucks, grasp your breast well away from the nipple, squeeze and hold. You should see him start to have longer sucks with swallows as he drinks the milk you are pushing out for him. Hold the squeeze until he pauses. Once he has had a quick rest, move your hand to another location on the breast and repeat. You can continue this pattern throughout the whole feeding session ” when you squeeze and baby doesn't start sucking and swallowing again, then it's time to switch breasts or end the feeding.
Breast compressions are typically used after a mother’s milk has “come-in”, but can also be helpful in the first few days after birth to get more colostrum into baby. Breast compression gets a lot more milk into baby without a lot of added effort. Not only is baby getting more calories, but the breast is being drained more effectively which signals that the body should make more milk. The skin-to-skin contact also helps stimulate milk ejections, which tend to be less effective if supply is low or flow is weak.
#3: Consider Switch Nursing
This is simply switching breasts several times during a feeding rather than just once. When you no longer hear swallows even with compression, switch sides. Keep going back and forth as long as baby is actively getting milk – even if you switch sides two or three times. This keeps baby awake and interested in nursing, and stimulates the breasts to make more milk. It gets more of the fat-rich hindmilk into baby, too, helping with weight gain.
#4: Get Close To Your Baby
Consider infant massage. Research on pre-term babies shows that those who are massaged regularly gain weight better than infants who are not massaged ” and this may be true for full term babies as well as older babies. Consider going about your day with your baby in-arms ” a sling or soft carrier can help. Spend as much time skin-to-skin as possible, which has also been shown to help with weight gain ” probably because baby nurses more often in those instances. Try co-sleeping (safe co-sleeping tips here) ” milk-making hormone levels are higher at night, and being near baby at night will likely increase the number of night nursings.
#5: Supplement wisely
If your baby's healthcare provider recommends supplementation, expressed breastmilk should be the first choice. You might try feeding your baby at the breast, then pumping for 5-10 minutes and giving this expressed milk to your baby right away. Pumping immediately after a feeding will provide a greater proportion of fat for your baby, and increased fat and calories can increase weight gain. You can also avoid bottles altogether by using an at-breast supplementer (such as the Supplemental Nursing System, Lact-Aid, or an improvised version as described here). The advantage of these devices is that they save you time (you're supplementing as you're breastfeeding, rather than after) and they keep baby stimulating the breast (which is important if your supply is marginal).
While you're working on better breastfeeding, milk transfer and weight gain, it can be helpful to meet all of baby's sucking needs with the breast. Any time baby is fussy, offer the breast. Get rid of the pacifier or supplemental bottles (unless medically necessary) so that baby learns to breastfeed well and your milk supply stays solid. If you have concerns about your milk supply, be sure to get help from a trained breastfeeding counsellor or IBCLC. Weight gain issues can be stressful ” especially for breastfeeding mothers who are baby's sole source of nourishment. Go easy on yourself ” you're doing the best for your baby.
Also read: BellyBelly’s Top 10 Breastfeeding Tips.