Appropriate weight gain for a breastfed baby

[*Infinity*]

Ok, this is probably going to be a bit long-winded so I apologise for that, but essentially what I would like to know is what is considered acceptable weight gain for a breastfed baby. I'm talking over two days or a week maybe? I've looked at the WHO charts & TBH I can't process it right now, I'm after a more specific figure.

Some background.....DD was born in June at 25 weeks gestation. She has been home with us for 3 weeks now. Corrected age is almost 7 weeks old. During her hospital stay she had gut surgery due to an infection which has now all been sorted. Due to the infection and trauma to her bowels she recommenced feeds on an elemental formula (a formula broken down into the most basic elements for easier digestion - I'll refer to it as EF for brevity). Babies like DD often have trouble breaking down the fats & sugars in breastmilk after gut trauma, hence the EF.

DD came home on 3 breastfeeds a day (with a top-up) and the remainder of feeds all EF. With the help of the outreach nurses and in consultation with the paed's over the next week or so we gradually increased the breastfeeds and reduced the EF and top-ups to test things out for her. Her weight gains were initally very good but then they plateaued. As we currently stand, the paeds are querying whether DD has more of a permanent problem digesting the sugars (lactose) in breastmilk. The two things that point them in this direction are lower weight gains and runny, wet and sometimes frothy poos. Basically, when the EF is part of her feeds, her weight gains are much higher than when she's on breastfeeds & EBM.

I myself am not convinced yet that this is a permanent issue. Here is my reasoning in a few points:

1. She's not LOSING weight on breastfeeds or EBM, its just that her gains are smaller by comparison. From Monday to Friday in this week just passed, she gained 95g. Same scales, naked weigh. So comparing apples with apples. That's almost 20g per day. On discharge from hospital 3 weeks ago she was 2865g and last weigh (on Friday) she was 3295g. So the general trend is up.
2. Her output is great and she examines really well. i.e. she's pink and healthy, alert when awake, demands for feeds, settles & sleeps in between feeds, has very wet nappies and poos about 2-3 times each day.

After her weigh on Friday which the paed said was borderline acceptable, we agreed to test out if it was simply a volume issue i.e. is she taking in enough when b/f? There is an unknown quantity when I b/f her so we wanted to rule out low supply before anything else. So we've been feeding her EBM by bottle over the weekend to know exactly what she's taking in. BTW I was happy to do it to lay it to rest. If her gain is very low and indicates that its not a volume issue, then I think they'll be suggesting its a digestion issue and we'll have to consider moving over to all EF feeds but I'm not ready to go there just yet.

In the meantime, my poor boobies have no idea whether they're on or off and consequently my supply has taken a hammering but I'm holding onto hope that I can negotiate a situation where we can still breastfeed. I'm taking Motilium to help with supply and pumping as often as I can (hard!) so we'll see.

What do you think? I don't want to compromise DD in anyway. We threw out the book on 'normal' when she arrived and her gut issues do make her unique, but I just don't want to give up on b/f yet. We've come so far and worked so hard, and we've still got a long road ahead with attachment & supply issues but I would hate to throw in the towel because of 'borderline' weight gain ITMS?

I want to be prepared for Monday to go into bat with the paeds and suggest that even though her gains are small, they're still ok.

Thanks for reading. Sorry for the ramble?! LOL too much thinking about everything me thinks.

[Kazbah]

There's a book I'm reading at the moment called "Increasing Milk Supply" (riveting stuff!) and they have some charts there, but I'll have to get from the car in the light.

[PollyA]

My DD was born at 41 weeks and is now a very robust 3 year old and 95 grams a week was about the most she ever gained. She never had the "recommended" gain. The most important thing would be to make sure the trend is good. Forget the lines on the chart and just look at DD's line. As long as it finds a steady upward trend and doesn't flatline she should be ok. I think you should see what the paed says because it may they'll be happy with 95g and you won't need to go into bat!
Good luck!

[miss.cinders]

I've never had a premi babe, so I'm honestly not sure if there are any 'rules' you need to follow.

BUT 2 of my kiddies were always below the 'correct' weight for their age. And didn't always gain what they 'should' have by the Drs opinions. I stuck by them being happy, content & well. If they were all three I knew they were okay.

I guess all you can do is listen to your gut [because your gut knows more than anybody else], and take the advice you are given and process it yourself. You are her Mum, and you know her.

I hope your bf journey continues

[feeb]

DS1 was slow to gain weight after inital greater than 10% wg loss.

He was putting on 100 grams a week and they wanted 150 grams, I tryed carying herbs (fenugreek, blessed thistle and Alflafa to increase supply).

He was below 3rd centile for ages by 18 months he was on 25 centile and same at 2 year old he is smaller, DS2 is I am guessing about 2 kg lighter than him!!!!!

Sounds like you are doing a good job keep up the god work.

[helle]

My chn always said 100grams a week gain oO; but she would only ever weight fortnightly as one week could be small and the next could be a massive gain.

[LisaBear]

My ds1 was classified as a "failure to thrive" baby as he was on the 25th percentile and still is. He ways had very small gains but they were GAINS. That's the important thing.

I know nothing about premmies but I'm sure that a gain is still good

as was said above, youre her mum. You know her best. If you thinks she's content and full then I'd go with that.

[thepixie]

Sounds like she is doing great to me!!! I thought 100gms a week was about normal but I'm pretty clueless and I certainly didn't think they would be applying FT rules to a prem of your DD's gestation. Sounds like she is doing very well, I guess the real concern would be if she starts losing or if the stools continue to be unusual over time?
PS you are awesome Infinity you're doing a great job

[Aligater]

I dont know about prmmies but they sound like better gains than my bub so YAY it has just taken 3 months for my 11 month old to gain 1 kg and reach 7 kg and she was born at term

[HotI]

I thought about 100g a week averaged over a month was good, with 150g being better.

Have you compared it with your son's weigh gains at the same corrected age?

[peanutter]

not sure about premmies, but big and a congratulations for how well you're doing with your DD

and a quick bump, in case others can add to the advice given already

[Santosha]

I have no specific advice or knowledge but tend to agree with the general sentiment that a) a gain is a gain, she's not following a rulebook, she hasn't from the start (!) and she sounds well and happy, and b), you know her best.

More so, I just wanted to say... I think you're doing an AMAZING job for your little girl, I think YOU are AMAZING, and am so happy to hear how well your precious girl is doing at home.

[thepixie]

Or if you belong to or join an association for premmies would they be able to give you an idea of what would be a normal weight gain?

[peanutter]

Or if you belong to or join an association for premmies would they be able to give you an idea of what would be a normal weight gain?

that's a fab idea!

[*Infinity*]

Thank you all so much for your responses.

MantaRay, as always you were spot on with everything you've said in your post. Especially in relation to the temporary lactose issues and the article from the ABA. I think its exactly where we're at right now and certainly not going to be permament for DD.

To respond to a few of your points....

Do the doctors you are seeing see many breastfed babies? Bf poos are usually wet and runny. That is very normal for bf babies and another sign that she is getting enough milk. Frothy can be a sign of either too much lactose (ie lots of the early, watery milk) or a temporary issue with processing it. It doesn't necessarily mean any problem at all though. I wonder with all the meds you are taking for supply whether you might be getting very full, which will definitely increase the amount of lactose miss H is getting. This could also reduce her gains a bit as she would be getting less of the high fat milk in this case.

The paeds do see their fair share of bf babies. They keep saying that yellow, mustard, pasty poos are more 'normal' but surely there is a whole spectrum of normal DDs bowel motions are certainly wet & runny and occasionally a bit frothy too and I do think she has some temporary lactose overload going on....firstly as a result of her gut surgery but also because they were asking me to limit the time of bfs i.e. 10 mins each side then offer a top-up (with the aim not to tire her at the breast). But of course it doesn't allow her to finish a feed in her own time and probably only gets foremilk and less of the fatty hind milk. So what I'm doing now is just offering her longer on one each feed with the hope that she gets more hindmilk.

With regard to my supply I know that it dropped off initially when DD came home for a number of reasons:
a) using nipple sheilds
b) changing the feeding program every 2-3 days based on what the paeds wanted us to do hence my boobs getting very confused
c) a couple of days where i was less vigilant about expressing when I should have - but gee whiz, I had to get a bit of rest here and there (tutt tutt I know)

I've managed to build it back up a bit so I'm hopeful it will be ok.

Firstly, 95g in a week is not a bad gain. Usually doctors like babies to put on at least 150g a week, but 100 or so gms a week usually doesn't raise too many concerns. Also gains do vary a lot from week to week which is why in most cases weighing only every 3 - 4 weeks is a better idea. Obviously with premmies more emphasis is put on weekly weights, but it makes it hard to know if 95gms is a typical gain, or a whether it's a small gain week. I can understand them reacting immediately if she's lost in a week, but in this case I would have thought seeing how she goes over another week or two wouldn't hurt.

They've said they actually like to see 150-200g gains over a week holy moly that is a tough expectation. But equally, the outreach nurses do acknowledge that every baby is different and will follow their own trend. I'm confident enough now to go in and advocate for DD because her gains are still really good and everything else is well for her. The outreach team are coming to weigh at home on Monday so I'll be asking them to go to weekly weighs after that. Half the problem has been created by weighing DD every two or three days....no wonder I feel like the pressure is on.

Have you compared it with your son's weigh gains at the same corrected age?

Great point Kate. DS isn't really a good comparison as I switched to artificial milk after bf went horribly wrong when he was around 6 weeks old. BUT, despite that....he is still a tiny little guy - a real lightweight - and he always will be, because that's just him. So really, DD wasn't genetically destined to be a big chubba either though....so they need to take that into consideration as well.

I don't like the express and bottle feed idea - she'll get less that way, I would think, than straight from the breast. But I do understand the rationale for it.

I didn't either Marcellus, but I felt it was worthwhile simply to prove to them that breastmilk if fine for her to tolerate. And after bottling EBM for 3 days she had a really solid gain (over 100g) so the proof was there for the taking. Just part of playing the game really. And really just emphasised that its more of a volume issue than anything. When they're in hospital they set input targets on a mls per kilo calculation....so we needed to aim for about 600ml over 24 hours and it worked. But it kind of flies in the face of babies regulating their own intake. And that is just a compromise I need to make to keep them satistifed now that we're home. But it was a major PITA trying to bottle her, express to keep supply going etc on top of everything else right now. Its not the way I'm planning on doing things long term.

We're back to breastfeeds with EBM top-ups now YAY! I'm still struggling A LOT with very bad pain and attachment issues, I truly hope it starts to improve. The nipple shields are going to be required for some time yet, the pain is just exquisite. I did see a GP (very b/f friendly too BTW) who gave me some nifedipine for the vasospasm issues but I had a really nasty allergic reaction to the drug so it won't be easily solved unfortunately). The other thing is trying to encourage more vigorous feeding at the breast....DD still tires quite easily and rather than feeding she's comfort sucking a lot. Which is lovely, but more milk in would be great LOL! And the key to her gains is going to be efficient feeding....so any suggestions are welcome there.

Phew, that was a big response LOL!

[Jennifer13]

Hi hun, I have no specific advice, as I'm not really familiar with prem bf bubs. I think you've been doing a fantastic job though!

One thing I did read was that lactose intolerance can be a temporary result of an infection or virus in the intestines. It generally clears over a few weeks, from memory. Maybe you could ask your paed if he would be prepared to see how she's going in a few weeks time. I'm not sure how this would work with prems, but it might explain the possible lactose issues?

GL!

[Early Kids]

You are doing such a great job

My boys paediatricians all recommended monthly weigh-ins as it's a bit more accurate than weekly (because they can fluctuate so much). Brendan follows his own curve, has never been 'by the book' and Tristan's chart looks like steps. One month he might only gain 40grams or so but the next he would gain 500gm. It varied so much. Tristan's paed and CHN always looked at the bigger picture, his weight was only a small proportion of their concern.... they looked at development, over-all growth and how happy he was. At 17 months he is *just* on the 3rd %ile.

They were happy with an average of 100 gram weight gain over a week.

I hope that helps x

[black_rose]

Hope it goes well on Monday. It sounds like your they need to back off a bit, changing a feeding pattern is really hard at the best of times let alone every few days. Her weight gain is pretty good for a premmie.

She probably would be having such good gains if the lactose was a big issue. Dd1 was a 34 weeker and we struggled to get her weight to 80 a week, it only improved once she was on solids. It was only at 8 months that I worked out she was lactose intolerant. She would throw up a thick sticky vomit.

Ds was full term but his weight gains for his first three months were barely 60 grams. He was screaming a lot too, through a process of trial and error we have confirmed he is lactose intolerant too. He is putting in about 170 a week know.

My point is your dd sounds like she is doing so well, she has probably got a sensitive gut after all she has been through and just needs a chance to settle into a proper feeding routine.