Appropriate weight gain for a breastfed baby

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.

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.

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!

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 :)

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.

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.

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.

Sounds like she is doing great to me!!! I thought 100gms a week was about normal :dunno: 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 :hooray: you're doing a great job

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

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?

Good on you for doing your research before the paed visit. Being well-informed makes a huge difference. Unfortunately it is a very long, hard road with a premmie - it's not over once they come home like a lot of people think :hug:

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.

Of course there are also some babies who will never put on 150g a week and are still perfectly healthy. Weight as you have mentioned, is only one of a number of signs of sufficient milk and a healthy baby. Plenty of wet nappies is a great sign, and at that age multiple poos a day is an even better sign. Also the good skin and muscle tone etc are all signs that Miss H is doing well.

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. If this might be happening, perhaps feeding (or expressing) more frequently would help, so that you are less full each time. Also if you have plenty of milk you could perhaps discard some of the early milk so that there is more fattier milk. Also expressing/feeding from the same breast a couple of times in a row can help in this situation, while taking care not to get engorged on the other side (you might need to express from the other side for comfort). Another possibility is that Miss H might still have some secondary lactose intolerance from her tummy trauma. At her age that can take a few weeks to go away, but there is no harm in feeding her breastmilk in the meantime, in fact it is recommended that you do. This article - Australian Breastfeeding Association - Lactose intolerance and the breastfed baby - is well worth a read hun. You might even like to print it out for the paed.

All the best with the appointment. Trust your instincts and I'm sure you will do a fantastic job of advocating for your little girl. :hug:

100g a week is great. DD1 only put on about 50-60, she was happy, healthy and developing normally (wasn't prem though). I personally prefer to guage their gain over a period of a months than weeks. Bf babies will gain in spits and spurts, they can even platue at times, then do a huge spurt, as does their feeds.

Her behaviour is more of an indication than her weight gain, if she is mainly contented then she is having what she wants.

Breastmilk contain natural healing properties, so it will help her guts to heal faster. It can take quite some time for the damage to heal and stools to return to normal, I'm talking months not weeks. Having runny and slightly frothy stools can be okay, you didnt mention the colour or smell? If they are green and really really stink, like an acidic foul smell (not that sweetly smell), its an indication of digestion being unbalanced but it can still not be a major issue on its own. We've gone months with DD2's being up and down due to lactose and cows milk protein issues through my bm, the slightest sickness sets it off again, and she have been growing fine. They tried to make an issue of her dropping percentiles, she didn't loose weight just went from 99% to 75%, but IMO there is no way of knowing whether she would have done that anyway.

If I were you, I'd concentrate on the bf's and getting them the main source and let her weight gain be part of who she is. Tell the paed's how you feel and that for now you want to concentrate on her happiness and milestones rather than her gain. As long as she doesn't loose alot, its all good. You've obviously feeling like its okay, so go with your instincts.

95g over 5 days sounds pretty good to me. And like MR says, their gains can be very irregular. She is gaining and other signs sound good!
DS only put on around 90g per week in the first 3 months (on average).
I imagine there are differetn rules and considerations for a premmie, though - argh, extra stress for you!

When DS was little I had to go on antibiotics and it messed with his gut. This resulted in temporary lactose overload - green, frothy poos and discomfort. Our pead suggested expressing off a little of the foremilk before feeds. I did that for a few days and the problem disappeared. So I would second MR's suggestion, just to see how you go.
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.

Anyway, don't throw in the towel just yet. Have you been in touch with the ABA? Maybe they have specific advice for premmie babies?
:hug:

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

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

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.

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? :think:

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!

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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? :think:

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that's a fab idea!