Breastfed baby, slow weight gain at 4 months....

I'll start by saying that I'm trying to be more relaxed on the worry front with DD2. I'm inclined to wait a couple more weeks and see what happens and then see a doc if nothing changes, but I'm just wondering what others think or if they've had similar experiences.

History:
DD2 was born at 36 weeks and was just 1.84kg due to IUGR. When she was born her length was on about the 3rd percentile and weight way below the 1st. In the first 3.5 months she stacked it on - she put on 3kg in that time (breast fed only). Understandably, due to her small size, I've been keeping a constant watch on her weight.

Recently:
Just before 4 months DD2 started only taking one side each feed. If I tried the other side she would just pull back and not want to latch and would just smile at me. I didn't worry. I've been feeling really 'full' lately so figured she was probably getting enough from one side only. Last week I weighed her and she'd only put on 150-200g in the prior 2 weeks. I was a bit concerned but figured there would be a big gain this week. Yesterday when I weighed her she'd only put on 20g. Last night she did some massive poos so in actual fact she may have actually lost weight.... I always weigh on an empty stomach just before a feed, so I know the weight is pretty accurate.

The non-worried part of me says that she is in proportion. She is no longer way underweight for her length, she's just below the 10th percentile for height and weight. She's even got a bit of chubb on her legs. The worried part of me wonders why she's suddenly stopped gaining (and possibly started losing). Is it something to do with my milk? My supply? She's not massive so she can't really afford to lose much (if any).

What are your thoughts? Is it likely to be me? Should I wait a few weeks or do something sooner? Should I try some formula feeds (not what I want to do yet but she will always drain a bottle when she was EBM....)

I'd probably have a chat to my MCHN or GP (whoever you're on the same page with) and take a wait and see approach for a few weeks, maybe start popping some blessed thistle and fenugreek to ease your mind about your milk supply a bit and just keep an eye on her weight. Unless of corse you start noticing consistent drops or something. But I definitely wouldn't go from where you are now to formula straight away.

Congrats on the first four months!
It's always good to keep an eye on these things, particularly when you've had a tricky start. It sounds like things have been going pretty well with the feeding and growth? No other issues at all?
How many wet/dirty nappies are you getting? How has she been otherwise? Weight gains are just one thing to watch when tracking your baby's development.
So you think maybe she's gained 200g-ish in the past 3 weeks? Weight gains really do drop off after 3 months for the fully breastfed baby - it's quite different to those on formula, which tend to continue growing at a steadier rate. If she's gaining weight (I can't remember the average at this age, but maybe 50g+) and all the other signs look good, then perhaps you could give it another week or so and see?
Breastfeeding is pretty robust - so long as you feed your baby according to their need, you'll make enough. And the milk you make is always perfect for your baby. If there's something up with your baby that means she's drinking less, then that may affect things and might be worth following up on. With any luck it's a temporary thing.
You always have the option of using formula if you want to and certainly follow up with your health carer if you have concerns.

at about this age weight gains in the average BF baby will start to slow down and taper off - not plateau, but just slow down so the curve on their chart flattens out a little. There is some info on Kellymom that explains this. Maybe try to get some skin to skin time and just try to feed as much as you can. And are you drinking enough water yourself? that makes a big difference to supply too. It's easy to not drink as much when the weather is cooler.

Chody, I have had a similar experience DD basically put on nothing much ( maybe 100-200g in about 3 or 4 weeks) which was picked up at her 4 month check. I have been back for weekly weighs, and last week she put on 120g luckily because I was getting pressure to start her on solids, which I don't really want ot do. The fortnight before she only put on 140g. Between 2 and 4 months she put on 1 kg which is the bottom level of normal. Went from 70%ile to 50th%ile.

My DD is fully BF, and to me she is fine ( great output, meeting milestones, doesn't look skinny at all, she is quite tall, happy baby), but I had a good look at what was happening and a few things stood out as possible problems.
Firstly, she as very distractable, she would pull off and look around every few minutes and it took so long to have a feed I think I often forgot to offer the second side because she was mucking aorund so much. Secondly i went through a few weeks of being obsessed with her day naps which had gone to pot and think I spent too long trying to get her to sleep and a few feeds were delayed or missed here and there.

I made a real effort to make sure she fed both sides and proper feeds, often needing to go into a quiet room. I stayed home for a week and didn't really go anywhere so I could concentrate on feeding .I expressed about 5 times but I got really full boobs like rocks so I stopped doing that. I also had some lactation cookies. I had been adament my supply was ok, but in retrospect I think it was on the border of starting to drop becasue my management wasn't good for some weeks. Now i feel confident again.

When i did research, I discovered there are some BF babies that have weight problems around this time. I am happy to keep plodding on and my MCHN is letting me just keep an eye on it as long as it keeps gaining.
I would just check her every week and make sure she is feeding well when she is feeding. It also wouldn't hurt to do a bit of pumping here and there just to boost your supply? Good luck I was initially stressed but have relaxed about it a lot.

Thanks for the advice everyone. I'll try to respond to as many points as I remember.

1. I am happy with how she is. She seems happy. Several wet nappies a day. A decent size poo every 1-2 days.

2. I honestly think my supply is fine. I'm actually feeling fuller than usual lately (as she will only take one side at a time). The side that she doesn't take generally feels quite firm by the time she does feed from it.

3. I dont think this was asked, but she generally feeds 7-8 times in a 24 hour period. She's slept through the night from 10 weeks, so 6-7 of the feeds are between 7am and 7pm and then she has a bottle of EBM at about 9:30 and doesn't stir til the morning. I think this shows she's having plenty of opportunity to feed.

4. Saffy - your point of being busy and maybe not feeding as much could be true for the past week. DH was home and we were out and about more so there was a day or two that she only had 6-7 feeds a day.

5. Trillion - I'm probably not drinking enough water to be honest, but I really don't feel that my supply is the problem, she just won't take more.....

8. Just so you all know, at just over 4.5 months DD2 is 59cm and 5.42kg.

EDIT - Saffy - what were the weight problems you read about?

i went to a breastfeeding day stay program with DD at a similar age, due to low weight gains. I was encouraged to change sides more often to keep DD interested.

I did have a bit of success with this, but too much and i felt like i was force feeding her and dd began to vomit. i decided i wanted to go back to what we were doing, letting dd decide on feeds. All other signs were fine, it was just slow weight gains that were ?an issue. DD was born at the 75th for weight, but dropped to 10th for weight by 15 months.

i don't think it was ever a supply problem, i think she was just adjusting to her genetic weight over time. DS hasn't been weighed as much but has also dropped from 99th percentile to 50th for weight.

So, i agree that it's worth keeping n eye on, but there may not be any problems, some babies just gain slower than others.

It sounds like everything is perfect and the only thing to be concerned about is a slowing of weight gain. I think as long as she is gaining, happy, sleeping, wet and pooey nappies then it's all part of her regulating to what she needs.

We are all genetically different and our babies have a growth pattern for their particular DNA. It's interesting to watch how two children breast feed, and my dd would only ever take one side, while ds would take two and not spew. They are the same size although two years apart, so ds is going to be massive. Dd on the other hand is very petite, with small hands and feet.

You sound confident and happy with how she is feeding, and it is just the charts and her small size at birth which is overhanging you a bit. I think a wait and see approach sounds best and if she needs another feed, try and squeeze one in say straight after her nap, or double up the feeds before bedtime.

Sounds like you're more or less on track, then :)
If she's taking less milk, then that would explain why you're feeling fuller. You'll probably notice this goes away once you supply adjusts again, or when she starts drinking that milk again. If there's a time of day when she's more inclined to feed, maybe make an effort to offer again, switch sides at those times. Breast compressions can help to get more milk in during a given feed - you're basically expressing straight into their mouths as they're at the breast.
Probably this is just a blip - hope you're feeling relaxed about things again soon!

Ds1 was 9kgs at 5.5mths old. Ds2 had almost dropped of the bottom of the chart at the same age. The paed watched his weight gain and decided there was nothing wrong but that he was just a slow weight gainer. This could be the same with your Dd. If she is happy, sleeping well and her output is good then I'd say she's just one of those kids who gains weight much more slowly. Ask booth yours and your DH's parents of either of you were slow weight gainers. I was a very slow weight gainer as well. Paed said it was constitutional rather than because of anything sinister.

Thanks everyone. Just a little update...

After a few weeks of DD not feeding much my supply seemed to think it was finally time to make less milk. I woke this morning with very soft BBs (they're usually fairly firm in the morning). DD seemed to pick today to suddenly start feeding for longer again....I'm not sure if its because there was less milk or if she was more hungry or a combination. Where she has only been feeding for 7/8 mins at a time (and only accepting one side), today she was feeding for about 20 mins and accepting both sides. She didn't act as if there wasnt enough there, in fact, she was much more calmer and focused on her feeding today. Tonight she even drank about 50ml more of EBM than she usually does..... Maybe the lull is over???

Sounds like she knows what to do :)

Sounds like she knows what she needs!
All 3 of my kids have had slow weight gain. DD was born 3.7kg and dropped down to the 3rd %. Same pattern that DS2 did and he turned out ok, so the MCHN and GP tend to back off a bit when I've got living proof of an older child who did the same thing. I also found that when they started getting their front teeth, they went off the breastfeeds for awhile and my kids got teeth early. I think it will peak and trough with breastfeeding and growth spurts etc. It's good that she's creating more demand again!

Chody I ill pm you a link to some stuff I read about 4months weight problems

Hun, I think she is doing well. I just had little miss weighed today and at 4 months is 59cm and 5.2kg and she started 1.5kg heavier. I was a little worried about her weight but my chn wasn't concerned at all. She said she looks healthy and bright so she's doing fine. It's strange for me after 3 babies that sat on the 90% to now have one on the 10%. Dd2 isn't a big eater so I have always worried about how much she's putting on. But her output is generally good and she's a happy content little thing so maybe I'm just worrying for no reason.