Baby not gaining enough weight? Not “thriving”?

[peanutter]

Ok, so bub was born 25 May 2010 at 4.170kgs, at around the 90th percentile.

He quite quickly dropped down to the 50th percentile for weight, and was staying around there – and the MHCN was pretty clear with us that this is perfectly normal, and nothing to be worried about.

Then he basically stopped putting on weight ... he’d gain 50gm here or there, but nothing like the 150gm or so he should be gaining ...

It’s now been almost 2 months, and he’s only really gained 560 grams in that time ...so he’s sitting at 6920 grams now... so he’s around the 30-35th percentile ...

I’m very stressed!

Bubba is a booby only boy, and is just over 5 months old. He feeds 4 times a day, sometimes with an extra snack in the middle. He has a BIG bf around 6-7am, then a bottle of EBM (200 – 250ml) around 11am, another bottle of EBM (200 – 250ml) around 3pm, and then another bf around 7pm (smaller than the morning feed, because there’s less in there). We give him a top up of 75ml or more after that feed, if he seems like he might be hungry. Sometimes he drinks it, sometimes he doesn’t.

He’s a happy little boy, and while he cries during the day it’s normally because he wants to play, or is tired, and playing with him (or getting him off to sleep) settles him down.
I’m pumping as much as I can (I pump after the morning feed, at 11am, 3pm and 10pm) to cover the two day time feeds. There’s nothing left in the bbs after the 7pm feed to pump.

I’d love to be producing more milk, but we’re tapped out ... I had some very horrible during-and-post-birth issues which caused enormous upset, and surgery, and my milk production just isn’t what it initially was, probably due to the stress and the surgery.

We have some frozen milk stored up which we use when I don’t have quite enough to satisfy him, and so we’re thinking maybe we just need to make the day time feeds bigger.

While I think the 7pm feed is the smallest, I’m pretty happy that it’s enough, because he is an absolute angel, and sleeps from around 7.30pm until 6-7.30am every night. Surely he wouldn’t sleep that wonderfully if he was hungry?

But his day naps aren’t as good, and vary in length from an 1 hour to 2.5 hours. So maybe he could use some more milk?

We have some frozen EBM so we can do this – it’s a short term solution of course, because if I can’t increase my supply (which I haven’t been able to do over the past several weeks since the operation) the milk we’ve stored will run out, and we will have to supplement another way.

Or should we start him on solids? Or formula top ups?

I’m a bit confused, because the MHCN said that he’s fine ... but he’s not putting on weight! And she said that maybe we should give him some pureed food, after his evening meal.

But the leaflet they gave us says that introducing solids won’t increase weight gain ... what?

Can anyone please shed some light? Particularly as to whether bubba’s weight gain is ok, and if it isn’t, whether we’d be better to:-

1. Increase the amount of EBM?

2. Change his routine to accommodate an extra feed of EBM?

3. Get him up for a dreamfeed overnight (which might wake him up at his age, but might not...?)

4. Start him on solids? And if so, when? And after which feeds?

5. Stick to what we’re doing at the moment, and hope that he either gains more weight, or maybe he’s just going to be smaller than he initially was?

Our plan was to exclusively breastfeed for 6 months, and then introduce solids, in an “infant lead solids” style, and give him 2 months to explore food before pushing them (because in 2 months he hopefully would have started eating himself!) with a view to him eating something at least 3 times a day by 12 months old.

When my milk started dropping off, we’ve just been expressing as much as we can, trying to get some stored and trying to stimulate more milk ... and we’ve been trying to get used to the fact that my plan of exclusive bf might not work out, and we might have to supplement with formula ... while I would be disappointed in getting so close, and not being able to stay the course, I know that the most important thing by far is to ensure that bub gets enough food, and even if we’re not sure, I want to err on the side of caution, because I don’t even want there to be a risk that he’s not happy with a full tummy and enough protein and nutrients and everything he needs to grow up big and strong.

Quick caveat:

Regarding me being disappointed if I can’t exclusively bf for bubba’s first 6 months, it’s not anything about my adequacy as a mother – I would be just as much of a mother if I’d fed him formula from birth. It’s just that SO MANY THINGS have gone wrong with the birth and post-birth with my body, that breastfeeding is sort of the last thread, and if that also is ruined by the birth and post-birth issues, I will be very upset.

Not defeated, but extremely upset.

But as I’ve said above, Joshua’s health and happiness is the first priority.

[PollyA]

My dd was just like this. 4kg at birth and eventually cruised between 10th and 30th centiles, I knew she was fine, a hungry baby doesn't sleep that well unless they're starving then they don't have alert times. She was weeing pooing and developing fine but the percentile chart disagreed. I went to a paediatrician who said there is nothing wrong due to all of the above. The charts are only a guide and they are flawed. They ate based on formula fed bubs in the 70's.
Solids now would be fine if that's what you feel you want to do. See how he goes but honestly, don't stress too much.
Dd was tiny in mothers group. By 18 months she was the same size as all the budda babies. They just find their own way.
I would recommend NOT waking your peaceful sleeping bub for your good and his. I tried that too. Made our nights stressful as she wasn't interested.
I think your boy sounds happy and healthy and you need to get yourself recovered too.
Hugs
I wouldn't wish the stress about weight gain on my worst enemy. Dd never gained triple figures... Ever! And it was unnecessary stress. She is an average sized dancing, climbing , laughing BEAUTIFUL 3 year old now.

[Olive]

its completely normal for bubs weight gain to plateau around this age, no need for solids, keep doing what you are! as long as hes not losing weight!

[onthefly]

Your baby is still gaining some weight - good.
Your nurse is not worried - good.
Your baby is happy and active - good.
Mummy is stressed - not good....
My DS was 4.3kg at birth and quickly dropped down the charts. He's still a lightweight but has been pretty steady at 40th-odd percentile for height. Have you looked at the WHO charts for a comparison - he might look better on those ones.

Are you bf as well as expressing? Are you working...? (sorry I get everyone's stories mixed up)
Teh best thing for supply is more feeding - so if you can get extra feeds in that would work best. Solids won't help with weight gains generally because they displace milk (best source fo nutrition at this age) and are generally fruit/veg etc at this point and so low calorie.

I don't think the day naps are any indication of low supply - they can be utter crap sleepers with plenty of milk in them.

The best indication of supply, besides weight gains, is output - how many wet & dirty nappies? (at this age maybe not so many dirty ones, but still getting lots of wet ones?)

I think you're doing very well and your DS is thriving on your milk - he's just not a big boy.

[peanutter]

thanks, ladies.

marcellus - I breastfeed at the first morning and last evening feeds. He has a HUGE booby first thing in the morning - I feed him until he gluts out, and then express more if I can. The couple of mornings I haven't been able to bf (because I have to leave too early to wake him) I normally pump 200-300ml, and he can drink better than I can pump! sometimes he feeds so much I can't even pump anything! he's drunk it all!

and I work full time, and DH is a SAHD (best in the tri-state area!) so more feeds during the day would be tricky ... I'm out of the house from around 6.45am until 6.30pm and he sleeps from around 7.30pm til 6-7am

weekends, I feed as much as he likes, but it's usually pretty on par with his weekday routine.

he wets about 7 nappies per day, and does a poo every other day usually.

thanks so much for the replies! am trying to calm down ... spot the first time mother ...

[Doodlebug]

I really don't have anything to add but big hugs to you hun! You're an AWESOME mother!!!!

[HotI]

I would think (hope someone more knowledgeable can confirm or deny this) that just 4 feeds in 24 hours would be a bit low for a 5 month old bub.

My baby was the other end of the scale but was still feeding around 10 times a day at that age.

On the weekend can you put bub to the breast more often? Even if he only has a small drink in the middle of the 4 hourly usual feeds, every bit will help. Could your DH similarly offer a smaller feed between feeds or do 3 feeds during the day of slightly smaller bottles instead of 2.

I am so inspired by full time working Mums who breastfeed. Just want you to know that.

[black_rose]

Its tough, but if he looks healthy then he is probably ok. If he us unsettled during the day then you could try another feed. I have been down this path twice now and it's not easy
. Ds only put in 200g over his birth weight at 8 weeks, it turns out he has acid reflux, by giving him Zantac and offering one bottle if ebm and 120 of formula he has managed 260 in a week!

I hope you can find a solution.

[peanutter]

thanks ladies! I really appreciate you all coming on and giving me advice and ideas.

kate07 - thanks so much!! it's not easy, but I get a lot of support from my DH ... I'd like to scream "it can be done!!" from the rooftops, but just as I've had *heaps* of issues with my birth etc, I know some mums have just as negative experiences with breastfeeding, and they no more chose to be unable to bf than I chose to have internal damage, pain, embarassment and surgery ... but it's so nice to hear positive comments from other mothers! there's unfortunately a lot of haters out there ...

and doodlebug - you rock thanks for your support

[onthefly]

4 feeds is low, but 7 wet nappies sounds pretty good. If you can fit in any extra, then all the better. Could you, for eg, feed him at 6:30 when you get home, then again at 7:30?

I'd say keep an eye on things and give yourself a pat on the back for your hard work (and DH too!)
And remember the ABA helpline is always there if you get stressed again.

[peanutter]

thanks, marcellus - I get home between 6.30 and 7.30, but maybe I can try doing a feed, then bathing, and then another feed before bed...?

instead of bath, boob, book, bed ...

but would my boobies get more milk in that hour?

[onthefly]

If you feed you make more milk - you don't need to wait for them to fill up or anythign like that.

[PollyA]

Just wanted to reiterate that you are doing a great job.
Sounds like bub is healthy and getting huge feeds too which might explain why he doesn't need as many... Breathe... Look after yourself too. From my experience of working full time, feeding. Surgery which smashed my supply at 5 months, bringing a feed forward in the evening will be hard for you! I used to feed the first thing as I walked through the door, then bath my two gorgeous babies, bed time routine and then I'd realize I really needed a glass of water and had been busting for the loo for the last couple of hours.
I think you should do whatever works for you bur quite honestly it doesn't sound like you need to DO anything except give yourself a pat on the back. You are inspirational. Down the track you'd be a great to help to others who have surgery etc. Hugs and congratulations for being an awesome mum!

[YoYo]

Peanutter.....We're here backing you. You're doing the best job ever x

[HotI]

but would my boobies get more milk in that hour?

I sometimes feed right side, then left side, then right again. The right makes more milk whilst bub is feeding from the left.

[peanutter]

Thanks ladies for the support

Over this weekend, I have a lot on but will be with or near DS pretty much the whole time, so I'm going to have a hawk eye on his cues, to see whether he's getting hungry much before his feeds, or whether he's just a little light.

He's very, very active - whenever we're having cuddles, he pushes himself up to look at you, play with your face, shove his fingers up his nose, etc, or he wants to stand, etc etc etc.

He's still around 50th percentile for length and head circumference ... so maybe he's just lean because he's so active, perhaps ...?

DH tried to get a sneaky feed in between feeds yesterday, and DS just wasn't interested, and cracked it ... but for his 3pm DH gave him 280, and he drank it all - so maybe just after a boob, we'll offer a top up bottle of EBM and see how that goes, as DS didn'just wasn't interested in the extra bottle between feeds.

I just need to stop freaking myself out about long term neurological and developmental damage which could be sustained by DS if he's not getting enough to eat ... the logical part of me keeps trying to say that he eats, he plays, he sleeps, he smiles, he cries, he wees, he poos, he perks, and he's generally a good, happy baby. And that if he wasn't getting enough to eat (to the extent that he's at risk) he would not behave the way that he does.

But then the head gets cloudy, and suddenly I'm the worst mother in the world because he's not growing as much as I'd like, and so clearly it's my fault blah blah blah ...

I think a weekend of close contact, careful attention and offering a feed whenever he seems at all hungry (making sure that he's feeding long enough to get to the hind milk, of course, at least the 4 times a day he normally feeds) might be the way to go, to see whether he can drink anymore.

'Cause maybe he's completely satisfied, and he's just drinking more than we realise at 7am and 7pm boobie o'clock.

[YoYo]

One thing I have to ask Peanutter - What is your and your DH's stature? Are you tall....? Long and Lean? Short and chunky? You've got to rememeber that genes will also play a part in how Josh grows.

As it is with my two, they are basically on par with eachother at the same age when it comes to length and head circumference, BUT DS was about 1.5kg heavier than DD and I just put it down to different genes. They have been fed the exact same way, yet they are so different from eachother. I can only put it down to the sad fact that DS took after me (shorter and stockier!) and DD took after DH....tall and slim.

They are both happy, healthy, eat, sleep and poop and I'm doing the best I can. You aren't doing a single thing wrong....you are doing the best you can.

[onthefly]

He really sounds just fine!
I hope you can relax with a bit of time.