Breastfed baby not gaining weight

Gataloca

Gataloca

Registered User
My baby has recently turned 4 months old. We went to his pediatrician and to the MCHC and noticed that he hasn't gained much weight since his last check up. 2 months ago, he was weighting around 5.38 kg. Yesterday his weight was just around 5.8 kg. This mean he dropped from 50 percentile to the bottom 3 percentile in 2 months. His length also has dropped from 97 percentile to 50.

His pediatrician was concerned that maybe he wasn't eating enough. I know that this may not be the case as I have lot of milk.. and by the way, my baby for sure would have let me know if he is still hungry. He said then said then he hopes that the drop is due to his bad case of eczema.

My baby usually eats around every 3 hours, although this last week he has been very fussy and has been eating more frequently (every 2 or even 1 hour)... don't know if the fussiness was related to the eczema or or growth spurt though. Anyway, at the MCHC, the midwife said that a baby his age should not be eating so frequently. She was concerned that when being fed so frequently the baby may eat too much foremilk and not enough hindmilk.

Actually I did have this foremilk/hindmilk imbalance concern months ago, as my baby would sometime chock when feeding, and his poop was sometime slightly green with a strong sour smell (like yogurt). What I did was to express some milk (around 1 once) before feeding, specially in the morning, when my breasts are very full.....

The MCHC said that although the baby can start eating solid, breastfed baby usually doesn't need to be weaned so soon.... but as my baby is not gaining enough weight, I am wondering if it would be a good idea to introduce him some solid?

Also I had some episode of mastitis, blocked ducts, milk blisters in the past, so I have been taking lecithin supplements. I am wondering... if the lecithin makes my milk "thinner", can it also reduce its fat content.... Could my baby been drinking "low fat" milk all this time? could this also be a reason why my baby is not gaining enough weight?
 
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When my baby was about 4.5-5 months old, He started feeding very often, like nearly every hour. I also feel he was getting more foremilk than hindmilk bc he was just drinking enough to be satiated.
I can't remember his weight increases now, but I do remember that he started to fall a bit in the percentiles. He was very quick to gain weight at the beginning but then he started to fall a bit. I got a bit freaked out and as I was Back home visiting at the time, I couldn't take him to the clinic here. So a week before his 5th month, i decided to start feeding him solids. Actually, the amount and the frequency that you feed them is quite small compared to their milk feed, but I do believe it gave him that tiny bit extra.
 
are you totally against introducing formula? I switched for BM to formula for my baby at 4mths - at 6mths now I am starting to introduce a little rice cereal, but it does not replace a bottle yet as she does not reallly like it so much. In my opinion formula is good for the baby too and you should not feel that you must breast feed...when you get stressed / worried, the level of milk will drop so that is not good either. just a thought though! seems to me formula than solids would be easier - especially since you have used the bottle with your baby already so your baby will not have to get used to something new (the spoon when eating solids).
 
The number of feeds a baby has doesn’t matter. Some babies like to have a few large feeds and others like to have lots of smaller feeds. It also doesn’t make much difference with how much fore milk and hind milk the baby gets – if anything a baby who drinks often and keeps the mother’s breasts less full will get more hind milk than a baby that allows the mother’s breasts to get full. It is how full or empty the breast is that determines the amount of fat in the milk not how long the baby has been feeding.

Sometimes, especially when the mother has an oversupply (and it sounds like you have one) the baby can not drink enough milk to empty the breast. One suggestion to help this situation is to put the breasts on a schedule. This means feed the baby whenever he wants to but swap breasts every three (or four) hours.
e.g.
From 6:00 am to 9:00 am feed on the left breast
From 9:00 am to 12:00 noon feed on the right breast
From 12:00 noon to 3:00 pm from on the left breast
From 3:00 pm to 6:00 pm feed on the right breast
Etc.

A baby behaviour that is very common at four months is getting distracted. The baby will start to feed and then something interesting happens and the baby pulls off. If this is happening to your baby try to cut the distractions. A cool, dark room often helps – I remember using St. John’s Cathedral to feed in when my son was this age.

I have just checked on the WHO growth standard charts, http://www.who.int/childgrowth/standards/w_f_a_tables_p_boys/en/index.html
5.8 kgs for a four month old boy is at the 5 percentile. Is your doctor using these charts? They are the latest charts and based on exclusively breastfed babies – the gold standard.

I would be very careful about starting solids if your baby has eczema. Eczema is an allergic reaction. Usually from something the baby is getting directly – are you give any formula? If the baby is exclusively breastfed (nothing but breast milk) then it could be something in your diet. You need to be very careful when giving the baby solids as if he gets a reaction to a food through your milk he will get a much bigger reaction when he eats that food himself.

Usually the allergic reactions are to proteins, the most common being cow’s milk proteins, followed by soybean proteins. Lecithin is a protein supplement – did the eczema begin when you started taking the lecithin?

Taking lecithin will not make your milk low fat. The quality and quantity of your milk remains the same no matter what your diet. Remember that the milk is made from your blood not from the food you eat.

Best wishses,
SARAH
 
Thanks ladies, for your feedback!

Lesliefu, I am not totally against formula. Actually I started combined feeding, but as I soon as I produced enough milk to exclusively BF, I really enjoyed not having to wash/boil bottles/nipples anymore. The reason I wasn't considering switching to formula is because I think that the problem is not I don't have enough milk to feed my baby.... Although formula may be an easy solution to my baby problem: I will not have to deal with foremilk/hindmilk imbalance, I will be able to measure the exact amount of milk my baby will be taking, and I will not have to guess if I may have been eaten something that may have caused the baby eczema.

LLL_Sarah, I just compared against the growth chart that comes Child Health Record notebook. My husband and I got really shocked because we thought that the baby was doing pretty good. We noticed that he was skinny, but thought that he just look like that because he was quite long (when he was 2 months old). I am trying now to express more foremilk before feeding and to follow your suggested block feeding. Before I would switch breast if it has been 2 or 3 hours since the last feed, and would give the same one if the baby seems to want to feed/suck again after just an hour or less... probably he has been drinking too much foremilk, specially because my right breast fill up pretty fast.

About the eczema, the doctor at the MCHC also suggested me to stop eating milk products for 2 weeks to see if the baby condition would improve. I started taking the lecithin supplement 2 months ago, when I got a back case of blocked ducts. By then, my baby already had some ezcema, but not as bad as it is right now... it was just some rashes on his face... now he has rashes all over his body... I am stopping taking the lecithin and stop drinking soy milk also.... hope we will see some improvement soon, on both his weight and his skin.
 
Are you taking any diary products? Milk, Cheese, yogurt, etc.?

As your baby has already had some formula he could have become sensitized to the cow?s milk protein (this actually only takes one formula feed) and thus be more vulnerable to it in the food you eat. This is the most common allergen which is why your doctor has suggested you stop it for two weeks and see if your baby?s condition improves. The second on the list is soy, so this is also a good one to try next.

You may like to look at Dr. Sears Elimination Diet, http://www.askdrsears.com/html/4/t041200.asp

There is an introduction to this diet at Breastfeeding & Infant Milk Protein Allergy, http://www.ehow.com/about_6310109_breastfeeding-infant-milk-protein-allergy.html

I would discourage you from pumping your milk ? this will make any foremilk and hind milk imbalance worse not better. When you express the foremilk off you increase your supply and thus make it take more feeding for the baby to get to the higher fat milk.

A much better technique for getting more hind milk into your son is to do Breast Compression. Dr. Jack Newman explains how to do this on his web site, Breast Compression at http://www.breastfeedingonline.com/15pdf.pdf

He also has video clips which show the Breast Compression technique:

Compression also at http://www.youtube.com/watch?v=e__lgR7mRIg
Compression Two and at http://www.youtube.com/watch?v=-4lnvL2_6V8

I hope your little boy is feeling and feeding better soon,
SARAH
 
Thanks a lot again Sarah! I'll try using compression once the baby slow down so that he will get some more hindmilk. Lately he get distracted easily, so probably that is the reason why he is having frequent short feedings.
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When my baby was 3 month old (he's now 11 month), his body weight dropped to 25 percentile and has been like that ever since (although recently it’s going up a bit). I tried to investigate so many possible reasons for his not-so-great weight gain and talked to lactation consultants, midwives, and pediatrician. I initially thought my baby wasn’t drinking enough, but I knew I had a good milk supply, and he was drinking every 2.5-3 hours. Then I thought maybe I had an over milk supply issue, because he often gagged while being nursed, and also he often had green pooh. I used block nursing techniques LLL recommended. Still not much weight gain and green pooh. Then I thought my baby had an allergy to cow’s milk that I was drinking, so I cut out dairy products for two weeks. Still he was having green pooh and not gaining weight as much as we liked. So, at 5 month we started giving him solids, and from 6 month, he’s been eating solids three times a day. He was exclusively breastfed for the first 6 months and started taking some formula milk after that. It was exhausting to figure out why his weight gain hasn’t been fantastic, but everyone told me that I shouldn’t be worried because my baby obviously looked and was healthy. Besides, even after he started having solids and formula milk (and he eats solids well), his weight increase hasn’t jumped significantly and he remains in lower percentile.

What I want to say is that even if you cannot figure out the possible cause for your baby’s weight performance drop in the development chart, as long as there is some kind of steady weight gain, and your baby looks healthy and happy, you shouldn’t waste your time and energy worrying about weight performance. Some babies are just lean (my husband and I are not really lean people, but somehow our baby is).

Good luck!
 
Hi Gataloca,

my daughter was also breastfed and has eczema (she's now 2.5, and still has it) I personally found that for her (and every baby is different) nothing I ate or didn't eat seemed to help. I eliminated nearly everything I could for a matter of months and there was no improvement. I did find that once her eczema was under control she slept better, which lead to less comfort nursing. I can recommend this site http://www.eczemacenter.org/eczema_center/ as it has some recommendations that differ from much of the "old school" ones you may come across here. (i.e. frequent bathing as opposed to very rare baths, etc.) and is all evidenced based/best practice oriented. I am happy to PM you specifics of what works for us, but those things may or may not work for you. I tried everything I could knowing that eventually something would work.

Also bear in mind that every baby grows at a different rate. he may be about to go through a growth spurt, or he may just be on the smaller side. MY daughter was 3.6kg at birth and now at 2.5 years is only about 11kg or so, but she has grown at her own consistent rate from 2 months onward. My personal advice after this is just to watch your baby. If he's meeting milestones and otherwise happy, I wouldn't worry TOO much about weight, provided he is gaining, even at a slower rate. Obviously talk to you ped or a lactation consultant if you need more info.
 
Thanks ladies!

I was a little bit concerned because my baby started with a good growth. His weight/length drop and his eczema really got me worried, specially since I got lot of pressure coming from my mom. Unluckily my baby was born in the the same month as my brother's baby and one of my cousin's grandson, so my mom got 2 other babies to compare my baby against to. For her, I am not doing a good job, and somehow seems to blame my baby eczema to my 2 cats.... so I am a bad mother for not getting rid of the cats. She sees my baby and would say: "see what you have done to your baby!"

Months ago she has been insisting that I should give formula to my baby... Reason? because my cousin's grandson was getting formula... What she didn't think was that they switched to formula because my cousin's daughter was pumping and her supply has reduced a lot, therefore, she had to introduce formula. My mom has also insinuate that my milk was not good enough, as I don't eat as much as she wanted me to....
 
my mom was also my biggest detractor from Breastfeeding... I tuned her out and paid attention to my baby :) Try your hardest to ignore those that don't matter, pay attention to your doctor, lactation consultant, spouse, and most of all your baby and yourself.
 
Underfed???

I feel such an idiot right now.... I always thought that I had lot of milk, because my baby would fall asleep or pull out from my breast to entertain in some other thing. Most of the time, specially in the morning, he does not empty my breast completely.. that is why I thought I had more milk than what he needs.

Lately I have been using the compression technique that LLL_Sarah suggested, and to my surprise, he drank it all! I even offered him the other breast, and he drank avidly from there for a while!..... have I been starving my baby??? I feel like such a bad mom now....
 
Gataloca... we first time mothers try our best. i think what is important as parents is that we reach out for help when we feel inadequate, we listen, we implement and we solve the problem... nobody can do better. just my two cents...

all the best.
 
Gataloca said:
I feel such an idiot right now.... I always thought that I had lot of milk, because my baby would fall asleep or pull out from my breast to entertain in some other thing. Most of the time, specially in the morning, he does not empty my breast completely.. that is why I thought I had more milk than what he needs.
Click to expand...

you should feel proud for reaching out and seeking opinions that will help make things better going forward. no need to look back on whatever happened.
 
I went through something similar as I struggled to exclusivly breastfeed my baby with a very low supply. He was not gaining and crying a lot. The day I introduced a formula top up he was happier than ever before. Yet I kept up my battle to minimise formula and give only the breast. When I did give him formula I did so through a lactation aid in an attempt to save the breastfeeding. Anyways I share with you the stress of a baby not gaining and the agony of feeling that we are starving our babies.


But now, 2 years down the road I have a tall happy healthy smart toddler who is a great eater and still takes the breast. There is a lot more to breastfeeding than just the milk. You have given a lot of love and should not have caused any long term trouble. Getting a little less for a while could be better than getting too much. He is only 4 months and has time to catch up. Take care of yourself and enjoy the ride that keeps going!
 
Glad to hear that he's taking in more milk. While it can be a blessing to have a baby that's so easily contented, it can be quite confusing when it come to feeding! The health assessments at the MCHC will also help to reassure you as the nurses and doctors there are very vigilant and will let you know if you have anything serious that needs to be addressed.

On your mother, are you able to tell her that she's not being helpful to you or your baby? For one thing, she's not respecting your choices and for another, comparing children (and grandchildren) is very unhealthy not just for her, but is negative to everyone involved. I had regular discussions with our parents on both sides to make sure that they understood how we felt about this as well as any other behavior that we felt was not constructive in the upbringing of our children. When stray comments do pop up from time to time, not necessarily from our parents anymore, but from other adults, we address this comments both to the adults as well as to our children who are within hearing now that they're old enough to understand. Where we can be polite, we will deflect them, but we will be sure to make it abundantly clear to our children that the views are not the views of their parents or anyone else who truly loves them. You might want to tackle this (when you have the energy) earlier rather than later.

On the eczema, we use Cetaphil for bathing and Ecolab aqueous cream to moisturize after every wash. We also wash the children's clothes and bedding in detergent and fabric softener that is specific for children. We like Kodomo, but we get our supply from Singapore: http://www.beautynscent.com.sg/. Another thing that we do use is a bit unusual is bittermelon. We heard it recommended by a confinement lady. Take a small piece, about 1 inch, of the bitterest bittermelon you can find - the small ones used for Indian cooking are PERFECT - and mash with a clean fork or mortar and pestle using a splash of boiling hot water. Allow to cool covered in the refrigerator so that it doesn't evaporate. Then, use a cotton pad to dab onto the rashes. I have absolutely no idea why it works, but it just does, so I thought I should pass the information on. We do keep topic steroids on hand for bad cases, but they have become more rare as we continue being vigilant about addressing any outbreaks as described above early and quickly.

Good luck with everything!
 
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