Newborn Not Gaining Weight

Swoon

Swoon

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I just had a new baby 1.5 months ago and now, after 6 weeks, she still hasn't gained back her birthweight yet. She was 3.8kg at birth and is now still only 3.6. The doctor said she should technically be 4.7! I'm quite concerned and have started supplementing with
formula although I really didn't want to do it, but I think I have no choice anymore. I don't think I have enough milk production. So, I will breastfeed and then top-up with formula afterwards (4 ounces). She will finish the entire 4 ounces after I breastfeed her. The doctor wants me to get her weight up and strongly advises that it's time to get the formula in now. When I was solely breastfeeding, she had about 6 soiled nappies everyday so I thought that she must be taking in something if something is coming out.

I've gone to both the government clinic and also to a pediatrician.
They have told me conflicting things so I am confused. The pediatrician, who saw baby at birth in the hospital, said that because she was quite big at birth, she has alot of 'reserves' and I don't need to worry, I can continue solely breastfeeding as long as she gets up to 4.2 at 2 months. The doctor at the govt. clinic, on the other hand, is much more worried and said to 'top up' with formula after each feeding. Since 4 days ago, I started the formula.

Currently, she sleeps alot and the govt. clinic doctor says it's because she has so little energy since she is so hungry all the time. I didn't realize this and now I feel pretty bad. I thought new babies were supposed to sleep alot. Also, she cries most of the time when she is not sleeping or feeding. Usually, we will put her down on the sofa or bed or crib and she starts crying after a minute or
two. So, we constantly need to pick her up and carry her. If we do that, she usually stops crying right away. The govt. doctor said she cries alot because she is not content and is hungry. But, if she is hungry, why does she stop when we hold her? I think it's because she wants to be held.

I am feeling quite bad about this entire situation and am not sure what to do at this point. I will keep giving formula top-ups but I really wanted to breastfeed only. I have not started pumping yet and am not sure when I should do it--ie. during a feed? before? after? how many times? The other problem is that when I feed her, she will suckle actively for about 4-5 minutes only and then usually
dozes off and no matter how I try to wake her, she will wake for a minute, suckle, and then doze off again. I do think she must be very low on energy but I'm just not sure.

Has anyone had similar type of experience? And if so, could you share with me how you dealt with it?
 
hi bzee, i understand that you're confused about your doctors' statements. i tend to think that doctors can't know exactly what's going on with your baby. and of course i can't either, but:
you say that she has 6 wet diapers every day. i am certain that, if she has this amount of soiled diapers daily, she's getting enough nutrition.
you also say that she sleeps a lot and the doc said that's because she has little energy. this is possible in certain cases, but could you specify how many hrs she sleeps per day? i think, at this stage, it should be normal to sleep a lot!
my baby used to cry in the first 2 months AS SOON AS i put her down, i couldn't even leave her for a minute or two. i'm sure she needed mommy very much, as she was so small.
i did top up with formula in the first 2 months, but i regret now, as i realised it wouldn't have been necessary. as soon as i realised (thanks to sarah, LLL) that when bfeeding babies, it's not about the amount of milk, but about its composition (unlike formula), i stopped and it has worked well! my baby is nearly 9 months now and reaching almost 10kg (3.3kg when she was born). the more i breastfed, the more i pumped, the more my milk became. if you're in doubt that you don't have enough, just pump systematically 1-2 a day minimum - or find out what works for you. at times, i pumped after each feed, to make sure breasts were empty, so they could produce more new milk.
also, don't forget that babies usually always take the bottle no matter what, but they stop suckling at the breast when they're full or tired.
one last thing: the govt. proclaims that bfeeding is best. contrary to this, however, the nurses - and maybe docs, i don't know from own experience -do offer and sometimes pressure to top up with formula. when my baby had neonatal jaundice and had to stay in the clinic, i went there 3-4 times a day to bfeed her. almost every time, they 'advised' me to top up with formula. i simply don't understand this until today (maybe they just wanted her to recover quickly so they could release her), but it's your child and you're the mommy. don't let them intimidate you when you want to give the best nutrition to your child - your own milk.
good luck, have patience and you will do the right thing!
 
Hi Bzee

I am sorry that you feel so stressed out about this, I completely understand.
Altough my baby did get back to birthweight fast, he did stop gaining at around 2 month.
At that point I didn't top up because he was already heavy at birth and not too skinny plus he had a lot of energy and seemed perfectly happy and well.
But now that I look back on it, I wonder if I should have topped up at that point, because as soon as I stoped breastfeeding at 6 month he gained a lot of weight and finally looked like a baby should. It seems that I had a lot of milk (also always pumped very much), but I guess my milk quality just wasn't good enough, altough I def made an effort to eat very well.

Reading that your baby seems kind of low energy, I think is not such a good sign.
I would suggest to pump as often as you can. Either pump them after feeding or pump the other that you weren't giving.
And if you have to, just top up with formula, it's not the end of the world. I understand that you really don't want to give formula, I was the same. But it's about your baby and if the baby doesn't get enough as it is you have to provide it somehow.
Formula is not the devil. Plus you could stop as soon as you think the weight is normal again.

I am sure it will all work out well.
All the best.
SE
 
There is often alot of pressure from doctors to change to formula, because they can measure what is happening.

There are a myriad of reasons why breast is best. My third child also didn't gain weight very well. My so called breastfeeding friendly paediatrician told me to change to formula-her argument was that my milk wasn't as good because this was my third child-absolute rubbish, that would mean all third children all over the world would be smaller.

After alot of medical investigation it turned out my son has a genetic disorder. Now before I go on- I'm not saying that your child has anything wrong with them, what I am saying is surround yourself with medical professionals who will support you, not undermine you. Also I would throughly recommend you contact La Leche League-they are more expert on breastfeeding than any doctor I have ever met!

Doctors are meant to aim to do no harm. If I had followed my paediatrician's advice it would have been catastrophic for his condition. Needless to say he is now 21 months and is still taking milk from his Mummy.

Good luck, you will find the support you need.
 
Bzee, I hope you get some insight from all of these great posts. I would like to add my bit too. I am very pro breastfeeding and believe that it is the best thing for a child. That being said, after my first child was born, a horrible realization came to light... I did not produce enough milk. I have heard time and time again that just keep going, your body will produce enough. I tried for over 2 months, I went to all kind of breastfeeding clinics and to the LaLeche Team. My latch was good, everything seemed fine. I feed frequently and pumped as much as I could. I just didnt' have it. Finally at about 8 weeks, my son was so thin, I started topping him up. The fact that he would take 4-6 oz after nursing was a real eye opener. He gained weight quickly and became a much happier baby. By three months I was feeding him just formula.

That being said, I did not give up and did the same with my second. She was a little easier and instead of topping her up with a bottle I used the SNS system where you insert a feeding tube (other end is in a bottle of formula/syringe) into the babes mouth when they are nursing so you get the sucking action to make more milk, they get both milk and formula. I did last to almost 6 months with my daughter but she always needed to be topped off.

It took me a long time to get over the guilt of not being able to give my kids entirely breastmilk but seeing them grow and get the nutrition they needed was the most important thing.

I truly hope you get eveything sorted out. Remembering the pain of it all brings tears to my eyes. Best of Luck
 
listen... breast is best, when it is best for everyone. if you have already been breastfeeding for 2 months, congratulations! your baby has had a wonderful start to his life! now, if you are concerned about weight, then it is up to you to decide what is best for all of you.

my first was 50-50 bottle/breast. i always topped him up. he was only 2.5kg at birth(2 percentile) and it took him a LONG time to catch up with those babies that were born bigger. it wasn't until he was 1 year old that he hit the 50 percentile.

now...my daughter was 100% breastfed. she was 4 weeks early and weighed in at 2.47kgs. she was an eating machine (and still is) she hit the 50% by 8 weeks! by 12 months, she hit the 95%!

what i'm trying to say is that every baby is different. if you feel more comfortable topping up, just to make sure he's had enough, then do it! you are still giving the breast, so he is still getting all the natural good-stuff, but you will feel more at ease because you will KNOW that he's had enough and is not hungry.

don't worry, you are NOT harming your child by deciding to top up. don't we have enough worries in this life that this is just another unnecessary one?

every mother does the best she can at the time. you are no different than the rest of us that muddle through this wonderfully fulfilling but sometimes terribly worrisome (did i spell that right?) thing called motherhood!

welcome to the club!
 
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Thank you everyone for sharing your experiences and feedback. I already feel better getting your support.

Kerry - how did you come to realize that you didn't produce enough milk? I also have this strong feeling but am not sure. Was it from pumping and then seeing the quanitity afterwards? With my first child, I used to pump for 45 minutes and only 1 ounce resulted. But I heard that the amount that you pump does not reflect the same amount as the baby might get from breastfeeding directly. My baby right now will also finish 4 ounces of formula right after I breastfeed her which adds to my suspicions that I haven't produced enough milk for her.

I think I will try to persist though with both breastfeeding and formula together. But will start pumping as much as possible. I guess I haven't started it yet because I dread seeing the amount that comes out which I suspect will be very little or next to nothing. So, I've procrastinated this long.
 
Hi Bzee,
I had a similar experience as you with regards to my baby. See my comments below:

>>So, we constantly need to pick her up and carry her. If we do that, she usually stops crying right away. The govt. doctor said she cries alot because she is not content and is hungry. But, if she is hungry, why does she stop when we hold her? I think it's because she wants to be held.

My bub cried all the time in the first couple of weeks. She lost more than 15% of her birth weight and is obviously "not thriving." She would cry and then, sleep after I put her on the breast for a few minutes. She slept a lot too and she stopped crying when I hold her. Sometimes, she would cry when I put her on the breast (on hindsight, I think it's because she was frustrated) It's only when we found that she lost so much weight that we knew she was not thriving. She had 6-7 wet diapers a day as well. She was diagnosed as a reluctant/inefficient nurser. I spent tonnes on lactation consultants and even went to the free government breastfeeding clinics to get advice on breastfeeding up until she was about 4 months old (she was back to her birth weight at around 4 weeks old).

>>I have not started pumping yet and am not sure when I should do it--ie. during a feed? before? after? how many times?

I started by pumping after each feed. I pumped just one breast at first (for each feed) but after a while, it started to get too much (I felt like I was pumping ALL the time). So, I pumped both breast about 5 times a day. Once I got quite a lot of milk (25 oz or more), I pumped 4 times a day. I found that I still got the same amount as pumping 5 times a day. For me, if I wanted to increase my milk supply, I'd pump more times. Every three hours or so. I still tried to put the bub on my breast at each feeding (with her kicking and screaming) before I give her the expressed milk. I kept at it until she was 6.5 months old when I finally stopped (more like surrendered) and gave her formula a month ago! I had enough of pumping. (Imagine waking up at 6AM each morning in an uncharacteristically cold winter to pump. Brr!)

>>The other problem is that when I feed her, she will suckle actively for about 4-5 minutes only and then usually dozes off and no matter how I try to wake her, she will wake for a minute, suckle, and then doze off again. I do think she must be very low on energy but I'm just not sure.

My bub did that as well. I am still not completely sure why that was the case but maybe she was just too tired, being hungry all the time. She had this cry which was sooo heart-wrenching and she never cried like that again after she started gaining weight. On hindsight, she must be very, very hungry but I didn't know that at that time! I thought she was just being a difficult nurser and kept trying different positions and every advice on breastfeeding under the sun!

Even now, I feel a chest-tightening pang each time I see a picture of a baby being breastfed. I couldn't do it with mine no matter how hard I tried. Did I feel like a failure? Yes. Did I do everything I can to help her? Sure I did. I have no qualms about that.

If all else fails, I agree with kerry and sarahesther; no matter what, we need to arrest the problem first.

Best of luck!
 
Dear Bzee,

It is true that babies are born with a fat reserve to see them through the first few days but this reserve doesn?t last two months. All babies loose weight in the first days of life. We are looking for about a 7% lost before the milk supply starts to increase and the baby gains weight. We are also looking for the baby to have regained its birth weight around the third week of life.

When talking about weight gain it is important to work everything out from the lowest weight of the baby and not the birth weight. As if the baby lost more than we expect it will of course take longer for the baby to regain it.

So after your milk starts to increase (usually between the 3rd and 5th day after birth) from the lowest weight we are expecting a gain of at least 20 grams a day, or an average of 170 grams per week.

It sounds from the details you?ve given that your baby has stopped loosing weight and started to gain weight but not managed to gain the amounts we are looking for. This means that your baby is getting enough to maintain his weight but not increase it much.

In these cases the baby is often sleepy because he is trying to use little energy and sleeping is the best way to do this. So we need to give the baby more milk so that he has the energy to drink more.

If you want to continue breastfeeding three things are important:
1) feed the baby more milk
2) protect and build up your milk supply
3) fix the problem

As the baby gets more milk he will become stronger and able to work harder to get the milk from the breast. I would seriously consider using an alternative method to the bottle to give your baby this milk. A mother above suggested the Supplemental Nursing System (SNS) http://www.celki.com/php/shop/shop.php?locat_id=72 from Medela.

I personally prefer the lactation aid that Dr. Jack Newman uses. He has a handout and a video on his web site at http://www.breastfeedingonline.com/newman.shtml (Scroll down until you find the heading At-Breast Supplementer)

I use an infant feeding tube FG/CH5(17mm) 105cm for this. I buy mine from the hospital and just put the other end into an open bottle. You can use the tube from the SNS but I find it a little short.

The big advantage of using the lactation aid is that the baby is still feeding at the breast and is willing to keep sucking when your flow begins to slow down. This means that the baby sends your body the signal to increase your supply.

Because your baby has got tired sucking at the breast he has stopped sucking when your flow slowed down. Over time this has sent the signal to your breasts that only the first five minutes of flow is needed instead of longer.

In order to increase your milk supply we need to tell your breasts that more flow is required. The way to do this is to get the baby to feed (or pump) on an empty breast. It is the continued stimulation on the empty breast that tells your body to make more.

This means either pumping or hand expressing as well as directly breastfeeding. Most recommendations are to pump after you have feed the baby.
Empty the breast as thoroughly as possible at each session. To ensure that the pump removes an optimum amount of milk from the breast, keep pumping for 2-5 minutes after the last drops of milk. Use breast massage prior to pumping, and massage and compressions during pumping to better empty the breasts and increase pumping output.
but I don't think it matters when you do it so long as you can fit it into your day but keep going for 3-5 minutes after the last drops of milk (stimulation to the empty breast).

Aim to pump at least 8 times every 24 hours including at night (10 times would be better). Don?t worry about the amount you get each time. It will be low to begin with. But keep pumping at least 8 times a day for 4 to 5 days and I promise you will see an increase. The body takes a couple of days to react to the signal of more stimulation ? so this increase won?t be immediate.

I also suggest that you contact a lactation consultant or LLL leader to review your latching on technique. She will also be able to show you how easy it is to use the lactation aid. And be able to show you when your baby is drinking and when just sucking for comfort at the breast.

Best wishes,
SARAH
2548-7636
 
What a scary situation. I have to say that breast maybe the best option when you can make milk, but if you can't make milk the bottom line is baby needs to eat and grow and thrive. The # of wet diapers does not really mean anything after the first few days. that is showing you that the mature milk is coming in and baby is drinking. 6 wet diaper now at a month old means baby is getting enough milk to be hydrated, that is it, it gives no indication that baby is getting enough milk to gain weight. You can tell whether or not bayb is eating enough by their weight gain, babies should have regained any weight they lost by 14 days, and many will regain it sooner than that. I can seee where it may be confusing that baby sleeps a lot, as don't all babies sleep? Here, the way to tell the difference is does your baby's sleep interfer with good feeding. If your baby is too sleepy to feed, then that is not normal and very likely due to low energy. It is a downward spiral, baby is too weak to eat, therefore doesn't feed well, therefore you make less milk, so on and so on.

Most people can produce milk but there are siutation where people do not produce enough, especially hormone related disorders, but other reasons as well. I would recommend seeing a lactation specialist, you can have a blood test done to see what your hormone levels are like, that can indicate whether you can produce milk or not. You can also take medication to increase milk suppy, not sure if it is available in HK. To maximize your chances of BF or partially BF I would have to agree with what LLLsarah said. Good luck. It sounds like you are doing the very best you can with the information you had.
 
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When my baby was first born, she was very small too. She always seemed hungry, always eating? And she would get cry and get hungry almost as soon as I put her down. It was really frustrating and I spent most of my time nursing or trying to nurse her.

What really helped me was Mother?s Milk Tea? it increased my milk supply and when feeding I could see that my baby was taking in more, and filling up better. She also started to last longer between feeds... And the weight gain became really significant.

Pumping also helped alot. I pumped before feeds, so that I could have see how much milk my body was producing and also make sure my baby got the fatty hind milk. I also woke up my baby and/or pumped in the middle of the night, because this also helps stimulate milk producing hormones.

Doing all of that, she went up from 3% (1st month) to 10% (2nd month) to 25-50% and jumped to 75% now!
 
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