Not gaining weight/height quickly enough

[TryingNottoPanic]

Hello. I have lurked for a bit and now have a question of my own. I a EBF my 4 1/2 month old DD. She has had MSPI so I have eliminated those from my diet since 3 weeks of age.

She just had her 4 month well check and DH took her. I just got a message from him that our doctor wants us to start solids immediately to get more calories in. Her height and weight are quite low in relation to head circumference. This has me very worried.

I am back to work and pumping three times a day. She sleeps from 9pm to 6 am each night. Rarely does she wake in the night to eat. She takes 3 bottles at daycare in the 5-6 ounce range. She nurses 3 times in addition. So 6 feedings total in a day. She always seems satisfied and is eating every 3 hours.

Her stools are sometimes green, but this is decreasing. I had massive oversupply and was pumping 24 ounces a day. This is down to 16-18 ounces a day now. I am not sure the quality of my milk is great based on her stats today. Maybe I have too much foremilk?

I pump until nothing comes out any longer, and typically get two let downs in 15 minutes. I nurse until she comes off and refuses to latch again. She typically nurses on the first side for 15-25 minutes and on the second for 5-10 minutes.

Any ideas? I am starting to feel like I am failing at this if I cannot get her to grow. My first DD did not latch and I had undersupply and it did not work out. I thought this was going well until today.

Thanks. Sorry for the length.

[evynsmama]

Deep breath

The most important thing is for your little one to grow and be healthy and it is your pedi's job to ensure that that happens.
It sounds like your child isn't hungry but maybe she just isn't getting the calories needed to grow, just what is needed to sustain. That is what happened to my LO and I stressed about it so much I had a panic attack. In the end I took the doctor's advice and my LO grew like crazy in no time and is happy and healthy. I would take dr's advice and add in some cereal.
Can you call and talk to the dr to find out why he is concerned? and that might help you feel better.

You are not failing, before yesterday you didn't know there was an issue, now you do and you can fix it by adding in some cereal. Failing would be knowing there is an issue and doing nothing to fix it. Good luck

[MamaMaui24]

Your feeding schedule sounds very similar to ours.

What did her growth look like on the WHO growth charts?

I'm not sure about wt/ht relative to head growth, but what does the growth look like by themselves. Ht % compared to last and weight % compared to last. (ds was 100% head circ with weight/ ht 75%. Some kids just have big heads!)

One thing you could try is to only feed one breast at a feed instead of offering both. She may be getting more fore milk by feeding both each time. (?).

And adding cereal at 4.5 mo is not that big of deal. I know a lot of BFers wait til 6 mo, but that's ok.

Good luck! You're doing a great job!

[TryingNottoPanic]

Thanks. My pediatrician is my uncle, so I will call him tonight and discuss. I am very lucky to have direct access to him at all times and he typically calls me if I don't come to appointments because he knows DH misses details.

DH said that her weight went from 19% to 5% and height from 68% to 38%. Her head was in the 75-80% and has been steady along the curve.

Apparently the worry is that height and weight are now trending down and not going up.

We will start solids in the morning. I have a ton of residual guilt for all the trouble we had with DD1.

She has also had a rough month with illness (two chest colds with 10 days each of breathing treatments), so perhaps she was eating less during that time. This last week has been particularly rough.

[gladys]

I would think her recent illness and decreased feeding may have impacted her growth. I don't mean any offense to your uncle, but I completely disagree with adding solids like cereal to improve weight gain. Cereal is just simple carbs, and not the balanced nutrition she gets from breast milk. I agree with PP about trying some things to reduce fore milk and maybe boost your caloric and healthy fat intake (avocados, nuts, etc). Do you have a weight check in a month? Have you seen a LC?

[heyjude]

That sounds like enough BM to me...?

[curbsideprophet]

Since she has been sick I would hesitate on rushing into solids.

[AmyRI]

Add me to the "it makes no sense" group.

Solid foods are less nutritious than breastmilk. It takes a lot more volume to get to the same calorie content. If you feed cereal, it is simple carbs - lacking protein and fat, which are essential to overall growth. If she needs to gain more weight and eat more in order to grow height-wise, it means she needs more breastmilk. Start there.

Add a pumping session and as many nursing sessions as she'll take. Top her off with an ounce of pumped milk after every feeding, or every other, or something like that so that she starts getting more.

If you can't pump enough, I would consider formula supplementation before I would think about starting solids early.

[Ashley&Scott]

OP what did your pedi say during your follow up discussion?

[lrs]

Hi, OP here. I had to register to respond, I assume Guest functions are gone.

I talked with him at length. He thinks all the extra effort to breath caused her to burn more calories. I told him I did not want to start with adding empty calories and wanted to try more breastmilk first. He agreed. He told DH that I could increase breastmilk and/or start solids (and used cereal and purees as an example).

Thus, we have added an ounce to each of her bottles at daycare (total of 18 ounces). I have also added a nursing session before we leave. So instead of eating right before we go, I wake her, she eats and then she eats again before we leave.

We will weight check in 3 weeks to see how it is going.

Hoping this works.

[AmyRI]

Jun 12, 2012 8:57:05 GMT -5 lrs said:

Hi, OP here. I had to register to respond, I assume Guest functions are gone.

I talked with him at length. He thinks all the extra effort to breath caused her to burn more calories. I told him I did not want to start with adding empty calories and wanted to try more breastmilk first. He agreed. He told DH that I could increase breastmilk and/or start solids (and used cereal and purees as an example).

Thus, we have added an ounce to each of her bottles at daycare (total of 18 ounces). I have also added a nursing session before we leave. So instead of eating right before we go, I wake her, she eats and then she eats again before we leave.

We will weight check in 3 weeks to see how it is going.

Hoping this works.

I'm glad he's on board with more breastmilk instead of just solids! That's great. I can't imagine that an extra 3 oz a day plus an extra nursing session won't do the trick. Hope your weight check in a few weeks gives you good news - make sure they check height as well since she's been slow to grow length-wise.

Thanks for updating!

[lrs]

Just wanted to give a quick update. We had a weight and height check today (20 days from last check). She has gained 1 lb and 11 ounces and gained 1.5 inches in the three weeks.

So it seems to be working out without introducing solids!

[MamaMaui24]

Great news! Good job.

[Ashley&Scott]

:y: Great news!

[curbsideprophet]

That is great news, thanks for the update!

[jennlin]

:y: