Official Weight Gain Concern

iVillage Member
Registered: 10-06-2010
Official Weight Gain Concern
14
Fri, 03-09-2012 - 9:48am

So, I've posted before about the doctor potentially being concerned about my DD's weight gain, but now it's official :(

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iVillage Member
Registered: 09-21-2011
Fri, 03-09-2012 - 11:42am
Fenugreek + blessed thistle is the combination that I've heard is particularly helpful when you are also pumping/nursing extra. So be sure you are emptying out frequently to keep the supply up.
iVillage Member
Registered: 07-15-2007
Fri, 03-09-2012 - 12:52pm
Well can you post her weight history? Which growth chart is doc using? There is a chart for ff babies and bf babies. There's quite a difference after 4 months (or maybe 6). Just a thought. Even with that I think bf babies are supposed to gain 4-7 oz a week. Well even with that she is still low though. :( olive oil is a good fattening oil....maybe avacodo? My ds will be 9 months march 20 and he eats avocado slices ... maybe sweet pot fries tossed in olive oil? Real butter noodles? Good luck. I went through a similar experience with ds1 and to this day he is very tall for his age but very skinny!
Community Leader
Registered: 06-10-2008
Fri, 03-09-2012 - 2:23pm
I'm curious to see the full weight history as well.
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iVillage Member
Registered: 04-13-2008
Fri, 03-09-2012 - 5:58pm

kellymom explains the various growth charts that have been used. The WHO ones are the only ones that show the normal growth pattern for breastfed babies. Formula fed babies follow a different growth pattern, and then growth does not slow so much in the second six months (possible contributer to later obesity).

This page provides links to the various charts.

http://www.kellymom.com/babyconcerns/growth/growthcharts.html#growth

I particularly like this next one. The red dots show normal growth ie growth of a breastfed baby. The dots are slipping rightdown in percentiles on the older charts. It shows why doctors will then be fearing the baby is not growing properly, when in fact they are. The red dots show the girl being close to the seventy fifth percentile, and later dropping to just above the 25th percentil. All normal.

http://www.kellymom.com/babyconcerns/growth/chart1.html

This is the WHO growth chart for girls from birth to 2 years. Notice how the shape of the curve for normal growth of breastfed babies is very different from the shape of the older charts. The curve noticeably is much less steep after about six months.

4 to 7 ounces a week is appropriate growth rate up to four to six months. After that, growth slows a LOT. You can see it takes over four months to gain just 2 kilos (a bit more than 2 pounds). So the rate of growth that is average for this age group would be more like just less than half a pound per month. Remember, that is an average, and some babies will grow slower or faster than that. Your baby seems to be a bit slower than that, but not far off.

Can you print out this chart and plot your baby's weights on it? Does it look different to the chart the doctor used?

http://www.who.int/childgrowth/standards/cht_wfa_girls_p_0_2.pdf

This page gives links to a lot of other detailed information about the growth of breastfed babies, if you want to look at other aspects of growth, as well as weight.

http://www.who.int/childgrowth/standards/en/

From the EPing, it would seem that your daughter is drinking plenty of breastmilk. Some women are able to keep a reasonable milk supply while EPing, but it can be difficult for many women as the pump does not stimulate the breasts as well as nursing. So I would be cautious about EPing, as it could well cause the issue you are trying to avoid. Are you pumping every couple of hours? Do you get up in the night-time to pump as well? Do you go for some time after the last bit of milk has come out to stimulate your breasts even more?

Formula has less calories than breastmilk, so it is not necessarily a solution. It would not be that your breastmilk does not have enough calories, in fact it is likely getting richer as your baby gets older as it changes all of the time.

A better solution would be to offer to nurse your baby more frequently. Babies this age can get so focussed on the world around them that they do not seek to be fed as frequently, so the solution is for you to offer. Even if baby is asleep in bed before you, give a dream feed as you go to bed. If you want to EP for little while longer, then the same applies to that - offer the bottle frequently and dream feed. But lots and lots of pumping as well.

iVillage Member
Registered: 01-12-2006
Sat, 03-10-2012 - 12:36am
While waiting on the full weight history, here are the things that jumped out at me (I'm on baby #3 ... all "drop" percentiles, but only one ever even looked thin). My 3rd is only 7 mos old, but my oldest two were well below any standard growth chart. So I have some experience in this area.

My first thought: how does the baby look? Is she chubby? Does she have fat rolls? My first child fell off the growth curve sometime before her 1st birthday, but I kid you not that her fat rolls had fat rolls. I don't know why she didn't weigh very much because she was really quite a chubby baby. We were simply never worried about her. In fact our very wonderful pediatrician at the time showed me that while she had "dropped percentiles" if I looked at her growth curve it was still a curve (no plateaus or dips). So she was growing at her own rate. Around 18 mos she did hit a plateau (following a very serious little illness), so we did monitor her growth a bit, but she remained "slim" and didn't climb back onto the growth charts until she was 3 or 4. So my point, is look at the baby not the scale. If she seems fine, there's a good chance that she is. Not that being cautious isn't worthwhile. It's just that sometimes a baby falling on the growth curve (which is actually quite common) doesn't really mean anything (at least not anything bad).

Since you are not planning on extended nursing I can understand your hesitance to cut back on solid foods. The reason this might be suggested is that solid foods (the ones we feed our babies) tend to be healthy and most often have fewer calories than breastmilk. So, very often when baby is eating a lot of solid foods early, baby does slow down weight gain and will pick it back up if nursing is increased and solid foods are reduced. Since that's not an option you're terribly interested in pursuing, I would consider focusing on higher calorie solids (banana, avocado, for example) and / or fortifying her food with healthy oils (olive oil or flax seed oils are both good options ... I fall in the camp of don't give dairy to babies, so butter is a bad choice imo. Also butter is a saturated fat vs the healthier unsaturated fats of the other 2 oils).

Lastly, I'm not sure that exclusive pumping is the right way to go, as this will likely negatively impact your supply. If you feel you must measure every feeding, rent a Medela baby weigh scale and do pre and post feeding weights at home to measure intake via direct breastfeeding, which is going to help you stimulate your supply far better than a pump. Certainly you ca use pumped milk when you're away from home so that you can quantify every feeding in a day. Probably just a week or so will give you a good idea of how much she's taking in on average.

And to be honest, the 20-24 ounces, in addition to 3 solid meals a day seems good (maybe even high) since we know that babies average 25 ounces a day in early infancy and then begin reducing the amount of milk they consume as solids are added to the diet (solids generally replace milk..not supplement it, which many people dont realize. There's an assumption that they're additive or on top of the exact same amount of milk as before solids, but they're really not.

Breastmilk is pretty standard in calories, and the likelihood that you have a rare condition that would impact your breastmilk calories is quite slim. As for the fenugreek, make sure you're taking enough. Not sure of your pill dosage, but the generally advised is 3 pills (500mg) 3X / day. And you must also increase pumping / nursing frequency. Also, many report enhanced results with fenugreek when it's taken in combo with blessed thistle.

After all that I want to leave you with the note on my 2nd child (who did look slim and was actually less than 16 lbs at 12 mos). Everyone was worried and eventually we realized she had acid reflux (silent and apparently pretty severe), which is why she didn't eat all that much. Despite being 2-3 standard deviations below the growth chart and looking slim (she did NOT look unhealthy in any way -- just lean -- and even a nutritionist really told me she thought she was just naturally petite) she was always quite healthy. And in the end, it really was just her genetic growth potential ... nothing seriously wrong with her (except the acid reflux). She's almost 5 and just now weighs 30 lbs. There was great concern from our new pediatrician (we moved) that she was somehow depriving her brain of nutrition, which I always thought was nonsense. And honestly we don't actually know if she was harmed or not by her slow gain, but we assume it not likely since she's reading independently and working with children at school 1-2 years older than she is. She's actually quite smart. And still very, very tiny.

HTH. Get back with any questions.
iVillage Member
Registered: 10-06-2010
Sat, 03-10-2012 - 1:54pm
I'm on my phone so sorry for abbreviated post. Here's her weight history.

Birth - 7lbs 5oz
Discharge - 6lbs 13oz
5 day c/u - 7lbs 5.5oz
1 month c/u - 8lbs 15oz
2 month c/u - 10lbs 7oz
4 month c/u - 12lbs 7oz
6 month c/u - 14lbs 2oz
9 month c/u - 15lbs 2oz

I will work on charting this later and replying with that. I'm not positive which chart the doctor is using but I've made it clear I am breastfeedig and would like to continue so hopefully they're using the appropriate chart
iVillage Member
Registered: 10-06-2010
Sat, 03-10-2012 - 2:03pm
Thanks teresa! I am on my phone now but will definitely read through all of those links later. I really appreciate all of the information!!

As for pumping, I am pumping 6 times a day (abt every 3 hrs from 8-5 and then I push it to every 4-5 over night). I am getting up once in the middle of the night to pump. I have also been diligent about pumping for 3-5 mins after the last drop i know bfing more would be a better option but for now this makes my dh happier (he's also concerned she's not getting enough despite my sharing all this information) and this will hopefully be usefule for the doctor to see in April of her weigh gain hasn't improved.

I will def check to see if they are using the appropriate chart for her. Thanks again
iVillage Member
Registered: 04-13-2008
Sat, 03-10-2012 - 7:50pm

I found this on the WHO site as well. It seems to give you an option to download software to plot growth on the computer, and evaluate it. That could be helpful. I did not try it out though.

http://www.who.int/childgrowth/software/en/

Teresa

Community Leader
Registered: 06-10-2008
Sat, 03-10-2012 - 8:09pm
I plugged your weight history into kellymom (http://www.kellymom.com/babyconcerns/growth/weight-gain-calculator.html) and here's the weight gain:

Birth - 7lbs 5oz
Discharge - 6lbs 13oz
5 day c/u - 7lbs 5.5oz - GAIN of 11.3 oz/week
1 month c/u - 8lbs 15oz - GAIN of 8.5 oz/week
2 month c/u - 10lbs 7oz - GAIN of 6 oz/week
4 month c/u - 12lbs 7oz - GAIN of 4 oz/week

Remember, from 0-4 months, we're looking for a weight gain of 5-7 oz/week. You're a touch low on the last one but pretty close overall.

6 month c/u - 14lbs 2oz - GAIN of 3.4 oz/week - Looking for gain of 4-6 ounces per week so only a touch under here.

9 month c/u - 15lbs 2oz - GAIN of 1.4 oz/week - Looking for a gain of 2-3 ounces per week

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iVillage Member
Registered: 06-17-2007
Sat, 03-10-2012 - 11:44pm
This actually doesn't look all that bad to me. Remember that you don't start from their birthweight. Rather, you start from their lowest weight measured. For your daughter, perhaps that is 6.13? If you had an IV of fluids while you were in labor or at any point before your daughter was born, her birthweight may have been affected significantly.

Those numbers are similar to my daughter's. She was 6.8 at birth, 5.13 at the lowest. 15.5 at six months, and 15.5 at 9 months. Not a single ounce of weight gain, not an eighth-inch of growth in three months. So maybe it's with that context that I'm not extremely worried about your daughter's gain in the last three months. She's gained a little on the slow side, but it's still a reasonable gain. I wouldn't be panicking yet.

I'd like some more details. What kinds of solids are you giving her? I get you don't want to cut back on solids, but if she's having most fruits and vegetables she's not getting much fat or calories from them. If she'll take dairy okay, try giving her full-fat yogurt. I give the 2% greek yogurt to my son because it has a decent amount of fat and lots of protein. Try meats, try cheese. Avocado has lots of good fat. With my daughter, I tended to avoid putting butter on her vegetables like my pediatrician recommended because I did not want her to develop a preference for buttered food and refuse food that wasn't slathered in fat. My daughter is small but in general my family is overweight so that seemed a bad idea to start such a habit.

Also, how long are you pumping? How many letdowns do you get? I've had oversupply for most of the time I've been pumping for my son but this time, my second letdown happens around the 19-minute mark. If I only pumped 15 minutes or less, I'd be missing out on 1-1.5 oz per session. That can really add up if you're EP'ing.




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