frequent waking, not gaining
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| Wed, 11-01-2006 - 10:44pm |
I'm in need of some advice. I've been reading a lot of advice already given since it seems a lot of people are struggling with some of the same problems I'm having. But I'm getting conflicting advice from my pediatrician and wondering what anyone thinks. My dd has never been a stellar nurser and has gained weight slowly. She started out with jaundice and spent time in level 2 nursery and then was a sleepy baby and I had to constantly try to wake her to feed her. I was pumping at the time and then around 3 months she woke up :) But still not a great nurser. Would eat 4 min per side short snacks all day. She has always fussed during most of her feedings and I do have a forceful let-down but I don't think oversupply was ever an issue. Anyway, she typically has gained 10 oz per month since Month 2 but this last month lost 3 oz. She was becoming increasingly frustrated during feedings and pulling off screaming and I wasn't feeling my milk let-down for about 2 wks so I decided to see a Lactation Consultant. That's when I learned of the weight-loss as we are in-between well-checks (she turns 6 mos on Nov 7th). Anyway, LC recommended the usual increase pumping and fenugreek. I had been taking the fenugreek and it has worked for me in the past but now the last 2 weeks I haven't noticed it working like before. (Does it require more if you have taken it before?) I take 3 tabs 3x a day. So I went in to the ped the next day just to get a weight on the scale she's usually weighed on and she was 13lbs 10oz, 4 oz heavier then the day before. I talked with the ped who I really like and is always supportive, and positive and listens. But she thought that DD is bored w/nursing. She suggested feeding her more solids. DD does love the rice cereal. But I'm worried this will just decrease milk supply further and won't provide enough fat and calories. She also has been waking about every 1/2 hr to an hour at night for the last month and comfort sucking and sometimes eating. I'm a wreck! Doc suggested feeding cereal in a.m. followed by BF. Then waiting 4 hrs (unless DD asks for it) before offering again. Then feeding another cereal feeding at supper followed by BF and then BF again before bed. The thought is that she will stop snacking and eat bigger meals and hopefully get more calories during the day and hopefully gain weight and decrease night waking. I don't know if this makes sense or what my point is but I'm feeling tired and defeated. I really was hoping to make it to at least 1 year breast-feeding but now I'm not so sure. If anyone has any suggestions I'm really needing some.
Thanks,
Vikki
Eli 2/19/03
Chloe 5/7/06

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Hi Vicky-
Welcome to the board. ((HUGS)) to you. You have done a great job, pumping for 3 months and waiting for your baby to come around to nursing. She is lucky to have such a patient mama!
With all due respect to your (and all peds), they often know very little about breastfeeding. And, often, if they 'know' anything, it's usually wrong. Surprisingly, they are not given any information about bfing in medical school and it's really up to them to research it themselves. They are so very busy that they often don't and 'know' what they've been told by others which is often wrong (baby should only eat a certain amount of time, etc). Your ped has said some things that really raise red flags to me.
Good for you for seeking out an LC. Did you ped recommend taht you do that, by any chance?
One good example of this is that your ped told you to increase solids, and your dd is not even 6 months old yet. The AAP recommends that babies recieve absolutely NOTHING but bm or formula until 6 months. As you mentioned, too many solids too soon cause supply problems, early weaning, as well as possible tummy and allergy problems: http://www.kellymom.com/nutrition/solids/delay-solids.html
One thing we usually mention if there is a weight gain issue is to stop or at least decrease solids. Your peds advice to give MORE cereal and decrease sessions (forcing baby to go 4 hours between nursing) will totally sabatoge your efforts.
Your bm (or formula) has MORE calories than most solids you would give her. So, by giving the low cal solids, she's filling up on those and isn't as hungry to nurse and get the good high cal bm. http://www.kellymom.com/nutrition/vitamins/babyfoodcalories.html
Then waiting 4 hrs (unless DD asks for it) before offering again. Absolutely do NOT make baby go 4 hours between feedings. How is giving LESS food going to INCREASE weight gain? That is completely against common sense. The absolute first thing you should do if weight gain is an issue is to increase the number of sessions that baby nurses.
I am wondering if maybe
Hi Vikki - along with Theresa's thoughts & info, wanted to give you this link and ask for a weight history
http://www.kellymom.com/babyconcerns/growth/weight-gain_increase.html
I read the difference in weight (the loss of 3 oz to gain of 4) as being two different scales - the one at the LCs and then the one at the drs? Is that right?
((HUGS)) to you, sweetie. You sound like you're getting tot he end of your rope. Hang in there. You're doing great.
I'm shocked that the LC is telling you to have baby on 2 meals of solids before 6 months. Do you know if she's board-certified? I still think you should cut back or totally remove the solids. Again, they have less calories than the bm she's getting from you. And, being full from those will cause her to nurse less, which will in turn give you a supply problem.
How many bottles is baby getting a day now? I'm wondering if we've gotten into a bottle preference situation. Are you supplementing with all ebm, or some formula, or nothing? Sorry if I missed that.
Have you tried pumping to get letdown and then putting baby on? What about breast comressions? http://www.kellymom.com/newman/15breast_compression.html
If you're looking at the losing of4 oucnes on 2 different scales, disregard it. Scales can very up to a pound, so that's not accurate. So, we're still looking at about 1 ounce gain in one months which still isn't where we'd like to see it. Can you give us a total weight history with ALL dates and weights, which scale it was done on (ped or LC) and show when you started/increased the solids?
Did the LC do anything to
I’m going to add my thoughts. Based on the persistent slow gaining pattern I’m going to guess it’s not an oversupply issue. Sometimes slow gain can be oversupply but it’s less common then the baby who gains a lot but is fussy with oversupply.
I really appreciate you all taking the time to help me through this. Here are answers to your questions....
What sort of pump are you using and what is your average pump volume?
I have a Medela Classic that I bought when she was first born because of her stay in Level 2 nursery and being sleepy at the breast. I have been pumping after a few feedings (not the last couple of days as I'm taking a mental breather) and usual get anywhere from a few drops to a 1/2 an ounce each but more like 1/4 oz each usually.
Does that make sense from what you are seeing? Does she takes bottles, if so how many per day, is she in day care or away from for work?
Yes I would say she does prefer the fast flow after a let down and then isn't interested for trying longer. She will never suck so long as to get another let down. But, most times after a feed if I pump I'll get another let down so if she'd try she would get more. She will not take a bottle I've tried and it's a no so I sometimes try to cup feed which isn't very effective. I stay home full-time.
What did the LC say about the effectiveness of the breastfeeding? Did she measure how much the baby took during a feeding with a special scale at all?
She said it looked like she was sucking well (but sometimes she is lazy and won't open wide and won't take a lot of nipple/areola into her mouth). LC did weigh her on their special scale and she got 2 1/3 oz total. I'm not sure if that is a real accurate assesment of every feed because she wasn't in her enviroment and was a little distracted.
How often are you pumping now? Are you offering your pumped milk as a supplement? How much each day?
I'm planning to start pumping again probably this weekend. I just needed to step away from the whole thing for a few days cuz I was going nutty. I've tried offering EBM but she's not taking.
Tell me are there some/any feedings that seem better than others……..related to time of day, position, last longer, etc?
Morning and early evening are usually better. She prefers side-lying position as she needs to wiggle while she eats for some reason. It was the mid-day feeds that were taking longer for my milk to let down and she would end up a screaming mess. That's why sometimes I would just feed her cereal then because she was a wreck and wouldn't even be patient to try to get any milk. So I would pump after and I was pretty low during that time. I think that since she would often skip that feeding a few months ago choosing to sleep through it that my supply was low.
Today over all was a good day. I have cut out the cereal and have been doing breast compressions and it seems to help. I'm going to look into renting a scale Monday because I really would like to know what she's getting each time. Do you have any suggestions about what I can do since it seems like she's not interested in sucking when the flow is slow? I have tried waiting before offering breast yesterday and today and it seems like it's helping. I've been waiting about 3 hrs but sometimes she'll fuss and refuse so sometimes it is 4 + hrs before she'll eat. Do you have any suggestions for getting her to nurse more frequently? It's like it's turned around and she'll do her long stretch during the day and then at night nurse constantly....ugh. I really appreciate your help.
Thanks,
Vikki
I'll leave the slow weight gain issues to the experts, but in response to how to get her days and nights turned around so that they match with yours, I thought I'd offer a little advice:
First, your baby is very young, and it is VERY normal for her to wake to eat at night. I don't think your goal is to eliminate all night wakings - just encourage a little bit longer stretches of sleep at night. The elimination of solids during the day to get more calories in her should help some - and may be why she stretched out to 2 hours at night after you cut back on solids. At any rate ...
I remember reading somewhere when my DD was very little that a great way to help babies regulate day/night is to get them outside into the natural light several times during the day. The light helps to set their internal clock in some way. Then at night, keep the lights low, stimulation low, etc. Also a good bedtime routine may work well.
My DD did very well from early on with the day/night thing, but I did always get her outside a lot. I love to be outside. And in the beginning we were doing sunlight therapy because of jaundice, so we were sunbathing 4X a day. I don't know if this is why she got the day/night thing figured out early or not, but I had read that it could help and my DD did seem to get is straight. So maybe the sunlight really was the key.
Also, at your DD's age (she's 5 months or so right?), the frequent night waking can be related potentially to teething (which can also impact nursing if baby's gums are really painful) or possibly developmental milestones, if she's learning to roll, sit, get up on her knees, etc. I do remember that at around 6 months my DD started waking more frequently, but it was always related to teething - which she did straight from 6 months to nearly 2 years. She always had at least one tooth trying to work it's way through. Teething tablets might help if that's the case.
HTH!
Hi again Vikki, Thanks for getting back to me.
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