Hello Lactnetters,

Permission to post.

I saw a mom of a 4 month old girl for the first time today.  I am concerned, but not sure if I should be reaching for the panic button yet.  Baby has been slow to gain weight since birth:

Birth 3250g (50th %)

no lowest weight recorded, but mom states baby did not go any lower than birth weight

3 weeks 3475g (20th %)

5.5 weeks 3625g (7th %) ***This and previous weights on same scale

13 weeks 4220g (-10th %) ***New Scale - following weights on this same scale

16 weeks 4770g (0%)

18 weeks 4940g (1st %)

So she fell through more than 2 curves (as per WHO charts), but for the last month has maintained her curve and even come up a tiny bit.

Developmentally, she looks normal to me.  She is alert and happy, interacts socially, physical ability is right on target.

Diapers are adequate, mom reports 6 or more wet, plus two very large stools that explode out her diapers.

No tongue tie (this girl has a very long and agile tongue, sticks down to the middle of her chin and she loves to play and twist it all around and up)

Mom's breasts and nipples appear normal.

Currently BFing about 8 times per 24hrs

Positioning good.

Latch could stand to be a touch deeper, but it is not terrible.

Nipple slightly distorted upon removal.

10 seconds of NNS, about 7 min of NS, with obvious swallowing.

Baby grew fussy at end of feed and then pulled off.

Burped, took second breast for about 10 min (with obvious swallowing) then fell asleep.

For now, I have suggested to mom that she nurse more frequently, aim for 10 - 12 times per day.

Use breast compressions before flow slows so much that baby gets fussy.

Wear baby skin to skin in a sling as much as possible to facilitate and stimulate frequent nursing.

With the exception of one longer period at night of 4-5 hours while sleeping, not to let baby go for more than 2-3 hours between nursing 

Always offer both breasts

Weigh again in two weeks and re-evaluate.

Baby has not yet been seen by a pediatitian.  I have strongly recommended mom find one for her baby to rule out any other issues.

Given that baby has maintained her curve for the last month, is this sufficient?  Are galactogogues or supplementation warranted now?

If curve has not increased in two weeks, I plan to suggest galactogogues (likely fenugreek & blessed thistle) and pumping to increase supply.

If that does not work to get this little one gaining better then I will recommend supplementation (preferably moms EBM, then donor milk, then formula or possibly starting some calorically dense solids a bit early, as per Jack Newmans guidelines.)

I am feeling a bit nervous here.  I don't want to recommend supplementation if it is not necessary, but don't want to wait too long either.  I know FTT is considered falling through 2 curves, which she has done, but she has maintained for the last month.  I am also reassured by the diapers, her behaviour and development.  Were my suggestions apropriate, or should I have suggested supplementation?

Thanks!

Jennifer Welch, IBCLC, LLLL
Montreal, QC Canada

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