Hi all,
If you plot the weights on the WHO growth curve for the infant that LJ Berkeley presented, assuming it is a female, she is growing appropriately around the 50% percentile at the 2nd and 3rd months of life.
Infants stop gaining about an ounce a day by 2-4 months of age, and then the rate of growth depends on where they are on the growth chart.
I see no reason for concern, this infant is doing fine.
Anne
Anne Eglash MD, IBCLC, FABM
Clinical Professor, Dept of Family and Community Medicine
University of Wisconsin School of Medicine and Public Health
Director, UW Lactation Services
Medical Director, Mothers Milk Bank of the Western Great Lakes
Founder and President of The Institute for the Advancement of Breastfeeding and Lactation Education (IABLE)
www.lacted.org
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Date: Thu, 15 Aug 2019 23:12:22 -0500
From: Laurie Wheeler <[log in to unmask]>
Subject: wt gain need ideas
Seems ok at 2 months. then only gained 1 lb from 2-3 months. then 4oz the next week. So it seems logical that something happened around 2 months. The first thing I think of is a birth control product it is for hormonal. The next thing I think of is can the baby be sleeping and missing some feedings or as someone else mentioned using a pacifier quite a bit. Has the mom return to work and maybe it's not quite keeping up and sending enough milk for him at a daycare or babysitter. Perhaps the tongue tie is an issue although I'm not leaning towards that but if her Supply was very abundant in the beginning it could have down-regulated. then you have the eczema and so perhaps there's something going on like EE. And then you had some reflux in there somewhere so maybe there's some reflux going on as they say silently. So maybe the baby needs a second opinion after carefully managing overall breastfeeding responsiveness infrequent weight checks. Laurie Wheeler RN MN IBCLC. Mississippi USA.
Date: Fri, 16 Aug 2019 08:00:49 -0400
From: Judith <[log in to unmask]>
Subject: Low weight gain, need ideas
A few lines of thought here to add for your consideration:
* Did the mom start taking hormonal birth control? If started after 6
weeks it could have made the milk production slow. In my area docs are prescribing the Nuvaring and the Nexplanon and saying they won't affect milk production but they do.
Could mom be pregnant?
* Any other medications, herbs or vitamins the mother is taking?
* Any medical conditions in the mother - PCOS, diabetic, hypothyroid,
etc.?
* Was there oversupply at the beginning? Sometimes if there is a
breastfeeding problem that is inherent the baby will coast on the milk production, but as the supply slows due to shift from endocrine control to baby driven the weight falters. Using a nipple shield in the beginning is a red flag for this kind of thing.
Did you check for tongue tie, cleft, and stridor with swallowing difficulties? I had a 4 month old come in for a first visit this week who faltered this way. Observed on the breast it 'looked ok'. Observed on bottle feeding and he had a terrible suck was slurping all over the place and bottle feeding taking 30 minutes or more still at this age. Suck assessment and he was chewing and compressing but not sucking. Oddly enough, mom had no nipple pain throughout. Had a tongue and lip tie release 2 days ago and feeding better immediately on both breast and bottle.
* Is mom working now and baby getting bottles at all? Sometimes they
don't want to feed when mom is away and don't eat enough and then sleep too much overnight to make up for low day feedings. This especially happens with very attentive parents when the baby is so secure and cared for that they don't fuss and go about happily starving.
* Regardless of the cause of infant faltering, the milk supply is
definitely very low now so I would immediately implement a plan to increase milk production.
* A baby who has been receiving inadequate calories this long can also
become very disorganized with sucking. Needs a good few days of lots of supplement, prefer as much breast milk as can be obtained. Might need some formula too. Increased gradually so that the kiddo is not spitting it all up. Once gaining weight suck can improve.
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Date: Fri, 16 Aug 2019 10:11:12 -0500
From: Allison Laverty Montag <[log in to unmask]>
Subject: Re: Low wt gain, need ideas
Looks like weight gain may have slowed after she stopped using the nipple shield at 8 weeks? Has she had a pre/post feeding weight done to see how much the baby is transferring? How about pumping after a feeding to see how much remains?
It may be worth having a SLP assess tongue function. Why was the nipple shield used and perhaps the baby needs some help.
She's fortunate to have you delving into this to help her out!
Allison
Allison Laverty Montag BA, RLC, IBCLC
Wisconsin
> Date: Thu, 15 Aug 2019 18:01:29 -0600
> From: Lj Berkeley <[log in to unmask]>
> Subject: Low wt gain, need ideas
>
> Hello Smart Women!
> I am in need of brainstorming help. What follows is a "case study" of
> a client that I have been struggling to help. I'll post in bullet
> point style so its easy to read. What I want to know is if anything
> jumps out at you (i.e. what am I missing?). He has dropped from the
> 50th percentile to the 12th and mom is very upset. Pediatrician is not.
>
> DOB 5/10/19 boy at 39 5/7 wks, vaginal birth (NSVD) in a hospital to
> an MD
>
> BW 7lbs 9oz
>
> Wt at 2d 7lbs 2oz
>
> Wt at 2 mo 11 lbs 3oz
>
> Wt at 3mo 12lbs 3oz
>
> Wt at 3mo + 1 wk 12 lbs 7oz
>
>
> Other pertinent facts:
>
>
> Exclusively breastfed baby. Mother used shields until 8 weeks. Feeds
> directly now.
>
> Baby feeds 10 x day
>
> Baby feeds 20 mins and generally both sides
>
> Baby had frenotomy in hospital at 1day of age (only tongue, not lip,
> scissors not laser)
>
> Baby had small amount of GERD causing frequent spit up which has
> resolved
>
>
> Stools: had frequent up to 2 mo and now has “massive” stools 1x day
> and smaller 1x day
>
> Urine: very frequently urinates, diapers “always” wet and it appears
> clear
>
>
> Baby developed eczema at 2 mo, began on his cheeks, spread to his
> face. Pediatrician prescribed hydrocortisone “oil” and mother states
> its helping.
>
>
> Baby does not sleep with parents, but in a nearby bassinet. Feeds q
> 2-3hr at night with one interval of 5 hours (usually) between 8pm and 1am.
>
>
> Sibling: Breastfed +- 2 years with great weight gain all along.
> Sibling also started feeding with shield and dropped it on her own at 6 weeks.
>
>
> Mother's nipples appear undamaged, she denies any pain, feels full if
> baby waits more than 2.5 hours without feeding. Her breasts appear
> normal to me, medium sized, mildly flat nipples but evert nicely when
> baby attaches (and round on detach)
>
>
>
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