Helping an EBF long lean baby to gain weight

[LeeMiller]

DS is 4 months, EBF.

When he was born (2 weeks late) he was 50th for length and 75th for weight, now he's 93rd percentile for length, and 25th for weight. He is happy, super active, meeting milestones early, plenty of wet and dirty nappies each day, and gains weight each week but not a lot. There have been weeks following vaccinations, mastitis, a virus etc when he's gained less. The pediatrician today said she thinks he's a bit slim relative his height and since he's gaining weight slowly wants to weigh him again in a fortnight. I'm worried she's going to recommend formula top ups which I'd rather not use (but of course would if it's best for him).

What can I do to encourage weight gain? I've started taking galactagogues and I'm trying to make sure I drink plenty in case my supply is low. Should I also try pumping (I never have) to ensure supply is up? Or giving him expressed milk as well? DS has always had short, frequent feeds at irregular intervals and often falls asleep on the first boob, then continues to suck on and off when asleep. Should I be waking him? Offering more frequently even without signals?

Both sides of the family are skinny and the menon my side are also tall so I tend to think it's just him, but I don't want to be blase and would feel more confident using or refusing formula if I knew we'd tried everything bf-wise first. There are no bf groups near me in the next 2 weeks but I could pay for a private lacation consultant.

I’d just feed more regularly. I always fed when I wanted to, I didn’t wait for hunger signals.

Hhm, he definitely won't just feed when I want him to, though I do always offer before we go out, for example. He eats every 1.5-2 hours in the day, max every 3 hours at night.

I agree. Feed more frequently. I have sons of the beanpole variety and they seem to need constant feeding.
How often are his feeds (or if they are very irregular - how many does he have in 24hrs)?

Sorry xpost

I'd just carry on if he seems content and is growing in length and developing well. I'd make sure I offered him the breast frequently but that's all. That's a drop of two percentile lines in four months, which isn't usually a matter for serious concern as I understand it - if he'd dropped down them quickly it would be more of a worry.

If you really want to make sure you've done everything then yes, try pumping and giving a few EBM topups, and in a few months you can start weaning and give him avocado, cheese, nut butter etc. But my guess is that this will turn out to be his normal growth pattern.

Maybe try doing breast compressions while he’s feeding?
Here’s a good video explaining how:

It might increase the volume he gets before he falls asleep.

Have a look at videos of breast compressions, and do this when he falls asleep on the breast.

How’s his latch?

Thank you all for replying. I do try to keep him awake during feeds but it's not easy! I've also noticed he gets easily distracted when feeding now so maybe feeding in a quiet dark room would maximise his intake.

We had some issues earlier on with overactive letdown and over supply so he could be used to a faster flow - I'll try breast compressions next time he's feeding.

Any suggestions for pumping - I don't know where to start. Is it better to hire a decent one or buy a cheaper one?

If he seems happy and content I'm not sure I'd worry too much. DD was a dinky dot (born on 50th centile, had dropped to 9th by 4-6 months). She put on weight very slowly (only weighed around 15lb by her 1st birthday), but was happy, slept well etc, so I wasn't worried.
If he seems to be hungry / unsatisfied, then it's a different story.

People always tell me his latch is great though I'm not sure how closely anyone's looked - nobody has checked for tongue tie, for example (I'm overseas and it's never mentioned here). But he latched on easily from day 1 and it was never painful. In the first weeks he gained over 300g per week which makes me think his latch is fine.

Do you think you will want to pump in future ie in order to go to work/go out of an evening?

The very cheapest and simplest way to try pumping would be to buy a Haakaa - it simply suctions onto the boob you aren't feeding from and draws out some milk while the other one is letting down. You can get a surprising amount that way. If you think you're likely to want to pump in future to be away from baby, you could think about a small electric.

I've considered pumping, what puts me off is the thought of the extra time and effort when it's not technically necessary - I'm on leave for a good while yet and afterwards can work flexibly. I also had mastitis twice followng engorgement and gota bit scared of messing around with my supply and it coming back - now I'm worried it's gone the other way as my boobs often feel empty (in the evening especially), but I've read that's normal at this stage.

Would you recommend ppumping to boost supply or also offering it (after/before?) as well. I've no idea if he'd take a bottle, he won't take a dummy.

I can’t see any benefit of pumping and feeding expressed milk over just feeding in your situation.

I can’t see any benefit of pumping and feeding expressed milk over just feeding in your situation

Tbh I think the main benefit is usually in placating nervous HCPs who are urging formula, just by demonstrating that the baby is actually drinking a reasonable amount and isn't desperate for more.

It's up to you OP - you don't have to give formula OR expressed topups if you're happy your baby is getting enough.

I know you're right SoHot, I just don't want to put my desire to EBF over his wellbeing, and it's hard to resist HCP pressure. She didn't seem worried by his weight/gain as such until she looked at his growth curve and weight-height ratio.

Surely growing length-wise is still growing? It surprised us that he was biggish at birth as we're a family of skinnies. He never stays still when awake, I have always been a fidgeter with a fast metabolism and suspect he is too.

I don't really understand the point of offering him expressed top-ups either except that he might be less likely to doze off, but I suppose it's about being able to measure intake. I did wonder about pumping to stimulate supply though.

OP I could have written your post, my DS is exactly the same and on the same centiles as yours. I’m not worried, I was always a tall (tallest girl in the class until I was around 14/15 and everyone started catching up) but skinny kid. I was an absolute beanpole but ate like a horse. I think DS takes after me. He eats when he’s hungry, is happy, alert, developing loads and is getting stronger by the day so I’m really not concerned. Unless there are other issues with your baby’s development or growth, I really wouldn’t be too worried.

Thank you Medium and others with long thin babies, that makes me feel a lot better. I always thought you were supposed to look at the baby not the scales and DS seems to be doing great. People are always commenting on how alert he is, how strong his neck muscles are, how smiley he is... I really can't believe he's hungry or underfed. He's just...long.

I think I'll try a week of offering to feed more, compressions when he seems drowsy, minimising distractions when feeding and lots and lots of snacks and water for me and see how he gains. And research pumps and EBF top-ups so I can propose that instead of formula if the Dr isn't happy at the next check-up.

You can also try keeping him awake for longer. Take the nipple away as he starts to fall asleep.

Your boobs won’t be empty in the evening. Mine feel super soft but DS definitely gets milk.

Lactation consultant said to me that the softer your breasts feel the richer the milk is.

Thanks for confirming that Sexnotgender . The galactalogues are definitely working as boobs are bigger again, whether they were actually needed I'm not sure.

I do try keeping DS awake but he is quite resistent when he wants to sleep (not every feed but after most), he does keep sucking (and I think swallowing, not just for comfort) when he's dozing though.