How much weight should a mostly breastfed baby be gaining?

[elkiedee]

Long post, sorry, with background - I failed breastfeeding with ds1 in 2007 and was very anxious to do better with ds2 born last month. DS2 was born at 4.5 kg (nearly 10 lbs) by emergency CS and while he was quite well at birth, I wasn't, which made focusing on establishing feeding much harder. We went home on day 4, on day 5 the midwife discovered he'd lost more than 10% of his birthweight, and on day 6 he'd dropped even more, apparently a record amount of weight in total. He'd not become ill but probably would have done, and he was taken back into hospital (this happened with ds1 who also had jaundice and was much smaller to begin with, by the time we got out after 8 days he was essentially bottlefed).

This time round a breastfeeding counsellor from the postnatal ward came to see us every day in the ward, and I got him feeding better, but his weight gain on exclusive bf remained very slow and after 6 days in hospital we were told to give formula top ups after every feed. He started to gain a bit and we were allowed out on home leave 3 days later - 2 weeks after birth, and after 9 days. We had to go to the hospital every day at first but now down to once a week.

Just over 3 weeks later, have managed to maintain breastfeeding and am hoping to be able to go back to doing so exclusively - he only had about 3 top ups a day/night last week and only 2 a day this week. Two paediatricians saw him at the hospital last Thursday - the first who'd met us before seemed happy with his general condition, but the second told me he should be putting on 50g a day - this is 350G a week. His actual gain last week was 130g - under 20g a day.

350g seems very high and I suspect it's a figure based on formula. On Tuesday this week, 5 weeks old, he was weighed at the local health centre - different scales - but was just over 5 kg (over 11lb) and his weight gain if that's accurate would have been about 30g per day. We were seen by our health visitor who is fairly sympathetic to breastfeeding and even she said the hospital were "mad".

I'm bf on demand and I'm quite hazy on intervals between feeds and their length (very variable but often intervals during the day are quite short, length can be a 5 minute snack or half an hour or more sucking). I'm asking dp to do the top ups, because they're always preceded by bf.

Would welcome an idea of reasonable weight gain for a large at birth, mostly breastfed baby at 5 weeks, and advice on how to handle the conversations with the paediatricians.

bump

My health visitor said for the first three months anything between 4 and 8 ounces a week is normal (sorry I'm crap at conversions). I think 4 ounces is about 115g and 8 is about 225g. 350g does seem like a lot (that's about 12 ounces I think). Kellymom seems to suggest between 5 and 8 ounces a week:www.kellymom.com/babyconcerns/growth/weight-gain.html

Perhaps the paediatrician is wanting him to gain additional weight to catch up? If so they should be explaining to you why. The unfortunate thing that seems quite common among various medics/health visitors/ midwifes/etc. is that they can give different information. Just keep asking as many questions as you need at the time and don't be afraid to say that you've been told different and can they clarify things. Perhaps even ask for a contact number in case you have additional questions once you're home.

Sounds like you are doing brilliantly though. Remember that formula top-ups don't need to go on forever if you can increase your milk supply. Let us know how you get on.

Hi Elkie

I have similar problems with my first two (over 10% weight loss, followed my failure to regain to birth weight by 6 weeks).

What I write below is based solely on my experience and any "knowledge" that I have is just my own view - and you may wish to check with a paed./gp/b'f cousellor.

This time however(DC3, 10 weeks birth weight 8lb14oz/4.050kg) she dropped over 10% before day 3 (so before my milk even came in). She is now gaining about 150grams per week - and everyone seems happy with that. She was born on 75th centile - but GP and paeds said her birthweight probably "flattered" her and she is most likely a 50th girl. She is now tracking slightly below the 50th but gaining in a general curve.

To do this - I feed on a GF schedule (or sooner, if demanded - but never later than that, if that makes sense). I found that purely on demand my kids just don't demand often enough. I know GF is very unpopular with bf experts etc but for me I find it strikes balance between constant snacking which for me means they never seem to get a good hearty feed - and going too long between feeds and not gaining.

I do follow those timings and make sure DD stays on breast for at least 45 mins to an hour - lots of non-nutritive sucking which helps supply. I also use the Kari-me sling a lot which helps supply (as its essentially skin to skin). I tried taking Fengreek to boost my supply but found it gave me and DD very sore windy tummies. Have you tried it? It does often have very good immediate effects. Because I couldn't take Fenugreek I do take Motilium (Domperidone) but you shouldn't do this unless told to my a lactation consultant. I follow the Dr Newman protocol on Domperidone - see his website for that and protocol for increasing supply. Its a great resource. I also constantly check latch. The best way of getting good supply is efficient removal of milk - the more they remove, the more you make.... Again Dr Newman has great videos and tips for good latching.

Sorry if this is a bit rambling. I have never heard of a baby supposed to be gaining 350g a week. Upper end is about 250g I think. Sounds (but I have not seen your babe) that he is doing well. If he has lots of wets and poos, is settled and happy then the gain you describe seems good. You may want to consider bringing him to the breast more if he is going more than 2-3 hours between feeds. I would ask the paed to show you the source of his requirement that your DC sould gain 350. Sounds like you are doing great and should be able to drop the top ups soon. How is your DC's gain on the centiles in your red book. Is he gaining in a general curve (need not be his actual birth centile apparently)?

here is the link to Dr jack Newman website. Fab in my view Dr Jack Newman

elkie if supply is the issue and you want fenugreek then I have some I can send you - bought two huge tubs last time - no one could get through that many but they were on offer! Still in date and sealed.

Thanks for the offer spb, I don't think supply is the issue and I have an unopened jar of fenugreek tablets that I bought last time when I was still attempting to express and reestablish breastfeeding.

spb I am up for that fenugreek if the offer still stands - I have a ds who is slow to grow also.

elkiedee - you have already had a few medical opinions, which show you that not everyone would agree with the 2nd paed, who is the only one with this rather odd idea that babies 'should' gain 50g a day. I have never heard this, and if you are concerned you need to ask why this figure has been settled on. Tell the paeds yu have had different advice.

Clearly for whatever reason bf did not get off to a great start, but from what you say you have overcome it.

There are ways of increasing your baby's intake of breastmilk - feeding more often, inc at night, 'switch nursing', breast compression. Maybe call one of the helplines and talk about these?

sorry, didn't see your post!
Yes, no problem, CAT me or email on Kate Fallon 44 @ hotmail . com and I'll send it soon.

Have emailed - look forward to hearing from you!

Sorry I haven't had a chance to do this yet - will do it tomorrow!

I'm a bit down as ds was weighed this morning - he's gaining but it's even slower than before - 130 g in 10 days compared to 130 g in 7 days, then 150 g in the following 5. I suspect if things don't pick up I'm going to be pushed into giving a higher number of top ups by the hospital. He seems generally well otherwise - alert etc when awake and far more dirty nappies than he was having when having top ups - I haven't topped up at all for about a week. They're a bit green in colour and I'm wondering about the possibility of something mentioned on another thread, not in relation to me, that he's getting foremilk and not enough hindmilk. He feeds very frequently, sometimes for a long time but sometimes just a few minutes.

I'm not even sure I'm looking for further advice at this stage or for a moan/some sympathy.

elkie, sorry you feel so low.

I have read your posts and I can't see what there is for the HCPs to be concerned about - I don't understand why the hospital is still involved in your baby's care...perhaps you have missed something out in the history?

Green nappies are normal - all babies have them some time. Its only a sign of something worth thinking about if the baby is ill ('cos it's a sign of gastro infection)or not thriving in some way...and your baby is thriving. Micro-analysing the weight the way you are doing is not helpful - babies do not gain weight at a static rate, and big babies anyway have a tendency to 'catch down' in weight as the weeks go by.

In any case, if there is an issue with weight, you can breastfeed more often, breastfeed with more 'sides' per feed - this gives him the opportunity to take more if he needs it.

I think you have been made to feel under-confident by the paed who talked about 50g a day weight gain. It's just struck me that he may have meant '50g a day when the baby is in dire need of catch up growth after serious weight loss'...no one sensible thinks babies should usually and consistently continue to gain at this rate - it's way over the top of expected weight gain.

Can your HV restore your confidence, I wonder?