Help! My Baby Isn’t Gaining Weight

It’s a story that has been told time after time. A mom leaves her pediatrician’s office in tears. “My baby isn’t gaining weight, they told me I have to use formula” is often the phrase we hear. Moms are often upset, sad, angry, and confused. “I thought everything was fine!” “she acts so happy” “he’s hitting all the milestones!” 

So what is a mom to do if she is told by her pediatrician her baby isn’t gaining weight?

This shows an example of a baby
who has stopped gaining weight

Step 1: Evaluate your baby’s weight gain from birth to current.

The first thing to do is look at a detailed weight history. Look at the scales and other factors when all weights were taken. Was baby naked? Was it a different scale? Remember that birth weight can sometimes be inflated, it is best to go from the lowest recorded weight when looking at weight gain.

Is your pediatrician using a correct growth chart? Often times a pediatrician will use an incorrect growth chart when assessing a baby’s weight. Remember that the WHO growth chart is to be used for breastfed babies. Sometimes a pediatrician will say there is a problem when there is none just because of this factor.

Is your baby staying on their growth curve? This is important. Some pediatricians feel a baby should “catch up” and get to the 50% even if they are born in the 5%.  This simply does not happen typically. A baby should stay in the same % range and follow a growth curve. A baby in the 5% who stays in the 5% is fine. A baby who starts in the 50% and drops to the 5% suddenly is a concern.

Has anything changed between the last visit and now? An illness? A change in behavior?  Did mom go back to work?

Evaluate how often your baby is nursing. Is your baby under 6 months nursing at least 8 times a day? Are you offering both breasts each time you nurse? Before 6 months a baby should be nursing at a minimum 8 times a day and be offered both breasts each time.  While a baby may not take both breasts, they should both be offered.  A baby struggling with weight gain needs to be nursing more: 10 – 12 times at least.

A breastfed baby should gain 5 – 8oz per week in the first 4 months of life. From 4 – 6 months a baby should gain 3 – 5oz, and from 6 – 12 months 2 – 4oz per week. http://kellymom.com/bf/normal/weight-gain/ Gaining outside of this range would be a cause for concern and further investigation.

So, you have determined there is an issue. Your baby is not gaining weight appropriately for their age. They are falling off their growth curve. What do you do?

Step 2: Meet with an IBCLC

Most pediatricians are NOT trained in lactation. In fact some may have never taken a single class. While a pediatrician is great to help you with general health questions, for breastfeeding concerns you need to be working with an IBCLC. You can locate one near you using this website: http://www.ilca.org/i4a/pages/index.cfm?pageid=3432

A good IBCLC will do a variety of things. They will watch you nurse,  assess latch and transfer, and do a weighted feed. They also should check for a lip or tongue tie and if they are concerned refer you to a specialist for further help.

What is a lip or tongue tie? This site from Breastfeeding USA explains it nicely: https://breastfeedingusa.org/content/article/tell-me-about-tongue-ties Ties are often the reason for poor weight gain in a baby. They can cause poor milk transfer which means that even if you are nursing enough your baby may not be transferring milk well. Many times mom think if a baby doesn’t gain it must be the milk, but often times that is simply not the case. This is especially true with a baby who shows a sudden drop in weight gain around 4 -6  months.  At this point supply regulates so baby has to work harder for the milk. It also means that your supply has regulated to what your baby is taking, and if there is a tie they are not transferring efficiently. If your LC doesn’t check for a tie or you still have concerns of a tie, get a second opinion. Signs of a tie could include poor weight gain, clicking whe nursing, a shallow latch, extreme nipple pain, cracked bleeding nipples, and a lip stick shaped nipple. This facebook group is an excellent resource: https://www.facebook.com/groups/tonguetiebabies/ The procedure to correct a tie is quick and minor and can be done in a matter of minutes in a doctor office.

But what can I do in the meantime?

Step 3 – NURSE NURSE NURSE

Sometimes you may not be able to meet with an IBCLC right away. There could be a waiting period of a few days. The same is true of a specialist to check for ties. In the meantime, there are a few things you can do to help your baby get more milk.

1 – Nurse. Nurse every 2 – 3 hours in the day and at least every 3 hours overnight. Sometimes babies who don’t gain well are sleepy to conserve energy. They need to be woken to eat. Make sure to offer both breasts each time you nurse.

2- Pump. Pump after every nursing session.  If your baby isn’t gaining well and an IBCLC suggests you need to supplement, you can do so with your own pumped milk. Remember: Pumping .5 – 2 oz combined after nursing is totally normal. If your baby is older and you haven’t pumped recently you can expect to get less. Make sure your pump is working correctly and your flanges fit right. Over time your body will produce more to feed the pump.

3 – Do breast compressions while you are nursing or pumping. Breast compressions help get the most milk out. If your baby can’t latch and transfer well, it helps make it easier for them.

The take away here is that poor weight gain is a serious issue. Sometimes it is quickly resolved with more nursing sessions and offering both breasts each time. Other times the issue is related to transfer, latch, or in rare cases true low milk supply.  In very extreme cases a baby may have a medical disorder that prevents them from gaining weight. Often moms who have a baby gaining slowly are told “Its normal” or given advice to just “take X supplement”. While the advice means well, it does not help identify the underlying issue. If your baby is not gaining appropriately for their age you need to be working with your doctor and IBCLC to come up with a plan to help your baby gain. Weight gain in infants is crucial for brain development. It is a serious concern and needs to be addressed with medical professionals.