Slow Weight Gain
Concerns about infant weight gain are common and often take a collaborative approach between your health care provider and lactation consultant to address. I'm going to explain some of the common reasons we might see slow weight gain in breastfed babies, this list is by no means exhaustive.
There are many things that could be contributing to a baby feeding poorly - poor latch making it hard for baby to sustain an effective suck? Premature baby needing extra support? Sleepy baby due to poor intake and low energy?
As you might guess, the ways we address each of these things is entirely different and if your baby is truly not getting enough to eat, there's no time for messing around. For this reason, it's difficult to give blanket recommendations and I highly recommend you seak expert advice from an IBCLC.
Once your situation has been evaluated, here are a few resources:
Premies: Breastfeeding by La Leche League International
KellyMom: How might I increase my baby's weight gain?
Both of these resources speak about simple things that will benefit all parents and babies, including: skin-to-skin contact, babywearing and responsive feeding based on baby's cues. Which leads me to my next topic...
Not Feeding Frequently Enough
Most commonly, the reason I see babies not gaining weight well is that baby is not feeding frequently enough. This happens for so many reasons, many of which stem from poor breastfeeding advice and a lack of education about what is 'normal' behavior for a breastfeeding baby.
Watch your baby, not the clock
Babies are meant to feed frequently. In order to give parents a frame of reference, many professionals now say something like, "Your baby will need to eat 8-12 times in 24 hours". But, what is not explained, is that this does NOT translate to: "Your baby will eat every 2-3 hours". But, why?
Especially in the early days of breastfeeding, babies have small stomachs and are taking very small amounts at each feeding. Breastmilk is highly digestible and to meet the daily caloric needs of a growing baby, they need to eat frequently. As babies adjust to this new world, there will naturally be times of the day where they are more alert and cue to eat frequently and then times of the day where they sleep for longer stretches. By following our baby's cues, we can trust that they will help us determine when they need to eat. As long as this pattern adds up to at least 8-12 feedings in 24 hours, most babies will gain weight well.
Keep in mind that all babies are different. One baby might gain well on 8 feedings/day while another may need considerably more. If you're feeding your baby on cue, 8-12 times in 24 hours and still struggling with your baby gaining weight, contact an IBCLC who can help determine if low milk supply or a different issue could be present.
Do you know what infant hunger cues are? Here is a good video that shows: Newborn Hunger Cues
If your baby is showing these cues, it's ALWAYS the right time to offer the breast. There's no such thing as your baby 'using you as a pacifier'. It's true that sometimes your baby will be at the breast for nutrition and sometimes more for comfort, but that's all part of a healthy breastfeeding relationship. Once breastfeeding is well established and we know that weight gain is on track, it's alright to use a pacifier. But, especially in the early days, any time you're offering a pacifier, first ask yourself, "Are these hunger cues? Should I be offering the breast instead?"
What if my baby is not waking to feed?
There are certain times when a baby may not be waking to feed frequently enough. This usually happens in the very early weeks or can sometimes go on for longer with babies born prematurely or with other medical conditions. If this is your baby, I encourage you to work closely with your baby's health care team to develop a feeding plan that works for you.
If your baby was born full-term (or close to it) and is healthy, but simply isn't waking to feed in the first several weeks, I recommend that you spend as much time skin-to-skin with baby on your chest as possible. It's possible that your baby is 'cueing' to feed but just isn't as vocal about it and so cues are being missed. Having them on your chest allows you to see and feel those cues right away. Keep your baby close to you both during the day and at night. Having your baby wrapped up in a bassinet or crib in another room is a good way to miss feeding cues. You may need to wake your baby to feed for the first several weeks, again, aim for 8-12 feedings in 24 hours. If your baby will not breastfeed even when woken, you will need to feed your baby another way (syringe, cup or bottle) while you seek further help.
Be wary of baby sleeping through the night too soon
I realize that sleep is a tough topic for many parents with babies and young children. Nobody likes to lose sleep, I get it.
The problem comes when we expect or want our babies to sleep through the night before they're developmentally ready. Some babies will sleep through the night sooner than others, naturally. If you're feeding on cue and your baby is gaining weight well and he or she starts sleeping through the night, it's probably fine to trust that your baby's ready for that and will continue to grow appropriately! But, we also need to realize that it's biologically normal for babies to feed during the night for well over 12 months in many cases.
Every family will need to decide for themselves how they're going to approach sleep. For the sake of breastfeeding and healthy infant weight gain, I highly recommend that you steer clear of any sort of 'sleep training' method/system/etc. that advocates for feeding and putting your baby to sleep on a set schedule for at least the first 6 months. During these first 6 months, milk is your baby's ONLY form of nutrition. And while these programs make all sorts of claims that they're 'breastfeeding friendly', in actuality, very few are.
I've seen it happen more than once, where a family follows a program meant to help their baby sleep better and it 'works' in that the baby eats and sleeps according to the recommended schedule. However, the baby is not gaining weight well, even while eating about 8 times in 24 hours. This baby happens to be one that needs to eat more frequently, even though another baby might do OK on this schedule! The problem is once this baby has gotten onto such a schedule and is not gaining weight well, it can be hard to get them back on track.
Babies who aren't getting enough to eat, can also stop waking often enough to eat because they're trying to conserve energy. These babies may need more aggressive feeding routines and even supplementation to get them back on the right track.
My healthcare provider says I need to give formula
There are certainly times that formula supplementation is necessary and even lifesaving. If you go to see your child's healthcare provider and they are concerned about your baby and tell you to start supplementing with formula, you should listen to them. But, you should also ask questions and make sure that you understand what the concern is and what other options might be!
It’s very common for supplementation with formula to be the standard response by some health care providers for a baby that’s not gaining weight effectively on breast milk without a thorough assessment of the breastfeeding routine being done. Sometimes, a few tweaks to a breastfeeding routine is all it takes to get a baby back on track and gaining well!
An IBCLC can help you figure this situation out. We have the ability to do pre and post feed weights (on a specialized scale) to assess how much milk is being taken with a feeding and help you look at the big picture to develop a plan to get baby what he or she needs while being sensitive to and supportive of your breastfeeding goals at the same time.