4 Mo. Old Not Gaining Weight

Due to a relocation, I had a different pediatrician for each of my two oldest. The first was a huge proponant of breast feeding, and said no solid foods (nothing other than breast milk) until 6 months. The second said to begin solids (starting with cereal) at 4 months. You might want to try a little cereal and see what happens. The experts seem to be split on this, so my motto is "whatever works for my baby."

My son was the same when he was born. He was born like the 85th or so precentile. But about 4 months out, he started to level out, so he dropped into the 25th precentile. I did not change much in his diet, just followed his lead- It went back up to 55%.
So don't worry. Maybe feeding him some beginning solid foods, esp right before bed, will help him sleep through the night.
Hope this helps.

Hi E.,

My name is J. Simpson and I am a lactation consultant in Sacramento. Let me give you the facts on what should be happening.

First - babies should be gaining somewhere around 5-7 ounces per week on average from birth to 4 months - then it drops down a bit. Had you called me I'd be asking you LOTS of questions because gaining 10 ounces in 8 weeks is not enough.

Second - yes babies follow their own growth curve and sometimes they do drop a bit - but 75% to 25% is a large drop and worth trusting your gut to look into.

Third - No there is nothing wrong with your milk. But clearly something is going on here. so let's take a look at some things that can set up a situation like yours (one I have worked with many moms on over the last 14 yrs being in practice).

A) have you started birth control pills in the past 2 months? Any birth control pill that contains any amount of estrogen WILL compromise your milk supply. Birth control pills that are progesterone only (mini-pill)can cause issues with milk supply - amount and fat content can be changed and we do have research that backs this up. I have worked with too many moms who were started on the mini-pill only to have to go off due to the side-effects to their milk supply and content.

B) Allergy meds - or medications for colds that contain antihistamines or pseudephedrine. These can dry up or significantly reduce the supply if taken continually for several days.

C) Scheduling the baby's feeds - many parenting 'programs' strongly (and wrongly) encourage Parent Directed Feedings or rigid scheduling of babies feedings. These can be quite harmful to the baby and the milk supply. Babies need to eat 8-12 times (or more for some) in 24 hours. Waking at night to feed is 100% normal - go with it. If he wakes, feed him. :) Take a look at your feeding routine - are you imposing a schedule on him or are you working with his cues and supporting his need to eat when he needs? When we rigidly enforce a feeding schedule we can inadvertently reduce feedings and therefore intake by baby. Reducing the intake by baby results in reducing our supply - both of which will reduce baby's weight gain...

Please, Please - talk to a Lactation Consultant in your area or feel free to call me at ###-###-#### (no charge for a phone consult!). Trust your gut here: It sounds like your gut is saying something isn't quite right here - listen to that - don't blow it off. And I have worked with Dr's who blew off mom's concerns about their baby's weight gain when the baby was clearly having weight gain issues (how does a 4 month old gaining only 2 ounces in 4 weeks NOT raise a red flag??). Peds mean well, but not all will catch that a baby/mom is having a struggle - this comes directly from 3 of my clients who are pediatricians. :) They just don't see you often enough and often times don't have the time to really sit down and read the charts...

Lastly, I've been in your shoes - many years ago with baby #1. I wasn't taught to trust my gut - and so I believed all the Dr's told me - knowing inside that something just wasn't right. They say hind-sight is 20-20...boy is it! Had I known then what I know now...things would have been a lot different. :) So, trust yourself and call me if you like.

Warmly,
J. Simpson, IBCLC, CIIM
Breastfeeding Network
www.breastfeedingnetwork.net
###-###-####

E., make sure that your pediatrician is using the World Health Organization charts for breastfed babies that were revised and published in April 2007. You can find them on http://www.kellymom.com/ , which is my favorite breastfeeding info site ever. Many doctors are still using the decades old growth charts that are based on babies being formula fed, and not breastfed, and don't know about the new ones. My little girl went from the 25% percentile to 55% percentile in weight once I checked these. Isabella is also a huge nightime eater--feeding your baby on demand and not scheduling may help with the sleeping issues, since your baby may be waking up because he's hungry.

Your milk is probably fine, but lactation consultants are great in helping to check your milk supply and whether the baby is getting enough too.

It sounds like your four-month old is doing exactly what a breast-fed baby his age SHOULD be doing! He's going to change his sleeping patterns around his whole life, so there's not need to be concerned about night-waking, though it is really tiring!! Breast-fed babes have a different rate of growth than formula fed babes. The growth charts are made for formula fed children, who gain weight much differently than breast-fed infants. Breast-fed babes gain a lot of weight very quickly initially, and tend to taper off at a much slower rate of weight gain or "drop-off" the chart around 4-6 months. Formula-fed babes gain weight a little more slowly at the beginning, and continue a steady increase from there, because the nutrients in formula don't change to meet the ever-changing needs of your growing baby. Unless you see poops less than once a week, or he starts to act dehydrated ( sallow skin, glassy eyes, very lethargic consistently) I would say this is what is supposed to happen at his age. Imagine if we all continued to gain an ounce a day! Congrats on your baby! I would not recommend formula at all, there is NOTHING wrong with your milk!
Additionally, Health Education Associates makes a growth chart specifically for breast-fed babies. It's amazing how different their growth rates are!

E.,

I have 2 boys one is 2 and the other 7 months. Both were very slow weight gainers in the beginning. The Dr.s always had be worried that they weren't getting enough because I was breastfeeding. I supplimented with formula with my older son but didn't want to do so with my 7 month old. My 7 month old would only gain 2-3 oz a week, but my Dr said since he was gaining he was ok (he is now in the 90th %). So, I wouldn't worry too much unless he start losing weight or staying the same.

However, have you tried pumping after you nurse him to see if he is eating everything? I really doubt there is something "wrong" with your milk. If you have concerns you could also go to a lactation consultant. I went to BEST with my older son and they would weigh him before I breastfed then again when I was done and they could tell exactly how much he ate. It is comforting to know how much they are actually getting.

Good luck!

Is your doctor concerned? Don't go around *finding* things to worry about, dear!! My son is/always has been a tiny thing (6yo and 32 lbs) and I can worry endlessly over it, or I can rejoice in how wonderful and special he is.

Weight is only a concern when there is sudden unexplained weight loss or a reversal in weight gain. (If your baby got sick and was throwing up/ having diahrrea for a week, of course he'd lose weight, that's not unexplained weight loss to be concerned about.)

If your child is alert, healthy, active, eating, gaining (even just a little bit very slowly), HE IS FINE.

The weight charts are skewed because there are so many fat heavy babies out there that it makes the lightweight ones so low on the percentile.

Just keep feeding him. He's 4 months old so in the next couple of months he'll be ready for cereal. He may or may not like it, or he'll like it but only eat 4 bites and be full. That's ok too (my son never ate much! I didnt bother buying baby food jars cuz he never finished them off, but made my own food for him, which he liked and I didnt feel was so wasteful.)

I wouldn't worry unless the doctor is worried. Percentile ranking just compare your baby to OTHER babies. Or pediatrician was always more concerned with our sons OWN growth curve. Between birth and 2 he fluctuated between the 20th and 60th percentiles for weight although his own growth stayed steady. He was born long and lean and has stayed that way... now that other kids have started to thin out at toddlers, his weight is normal, as an infant it was lower than theirs, but he was always gaining normally for himself and hitting developmental milestones, so we were told not to worry.

I hope this helps. Talk to your ped. if you are still concerned.

Good luck and happy mommying,
T.

As the mom of a preemie who was born at 2 lbs, 6 oz, and who had digestive difficulty, my understanding from both our pediatrician and the two ped GIs we saw is that your baby stays on his own growth curve. Our now five year-old son is only 36 pounds, and we don't worry about his percentile, but we do worry about his staying on his growth curve. What did the ped say? Did he/she show you your son's actual growth curve? It sounds to me like there could be an issue. You might want to get a second opinion if the pediatrician did not seem concerned. It's true that there are so many overweight children that it's not necessarily a bad thing for a child to be on the light side. However, that does not mean that it's okay for children to fall off their own growth curve. I'm not entirely certain, how concerned to be with what was a larger than average baby slimming down, as my son has never weighed very much! I do think you need to have a good convo with a doc you trust, though. With our son, we mixed formula that is specially made for preemies into a bottle of my breastmilk and fed him that. You might want to talk to the doc about fortifying your breastmilk *if* he/she thinks your son's weight is a problem. However, please do not do this w/out a doc's supervision. If you overload what your son is drinking, you could overtax his kidneys, which is quite dangerous. Also, if the doc thinks there is a problem, it could be with your son's digestion, not necessarily your milk. Again, if your son started off as a particularly rolly-polly baby, this change might not be a problem. Ask the doc to see your son's growth curve and discuss it with you. Best!

Was the doctor concerned? Follow your ped's cues -- if they say it's normal, then try to relax. If they want you to try other things to encourage growth, then use their guidance. Generally speaking, infants go through growth spurts at random times and may surge ahead then slow down. And a growth spurt may come after unusual midnight feedings, so he may be getting ready to burst back up to the 75th percentile. If he continues to drop in terms of percentages over to the next well-baby, then it may be something to look at.

E.,

Don't stress! My son has always been tiny (we've just broken the 2-digit mark in his weight percentile and he's 15 months) and my pediatrician was referring us to nutritionists, asking that I keep a food journal for my son, and giving me the look of disdain at every well baby check. We did everything that was asked and the nutritionist said that everything was fine. You just want to make sure that your son is getting enough to eat and all of the vitamins he needs.

Children are so different from one another and sometimes you may feel like you aren't doing the best job you can when you fixate on the numbers, but remember that the designation your doctor charts your son's growth at is comparative. Just like their motor skill development, their growth will fluctuate. Keep him happy, well-fed, and follow your intuition.

As for waking in the night, there is nothing wrong with your milk as long as you are eating healthy foods and eating regularly (nearly half your calorie intake is going to your baby). You may want to start him on solids if you haven't already. We were feeding our son Gerber 1s and 2s along with rice cereal mixed with breastmilk beginning at about 2.5 months. Diet will not necessarily affect his sleep patterns, though it may help him sleep more fitfully when he does. They hit growth spurts, teethe, and become restless, so just go at his pace and let him work out whatever has him waking on his own. Just don't go running in to entertain him wen he wakes in the wee small hours or you may create a routine you wish to avoid...

Good luck and roll with the punches.

Did your doctor seem concerened? I stopped producing enough milk when my son was 6 months old. I could still express some but not enough and he began to loss weight. However when we offered him a bottle he took it right away because he was hungry. Of course my older two never took a bottle no matter what I tried. Some kids are just small and don't gain weight for a time. Have you tried pumping to see how much milk you are making? If you feel your supply is too low there are some herbal supplements you can take to try to increase the supply. Hope this helps.

Hi E.,
The same exact thing happened to my son. He wasn't gaining weight after being born at 8lb, 10oz and getting to 10lbs really quickly. He actually lost weight. He was also exclusively breastfed. I added formula which he took and that didn't help at all. I ended up having to introduce rice cereal to him at 5 months (it was at 4 1/2 months we started trying different things with him). Turns out, he loved it, and although he didn't cry or fuss to be nursed more, apparently he was not getting enough nutrition to grow. He was hungry. And he started sleeping through the night again and of course gained weight. I know we are told that you introduce solid foods at 6 months (as I did with my daughter), but all kids are different. I had to get over that thought and after I did, we were all much happier. In the meantime, my son did go through tests just in case ie: blood test. That's no fun, but the MD wanted to rule out other things. Good luck.

Hi E.,
Is your doctor concerned? If not, then don't worry about it. The thing about percentiles is that they are just numbers. Half the kids will be above 50, half the kids will be below - it's really not important. My youngest child (now 3.5) was born 8 pounds and was above the 75th percentile for weight until 6 months. Then at her 9 month visit she was in the 25th percentile, and that is where she's stayed ever since! She's perfectly healthy, just small. (Which has caused me a huge amount of concern because both my husband and I, and our older daughter, are all tall.) But - the doctor says that the most important thing is that she IS growing, just at her own pace. So if your baby is happy, has rosy cheeks, and is developing normally, I wouldn't change anything. It sounds like you are doing a great job, with him sleeping well and you exclusively breastfeeding! Keep up the good work, mama! =)

Good morning,
My child was the same - just a little pipsqueak - not gaining much weight, waking up repeatedly - my doctor recommended starting her on a little rice cereal. A tiny tablespoon in a little bowl with breastmilk to make it really soupy. As your baby accepts it, you can add a little more and then start adding different foods, one a week and at a time. If your baby does not accept it from a spoon (the reflex to suck might confuse his ability to eat from a spoon and not push the food back out constantly at this point) you can add a pinch of this to a bottle of breastmilk. I know it is totally taboo, but if this is what your baby needs and if your dr is okay with it - everyone will thrive. This worked great for us and my child is now a robust girl at seven months...not fat, just growing very nicely. Of course, this was my doctors advice and definitely check with yours first. I wish you the best.

My daughter (now 16 -- 5' 3 1/2 and 120 pounds) also slowed down around 4 - 5 months. She was full term but just around 6 pounds at birth. I think at age one she was about 18 pounds. The doctor wasn't too concerned at her 6 month check up, but said that if it continued we would have to look into it.

In my daughter's case (I was just breast feeding her) when I started feeding her rice cereal mixed with formula I noticed that she broke into hives when the formuala (or milk) touched her skin. For the next few months, while I was still breastfeeding her, I stayed away from dairy products. Not only did she gain weight again, but she wasn't fussy anymore. (no more long crying sessions when trying to get her to sleep).

Good luck.

was your dr. concerned. If you are eating very healty, baby should be getting the nutrition, remember you are eating for 2 so what use to be enough for you might not be enough for both. also let baby eat whenever any time, to get weight back up. this is hard baby needs to eat at night as well. if you diet so is baby!

I would listen to your doctor. If he was not concerned with the weight percentile drop then don't worry about it. If he was concerned then he should have given you some ideas of how to help the situation. You could always contact some one from the LLL (Le lache leage) and they maybe able to give you some suggestions.

This happens with babies but if the failure to gain weight continues, I'd ask the pediatrician about gluten intolerance and celiac disease. Many doctors think it is uncommon but it can be a cause of failure to gain weight in babies. Especially if the baby seems to have stomach upset during the day or waking him up at night. Infants can get gluten throught the mother's breast milk even before they begin to eat solids. Gluten (found in wheat, rye barley and oats) is often present in formulas if your baby was ever supplemented. You can search "infant gluten intolerance symptoms" online and see what you find. Here's one artilce with a little info: http://health.yahoo.com/digestive-overview/celiac-disease...

Good luck!

Hi E.,
All I can say is I would be concerned too. PLEASE give Jaye Simpson (other mom who answered) a call. She is very knowledgeable in the area of breastfeeding and I'm sure she could help you. You didn't mention if you were feeding him on a schedule or on demand. Everything I've ever read says to feed a baby (especially this young) on demand. As long as it is just breastmilk or formula, a baby won't over eat. Call Jaye, she can help or point you in the right direction.
Sincerely,
L.

Call your pediatrician's office to make an appointment or talk to the nurse or a lactation specialist. It is unusual for a breatsfed baby to lose that much weight at that age. Normally babies continue to gain weight until they start being mobile...rolling, crawling, etc. It is also unusual for a breastfed baby that young to be sleeping through the night. If he is waking at night, he may be hungry. All babies go through growth spurts and change their sleep habits. But I would really talk to your baby's doctor.

I would increase the amount of breastfeedings per day. I have found fenugreek helpful to increase the supply . with both of my kids. You can pick it up at any local vitamins shop such as GNC. Be sure to drink a TON of water with it. My lactation consultant recommended 3 pills 3 times a day for 3-5 days to increase supply. Your baby is probably waking up at night because he is growing and is needing more calories. As much as we struggle to get our kids on a schedule, it is my experience to let a breastfed baby set the pace with his feedings. My daughter is 7 weeks old right now and it seems she is always on the breast! Sometimes you might find that he wants to eat every hour....roll with it. Your baby may also have just "streched out" and is needing to chunk up again before the next growth spurt. Having worked in pediatrics for 15 years, we frequently saw this pattern in babies. As long as your doctor is not worried about your son's growth and development, I would wait to see how his growth is at his 6 month check up. If he still is falling off the chart (below the 5th percentile), your pediatrician will look more closely into reasons why that may be happening. Always remember that your breastmilk is genetically PERFECT for your baby and that he gets everything he needs from it.

My son is also in the lower end of the spectrum... about the 15th percentile. I would say don't worry... as my doctor so eloquently put it... "we have enough fat babies in this world"

There is nothing wrong with your milk and it's normal for babies to want to eat in the middle of the night if they are the lower end of the percents. Remember that these imposed percentiles are based on the current trend of babies. So don't sweat your child not being in the 99th percentile... that would mean your baby is a roly poly and it would be harder for him to learn to crawl and walk. My son is 8 months and pulling himself to stand. He "walks" if he is being held up by the arms.

Trust your gut! My daughter was full term and weighed 6 lbs 7 oz when born. She tracked the growth curves well until about 5 months of age. The doctor wasn't worried but had us come in every 6 weeks for a height & weight check. My daughter gained but very slowly. She also started to suffer from severe constipation. Still the doctor was not worried and then went on maternity leave. At my daughter's 18 month check up the new pediatrician immediately diagnosed my daughter with failure to thrive. To make a long story short, my daughter had VU Reflux that resulted in undiagnosed urinary track infections and now she has Stage 3 kidney disease. TRUST YOUR GUT get a second opinion or at least a blood test!

How many times a day is your baby nursing? If your baby is sleeping to much during the day, wake him up to breastfeed. You might try when he wakes up at night to nurse him.
You are very lucky your baby sleeps through the night. This could be the cause of the slow weight gain. If you are worried wake him to feed him.
Did you talk to the Doctor about this? If he is not concerned, you should not be. your baby is gaining wait just not alot. You should only be concerened that your milk is not enough if he starts to lose weight! But he is not so you should be fine.

Good luck!

As my pediatrician said with my daughter: they all follow their own curve. If the doctor's not worried, you shouldn't be. The waking may be teething or a growth spurt making him hungry. If you plan to keep exclusively breastfeeding, I wouldn't try the formula: your body will adjust to your baby's needs. Rest when you can and eat well, and your milk will be fine fine fine! I am guessing that as long as he is gaining weight, there's no worry. As far as introducing a bottle: do it when he is hungry, not after a meal, and perhaps try it from someone else (not next to your yummy smelling food source!)

if you are offering him formula, then he is not exclusively breastfed. nurse him when he is hungry and he will grow. maybe he grew in length during the past 2 months? 10oz is a pretty significant percentage for little babies.

Dear E.,
My daughter was always tiny too. I worried about it way more than the doctor did. She only weighed 12 pounds at a year old but she thrived in every other way. She was a wonderful eater, and walked at 7 months. She was just little. No anemia or any other problems. Just little.
My daughter cried everytime she could smell me cooking and I figured out she wanted to eat some real food. By 7 months she was eating cream of wheat, scrambled eggs, mashed potatoes and gravy....she wanted to eat so I let her. All babies are different, but if your doctor thinks your baby is doing well according to HIS OWN growth curve, I'm sure he'll be fine. Try to introduce some cereals or pureed fruit at first and see what happens.

Best of wishes!