Home
> Breastfeeding
> Jack Newman's Breastfeeding
Handouts
Slow weight gain after the first few months
Handout #25: Slow weight gain after the first
few months. January 2005
Written by Jack Newman, MD, FRCPC. © 2005
Introduction
Sometimes, babies who are doing very well with exclusive
breastfeeding alone for the first few months, start not to gain
as well after two to four months. This may be normal, because breastfed
babies do not grow along the same growth curves as formula fed babies,
and it may appear that they grow too slowly, when in fact, it is
the formula fed baby who is growing too quickly. Breastfeeding
is the normal, natural, physiologic way of feeding infants and small
babies. Using the formula feeding baby as the model of normal is
irrational and leads us to make errors in advising mothers about
feeding and growth.
In some cases, an illness
in the baby may result in slower weight gain than is expected.
Supplementing with formula does not cure the illness, and may rob
the baby of the beneficial effects of exclusive breastfeeding. You
can tell when a baby is getting milk and when he is not (see below).
If he is not getting milk well, it is unlikely the baby has an illness,
and more likely the mother’s milk supply is down. The most
common cause of unusually slow weight gain after the first few weeks
or months is that the mother’s milk supply has decreased.
Why would your milk supply decrease?
-
You have gone on the
birth
control pill. If you have, stop the pill. There are other
ways of preventing a pregnancy besides hormones.
-
You are pregnant.
-
You have been trying to stretch out the feedings,
or "train" the baby to sleep through the night. If
this is the case, feed the baby when he is hungry or sucking
his hand.
-
You are using bottles more than occasionally.
Even when the milk supply is well established, frequent bottles
teach the baby a poor latch at a time when the baby expects
rapid flow, even if you are giving the baby only breastmilk
in the bottle. With slow flow, the baby may pull away from the
breast, decreasing time at the breast even more, and decreasing
breastmilk even more.
-
An emotional "shock" can, occasionally,
decrease the milk supply.
-
Sometimes an
illness,
particularly when associated with fever can decrease the milk
supply. So can
mastitis.
Luckily, illness in the mother does not
usually decrease
milk supply.
-
You are doing too much. You don't have to be
a super mother. Let the housework go. Sleep when your baby sleeps.
Let the baby nurse while you sleep.
-
Some medications may decrease milk
supply--some antihistamines (e.g. Bendryl), pseudephedrine (e.g.
Sudafed).
- You are feeding one side only each feeding, so that he gets
the high fat “hindmilk”. Remember, if the baby is
not drinking, he’s not getting any milk and if
he’s not getting any milk, he’s not getting hindmilk.
“Finish” one side and if he wants more, offer the
other.
-
A combination of some of the above.
-
Sometimes the milk supply decreases, particularly
around 3 months for no obvious reason. It is likely, though,
that you will find the reason in the next paragraph.
One more reason requires more explanation. In the
first few weeks, babies tend to fall asleep at the breast when the
flow of milk is slow (this slowing of the flow occurs more rapidly
if the baby is not well latched on, since the baby depends on the
mother’s “letdown” or milk ejection reflex to
get milk). The baby will suck and sleep and suck, without getting
large quantities at this point, but the mother may have a letdown
reflex (milk ejection reflex) from time to time and the baby will
drink more. When the mother's supply is abundant, the baby usually
gains fine, though he may spend long periods on the breast despite
the mother's abundant supply. However, by the time babies are six
or eight weeks of age, younger sometimes, many will start to pull
away from the breast when the flow slows down, often within a few
minutes of starting to nurse. This is more likely to occur in babies
who received bottles early on, but can occur even without the baby’s
having received bottles. The mother will then likely put the baby
to the other side, but then the baby will do the same thing. He
may be hungry still, and may refuse the breast, preferring to suck
his hand. He won't get those extra letdowns that give him a few
extra gushes of milk that he would have had if he had stayed on
the breast. So he drinks less, and the supply also decreases because
he drinks less, and the flow slows even earlier in the feeding (because
there is less milk) and you see what may happen. It doesn't always
happen this way, and many babies may gain even if they do spend
only a short period of time on the breast. They may still pull off
and suck their hands because they want more sucking but if their
weight gain is good, there is no need for concern.
The way to prevent this is to get a good
latch from the very first. However, many mothers are being told
the latch is good even if it isn't. A better latch can help, sometimes
even at a later date. Using compression
will often keep a baby drinking (see Protocol
for increasing the intake of breastmilk by the baby).
Sometimes domperidone will increase the milk supply
significantly. Do not use it if you are pregnant, however (see handouts
Domperidone
and Domperidone-2).
How do you know the baby actually drinks at the
breast?
When a baby is getting milk (he is not getting
milk just because he has the breast in his mouth and is making sucking
movements), you will see a pause at the point of his chin after
he opens to the maximum and before he closes his mouth, so that
one suck is (open mouth wide-->pause-->close mouth).
If you wish to demonstrate this to yourself, put your index or other
finger in your mouth and suck as if you were sucking on a straw.
As you draw in, your chin drops and stays down as long
as you are drawing in. When you stop drawing in, your chin comes
back up. This pause that is visible at the baby's chin represents
a mouthful of milk when the baby does it at the breast. The longer
the pause, the more the baby got. Once you know
about the pause you can cut through so much of the nonsense breastfeeding
mothers are being told. Such as: 'Feed the baby
twenty minutes on each side.' A baby who does this type of sucking
(with the pause) for twenty minutes straight might not even take
the second side. A baby who nibbles (doesn't drink) for 20 hours
will come off the breast hungry.
See also the videos at www.thebirthden.com/Newman.html.
The videos show how to latch a baby on, how to know a baby is getting
milk, how to use compression.
Questions?
see
my book Dr. Jack Newman's Guide to Breastfeeding (called
The
Ultimate Breastfeeding Book of Answers in the USA)
Handout #25: Slow weight gain after the first
few months. January 2005
Written by Jack Newman, MD, FRCPC. © 2005
This
handout may be copied and distributed without further permission,
on
the condition that it is not used in any context in which
the WHO code on the marketing of breastmilk substitutes is violated
