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  • Cleo Marchese, IBCLC, RLC

Poor Weight Gain After Birth, What to Do

You have been eagerly awaiting the birth of your new baby. The nursery is ready. You and your partner have taken childbirth and breastfeeding classes. You may even have a doula but your baby's birth didn't go as planned. You are told he isn't getting enough so it's time to supplement. So why is your newborn losing weight? You did all the basics such as immediate skin to skin contact after birth and your baby latched immediately but despite nursing for really long stretches of time, your baby is not gaining well. You may be struggling with this problems for days or the first few weeks.

The first thing a mother is told when her baby isn't nursing well is to supplement with formula using a bottle after every feeding. Some times donor breast milk. This sounds good in theory but if you are trying to preserve breastfeeding, it can be devastating. Many young babies cannot go back and forth between breast and bottle. They can develop flow and nipple preference.

If the mother is not taught how to pump and properly empty her breasts. She may think she is breastfeeding the baby before giving it a bottle. Instead, what is really happening is this baby cannot breastfeed and it is pacifying patiently at the breast until you give it something it can use. A lot of mothers will say my baby is a lazy nurser or sleeps at the breast then wakes up when I give it a bottle. Newborns are hardwired to do three things: breastfeed, grow and breathe. If one of these three things are not happening. Something is wrong.

Some mothers are told to triple feed: breastfeed, pump and bottle feed. Triple feeding is often used by care providers who don't understand lactation. It also causes early cessation of breastfeeding. It is impossible for most women to keep up this grueling schedule of feeding and pumping around the clock with little sleep for days, weeks or occasionally months. Triple feedings should always be monitored by a lactation consultant to ensure breast milk intake is increasing daily and some times weekly for infants with poor milk transfer.

Often the most basic question has gone unanswered. Why did this baby fail to breastfeed? If weeks have passed, why is this baby still unable or unwilling to breastfeed?

Reasons babies fail to breastfeed:

  • Small for their gestational age or born preterm. These babies often have immature sucking skills.

  • Large for their gestational age or born to a mother with gestational diabetes. These babies will often have low blood sugar after birth and need more calories. They will nurse sluggishly or not at all.

  • Vacuum extracted or c-section, either way an infant is being pulled out of tight space by their heads. These babies can be sore or in pain. They may find it difficult to nurse in traditonal mother led nursing positions.

  • Infants who need oxygen. Breathing takes priority over eating everytime.

  • A long difficult labor, babies are just exhausted and simply need time to recover.

  • Delayed milk supply in the mother because of health problems or birth complications such as excessive blood loss.

What can you do as a mother? Ask for the lactation consultant at the hospital immediately, don't wait. If one is not available in the hospital or they were not able to help you. Call a board certified private practice lactation consultant. Serious breastfeeding problems seldom resolve with time. They usally become harder to overcome.

What you can do on your own:

Start pumping immediately. Many women spend days or weeks breastfeeding baby first then given 2 to 3 oz of formula afterwards. If your child is not taking anything out of your breast or only a small amount of milk. You will have low milk supply because breastfeeding works by supply vs demand.

Directly after birth, hand expressing into a spoon or small cup is the best way to get out colostrum. A lot of women will try pumping and believe there is nothing there because colostrum will either leave a fine mist in the breast flange or come out in tiny drops. Colostrum is really thick and your baby's first natural inoculation against bacteria and viruses. It is worth the effort to hand express it out.

Use alternative feeding methods. Newborns don't have to be bottle fed. There is cup feeding, finger feeding and supplemental nursing systems, at the the breast supplementing. Be vocal, ask for an alternative feeding system.

For babies with newborn jaundice or sleepy babies, be proactive and feed your baby first enough food until they are alert and looking around then breastfeed. To ensure success, massage your breast first to stimulate a letdown, you are successful when milk is leaking from the nipple.

For all babies who are not breast feeding well. Undress your baby before feedings and do lots of skin to skin contact. Massage your baby and talk to them. Try baby wearing, it will stimulate natural breastfeeding cues for your newborn.

Paced bottle feed next to the breast while holding baby.. By slowing down bottle feeding and using skin to skin contact at the breast, it can be easy to lull a sleepy baby too the breast. Switch sides every feeding to mimic breastfeeding.

Try gentle body work. Cranial Sacral Therapy or chiro practic adjustments for infants can help get things back in line after vaccum extraction, a C-section, or a long labor. It is also helpful for unilateral breast aversion, a baby refusing the same breast every feeding.

Know the difference between active nursing and nibbling. This is critcial, when your baby is actively nusing, the jaw moves way up and down. The jaw movement is so strong that you will see the ears and sometimes forehead visibly move with each suck. You should hear a Suck, Suck, KAW sound. The Kaw sound is your baby swallowing a mouth full of milk. Dr. Jack Newman has wonder videos on YouTube and his website showing the difference between nibbling and actively drinking milk.

After the baby has latched, try deep breast compressions. You gently squeeze your breast about 1/2 inch to 1 inch behind the areola, the dark part of your breast. Hold until your baby starts to suck and swallow then release. Repeat until your baby stops drinking milk on one side then move baby to the other breast and repeat.

An old saying is don't watch the clock, watch baby. Exactly! But watch baby actively drinking milk not sleeping at the breast. You can be successful after a bumpy start, getting help quickly is the key.

Click on links for helpful videos:

Dr. Jack Newman - Baby 28 Hours Old Assisted Latching

Dr. Jack Newman-Really Good Drinking

Dr. Jack Newman- Nibbling

Breast Compressions


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