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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?
1. You have gone on the
birth control pill. If you have, stop
the pill. There are other ways of preventing
a pregnancy besides hormones.
2. You are pregnant.
3. 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.
4. 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.
5. An emotional "shock" can, occasionally,
decrease the milk supply.
6. 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.
7. 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.
8. Some medications may decrease milk
supply--some antihistamines (e.g. Bendryl),
pseudephedrine (e.g. Sudafed).
9. 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.
9. A combination of some of the above.
10. 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
handout on domperidone).
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
that show how to latch a baby on, how to
know a baby is getting milk, how to use
compression.
Questions? (416) 813-5757
(option 3) or drjacknewman@sympatico.ca
or 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
1. Breastfeeding:
Starting out right
a) The
importance of Skin-to-Skin contact
2. Colic in the Breastfed Baby
3. a) Sore Nipples
b) Treatments
for Sore Nipple and Sore Breasts
4. Is my baby getting enough?
5. Using a Lactation Aid
6. Using Gentian Violet
7. Breastfeeding and Jaundice
8. Finger Feeding
9. a) You should continue breastfeeding
(Medications and breastfeeding)
b) You
should continue breastfeeding (Illness in the mother or baby)
10. Breastfeeding and other foods
11. Some breastfeeding myths
12. More breastfeeding myths
13. Still more breastfeeding
myths
14. More and more breastfeeding
myths
15. Breast compression
16. Starting solid foods
17. What to feed the baby when
the mother is working outside the home
18. How to know a health professional
is not supportive of breastfeeding
19. a) Domperidone 1
b) Domperidone
2
20. Fluconazole
21. Breastfeed a toddler –
Why on earth?
22. Blocked ducts and
mastitis
23. Breastfeeding your adopted baby
24. Miscellaneous treatments for problems
25. Slow weight gain after
the first few months
26. When the Baby refuses to
latch on
27. Expressing Milk
28. Toxins and Infant Feeding
How breastmilk protects Newborns
Risks of formula feeding
Breastfeeding and guilt
Candida protocol
Protocol to increase the intake
of Breastmilk by the Baby ("Not enough milk")
When latching
Protocols for Induced Lactation
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