Managing Poor Weight Gain in Your Breastfed Infant

Managing Poor Weight Gain in Your Breastfed
Baby

Sometimes a breastfed baby will gain
weight more slowly than they should. This could be because the mother isn’t making enough
milk, or the baby can’t get enough milk out of the breast. Or it could be that the baby may
have a health problem. Your baby’s healthcare provider should assess any instance of poor
weight gain. Often a certified lactation consultant can help. Below are some general tips
for dealing with poor weight gain in a breastfed baby.

Check the schedule 

  • Watch for signs from your
    baby that he or she wants to feed. Your baby should wake and “cue” to breastfeed
    about 8 to 12 times in 24 hours. Your baby will cue by rooting, making licking or
    sucking motions, bobbing their head, or bringing their hand to the face or mouth.
    It’s important for you to understand these feeding cues. And to put your baby to
    your breast when he or she cues. Don’t wait for your baby to cry. Crying is a late
    feeding cue. Often a baby latches and breastfeeds better if they don’t have to
    wait until they are crying, frustrated, or too tired to feed. Putting a baby off
    to try to get them to go longer between feedings is often linked to poor weight
    gain. And so is frequently offering a pacifier instead of the breast when a baby
    shows feeding cues.

  • For many mothers, milk
    production increases and babies’ weight gains improve if they let chores and
    activities go for 2 or 3 days. This way they can breastfeed nearly around the
    clock. When a baby is not breastfeeding, the mother holds him or her skin-to-skin
    on her chest. This often helps her become more sensitive to the baby’s feeding
    cues.

  • Your baby may be a “sleepy”
    baby who does not cue to feed at least 8 times in 24 hours. Then you will have to
    wake your baby to feed frequently–about every 2 hours during the daytime and
    evening hours. And at least every 3 to 4 hours at night. You will need to do this
    until weight gain improves.

  • It can help to write down
    when your baby nurses, on which side, and for how long. Keep track of this for a
    full 24 hours, if not longer. Take this record to your healthcare provider or
    lactation consultant. They can help you find and fix the problem. 

Latching and positioning


Illustration of breastfeeding, massage technique

  • Be sure your baby is mainly
    uncovered during breastfeeding. A baby that is bundled papoose-style may get much
    too warm and comfy. He or she is more likely to doze off too quickly during
    feedings. If there is a chill in the air, drape a sheet or light blanket over you
    and the baby as needed.

  • If your baby falls asleep within minutes of latching on, massage your breast as he or she nurses. This can provide a burst of milk and re-trigger sucking. You can do this by stroking downward and inward on the breast.

  • Make sure your baby is latching on correctly. The latch should be comfortable to you. Your baby’s lips should be flanged outward like “fish lips.” The tongue should be under your breast. A large amount of your breast tissue should be in the baby’s mouth. 

  • In general, don’t do “switch
    nursing.” That is when your baby breastfeeds at one breast for a few minutes, then
    the other breast, and then back again. This may interfere with your baby getting
    enough of the calorie-rich hindmilk. Your baby gets more hindmilk as a feeding
    continues on one breast. But the switch strategy sometimes stimulates the sleepy
    baby. So he or she wakes up and starts sucking again.

If your healthcare provider recommends supplementing

  • Use your own expressed milk first for any alternative feedings.

  • Use an alternative feeding
    method if it is recommended by your healthcare provider or a certified lactation
    consultant (IBCLC). There are many alternative feeding options, so let them know
    if a recommendation does not feel right for you. Alternative feeding methods
    include:

    • Cup feeding

    • A tube system with a special feeding tube taped to the breast or a finger (Supplemental Nursing System, or SNS)

    • Syringe feeding

    • An eyedropper

    • Spoon-feeding

    • Bottle-feeding

  • Several methods require help
    from a professional, such as an IBCLC, so you can use them correctly. Depending on
    your baby and the cause of the problem, some methods may work better than others.
    Also discuss bottle nipple type with the IBCLC if you bottle-feed any supplement.
    Some types of bottle nipples are less likely to interfere with breastfeeding than
    others.

Maintaining or increasing your milk supply

  • Pump your breasts after as
    many daily breastfeedings as possible. This is even more important if you are not
    sure if your baby is effectively removing milk during breastfeeding. Many women
    find that trying for 8 times per day is manageable. They also find it helpful for
    their milk supply. 

  • Pumping will remove milk
    well, so your breasts will know to make more milk. Pumping will also express extra
    milk for feeds. Milk can be removed from the breast by manual hand expression, a
    hand pump, a battery-powered pump, or an electric breast pump. Use a
    double-electric or hospital-grade pump to help manage poor weight gain in a
    breastfed baby. 

Checking baby’s weight

  • Your baby should be weighed
    on a frequent and regular basis. Keep weighing your baby until he or she is
    gaining weight at a good rate. Digital scales are available that allow a
    healthcare provider or a certified lactation consultant (IBCLC) to get precise
    pre- and post-feeding weights. This lets the provider measure how much milk a baby
    takes in during a particular breastfeeding. This can be helpful. But babies take
    in different amounts at different feedings during a 24-hour period. So a provider
    may recommend that parents rent this type of scale. Then the baby can be weighed
    before and after different feedings. A provider also may suggest recording only a
    daily or weekly weight, depending on the situation.

Call your baby’s healthcare provider

If your baby ever shows signs of dehydration, call your baby’s healthcare provider right away. Some signs of dehydration in a baby include:

  • Fewer stools and wet diapers
    than normal

  • Dry lips

  • Sunken fontanelle (soft spot)

  • Dark circles around the eyes

  • Seeming more tired than
    normal

In some cases breastfeeding is
correctly managed, but the baby still is not gaining enough weight. Then it is likely
that some other factor is affecting milk production or the baby’s ability to breastfeed
effectively. Always talk with your healthcare provider, and your baby’s provider.