Low fat breast milk?

[dairymomma]

My 2 month old isn't gaining weight like she should. She only went up 1lb 4oz in 6 weeks and is weighing in under every curve now. The pediatrician isn't overly concerned because 1. she's having normal pee and poo diapers though she's only pooing every 2-3 days, 2. she isn't that far off the bottom curve, and 3. she's meeting her milestones pretty much on time. Baby girl has to go back in a month for another weight check. If she's low again, I'll have to start supplementing. I'm really wondering if it's because my milk isn't fatty enough for her. She's constantly hungry it seems and by the time her bedtime rolls around, I'm dealing with very sore boobs. (As in nipples on FIRE sore). The dr wasn't sure if this was the total cause as I am having up/down milk supply issues (up if I REALLY work at it and it's good for a day or two, then down if I don't do anything and it's slowly decreasing). And there is a very distinct possibility that LO has mild reflux as well. The dr thinks my steadily dropping milk supply coupled with LO's ability to spit up 1/4 to 1/2 her feeds are the two biggest issues here. I was given tips for dealing with the reflux and I'm going to double my efforts to boost my milk supply but I'm curious if anyone has ideas on how to get more fats into a 2 month old. I had this happen with my DS but he was 6-7 months old and starting to eat foods so I just added high fat foods like avocado into his diet and it worked like a charm. I can't really do that for my nearly newborn. Aside from adding fish oil to a bottle of expressed milk, I have no clue what I can do to turn my breast milk from skim to whole.

 

[Emmy0320]

I would see a lactation consultant. If you're in that much pain baby might not be latching properly. A poor latch could also impact supply. Good luck!

 

[dairymomma]

I don't think it's her latch tbh. I'm not sore all day. Just in the evening and only after she's nursed for hours on end. If I can get her to go 2-3 hours between feedings, I don't hurt at all. I did have a nurse check her latch when she was born tooand it was fine. But it might be worth it to have another opinion. I'll look into it though.

 

[TXJen]

A lactation consultant can weigh the baby before and after a feed, which can tell you if you are producing enough. That could put your mind at ease. My little guy is a lot like yours - he would feed for HOURS on end - but he was never satisfied. Turns out he's just a big eater and I can't make enough for him.

 

[sugarpuff]

Have you had her tongue checked for a tie ?

 

[MommyJogger]

After 2 months of nursing, a good latch shouldn't be resulting in a "fire" sensation no matter how long lo is nursing for. It does sound like you might have some latch problems and nurses (esp in the states) really aren't qualified to determine that or to check baby for oral problems that would prevent proper milk transfer even when a latch appears good (and neither are most pediatricians). I would also say that if a baby is struggling with weight gain or reflux issues, encouraging them to go longer between feeds is ill-advised (3h is outside of the average feed spacing for breastfed babies at 2 mo), so even more important to figure out how you can nurse very frequently without pain. I really recommend seeing an IBCLC, before you get to the point of supplementing. Dig the well before you're thirsty, so to speak.

 

[melfy77]

Sounds to me like she's only getting the foremilk (the low-fat stuff) and not the hindmilk (which is the super fat, rich milk). How long does she feed for? Are you having oversupply issues? Does your breasts feel soft after a feed?

 

[noon_child]

After 2 months of nursing, a good latch shouldn't be resulting in a "fire" sensation no matter how long lo is nursing for. It does sound like you might have some latch problems and nurses (esp in the states) really aren't qualified to determine that or to check baby for oral problems that would prevent proper milk transfer even when a latch appears good (and neither are most pediatricians). I would also say that if a baby is struggling with weight gain or reflux issues, encouraging them to go longer between feeds is ill-advised (3h is outside of the average feed spacing for breastfed babies at 2 mo), so even more important to figure out how you can nurse very frequently without pain. I really recommend seeing an IBCLC, before you get to the point of supplementing. Dig the well before you're thirsty, so to speak.

I agree with the above.

I also think your paed is right not to be overly concerned. She's gaining slowly but she IS gaining. My LO started below the lines and was still below them until 15weeks - wee DID have milk transfer issues (pain with every feed) but she got enough to gain weight slowly, increase my supply during growth spurts and meet all milestones. She got a bigger mouth and was able to latch properly at 11weeks old.

My thought with the evening feeds going on for hours is
1) normal BUT
2) could be comforting herself due to acid/reflux pain, and some LO's change their latch to make it shallow when they want to comfort suck.

Is she on anything like renitadine to help with the PAIN of reflux?

 

[dairymomma]

Thanks for all the advice, ladies. It's much appreciated. I talked to a consultant this morning and she said it sounds like I'm doing all the right things for the most part but maybe to try fenugreek. Other than that, she said LOs latch was fine since she's obviously suckling well, my nipple and aureole are fully in her mouth and she's not coming off the breast while actively nursing. She feels it's possible LO just is not wanting to work for the hind milk as a result of a very fast initial letdown. LO is filling up on the foremilk and leaving too much hind milk behind because my letdown makes it easy for her to eat. I've been told to try pumping for just a little bit first so that she doesn't get such a big guzzle of foremilk and see if that helps. The nipple pain is probably from comfort sucking since it's happening in the evenings when baby girl has been cluster feeding for a few hours and is starting to cat nap while on the breast. I did ask about lip/tongue tie too but LC didn't find either and feels that neither baby nor I have very many signs of it. I checked at home too, but didn't see it either. With the reflux, both the dr and consultant feel it's a very mild case of it and that LO should outgrow it in a few months. So far, LO isn't taking anything for it and she's not really in discomfort or pain from it. She doesn't cry or show any signs of pain after a feeding so I was given a list of things to try at home-keeping baby upright after a feeding, etc. The dr did say that if it doesn't get any better in a week or so, I should bring LO back in and I'll get the prescription. One interesting thing I learned from the consultant though is that thyroid issues can cause milk supply depletion and since I have a family history of thyroid problems as well as history of miscarriage, she feels it might not hurt to have that checked again. If things don't improve in the next week, I'm calling the dr to have that looked into. So I guess it's just wait and see what happens from this point.

 

[noon_child]

She feels it's possible LO just is not wanting to work for the hind milk as a result of a very fast initial letdown. LO is filling up on the foremilk and leaving too much hind milk behind because my letdown makes it easy for her to eat. I've been told to try pumping for just a little bit first so that she doesn't get such a big guzzle of foremilk and see if that helps.

You could also try breast compressions towards the end of a feed to increase the flow during the hind milk stage and encourage LO to stay on. There are some good instructions on Kelly Mom. My LO used to fall asleep before getting her fill and these really helped her get a few more valuable minutes towards the end of the feed.

 

[BigAl]

Just a thought (you seem to have things under control tbh), but have you tried block feeding? Just keep using the same boob for a few hours, rather than swapping.
Honestly though, if you've had everything checked out and she isn't excessively Sicky, I think you are doing fine.

 

[dairymomma]

I really watched her closely yesterday and today and marked down her feeding schedule just to make sure of my times. I also made note of how long each feed was and anything else I noticed. What I found out is she's eating every 3-4 hours during the day for 1-1.5 hours. Averages about 20-30 min per side total with a few burp breaks in there to help with the reflux. Spits up just about every burp session but the amount varies. She does make a clicking sound every now and then so I am starting to wonder about her latch. She was fine before so I'm not sure why she's suddenly not. Would a growth spurt cause issues with latching on? I did notice she's slept quite a bit in the last two days and I had to lengthen the straps on her carseat again today so I know she's stretched. And if it is a growth spurt, then it might explain her little bit lower weight. My other kids did that. It was like their bodies would either put the energy to stretching out or into pudging up but not both at the same time. :shrugs: I guess I'll see what happens. I am nursing on demand still and pumping if she hasn't eaten in 3 hours. Not sure if the stuff I've been doing is helping but I'm noticing my wee is lightening up in color and I'm back up to pumping 1oz per hour between feeds. FX I'm rebounding.