Breastfeeding probs! Or, factors associated with slow infant weight gain
Did your pediatrician tell you to start supplementing because your baby isn’t gaining enough weight? Hearing those words can be frustrating, disappointing, and unhelpful! Slow weight gain may not in itself be the actual problem, but a manifestation of some other factor that should be checked first. What I mean by this is, if your baby isn’t gaining weight the solution isn’t ONLY to supplement. We need to figure out what else may be causing slow weight gain in your infant- the slow weight gain is a symptom of some other condition. Slow weight gain can be caused by a factor in the mother, infant, or both!
Before I dive into factors that can affect infant weight gain, I wanted to briefly discuss when you should supplement with formula or pumped breast milk. If your baby has lost 10% of their birth weight, failure to return to birth weight by 2-3 weeks of age, average daily weight gain of less than 20g, unexplained weight loss, weight or length curves that fall flat at any age, or deceleration of head circumference, it is best to supplement!
Here is a quick overview of factors that might be associated with slow infant weight gain and what to do about it!
Problem: Previous breast surgery (augmentation, reduction, lumpectomy), insufficient glandular tissue (rare!), and breast trauma can result in reduced milk volume.
Solution: With breast alterations reduced milk volume is more likely the cause of slow infant weight gain. It can be beneficial to work with a lactation consultant in person to do pre and post weight to see how much milk your baby is transferring. Pumping, galactagogues may help, but supplementation may be necessary to keep up with the demands of your growing infant.
Nipple anomalies OR ineffective or insufficient milk removal
Problem: Flat, retracted, inverted, oddly shaped, or dimpled nipples can impair your baby’s ability to correctly latch, leading to reduced milk intake and nipple pain. Incorrect breastfeeding position or latch, ineffective sucking, or unresolved engorgement can leave milk in the breast and reduce milk supply. The more milk removed from the breast, the more you make. If milk isn’t removed, your body thinks you don’t need to make that much and slowly decreases your supply.
Solution: Correcting the latch will be key to helping your baby gain weight. When a baby is properly latched they compress the milk ducts and express more milk, leading to increased milk volume over time. If your baby is having a hard time staying latched (identified as your baby making clicking noises while suckling, falling off the nipple repeatedly, falling asleep within a few minutes at the breast) they won’t be transferring enough breast milk. I’d work with a lactation consultant in person to fix latch issues and to discuss the benefit of pumping until your little one has figured out how to effectively remove breast milk.
Delayed lactogenesis II (say, whaaa?!)
Problem: Lactogenesis II is when your milk comes in. The more your baby feeds (or the more you pump) in the first few hours to days after delivery, the more milk you make at 6 weeks.
Causes: Delayed or disrupted early feeding opportunities, separation of mother and baby, too few feedings, inadequate pumping opportunities or attempts, ineffective breast pump, unnecessary formula supplementation, and/or lack of access to a lactation consultant can lead to decreased milk supply. Additional causes to be mindful of: overweight, obese, diabetic, c-section birth, or retained placenta are at risk for delayed lactogenesis II
Solution: Read this post on how to protect your milk supply after giving birth! Takeaway: feed frequently or pump regularly (immediately)!
Problem: Hypothyroidism, PCOS, other endocrine-related disorders
Solution: These hormone disorders MAY interfere with milk production. Frequent milk removal during the first 24 hour after birth, early initiation of lactation, particularly breastfeeding or expressing within an hour of birth, has been shown to lead to a higher rate of breastfeeding beyond six weeks for term infants. There is more milk production at day 3 when the number of breastfeeding sessions in the first 24 hour were higher. Feed frequently! If you’re still not making enough milk, work with a lactation consultant to discuss pumping and galactagogues.
Gestational age and size
Problem: Preterm, late preterm, small-for-gestational age (SGA), large-for-gestational age (LGA) , a fetus who experienced intrauterine growth restriction MAY lack mature feeding skills, strength, and stamina to express and transfer enough milk from mom.
Solution: Check out my preterm or late preterm feeding plan. Give your baby time to grow and mature! Supplementing with pumped breast milk is the best way to protect your milk supply and help your little one continue to grow and gain weight.
Oral anatomy alterations
Problem: Babies with tongue or lip tie, cleft lip, cleft palate, bubble palate (or highly arched palate) can interfere with suckling and result in inadequate milk intake.
Solution: For babies with a tongue or lip tie, work with a pediatrician or pediatric dentist to evaluate the necessity of snipping the tie. Babies with cleft lips or cleft palates should work with a speech therapist, lactation consultant, and pediatrician to assure baby is getting adequate milk. Pumping and supplementing may be necessary initially as your baby figures out how to successfully feed at the breast. For babies with a highly arched palate, work with a lactation consultant! Sometimes with a highly arched palate there are feeding positions that allow your baby to take in more breast tissue which helps them to stay latched.