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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. Benadryl), pseudoephedrine (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.
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.
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