What to Do If Your Breastfed Baby Isn't Growing as Expected

Sleeping newborn
Slower than expected weight gain could mean the baby isn't getting enough breast milk. Yuko Hirao/Stocksy United

Most breastfed babies will get enough breast milk and gain weight in a consistent and expected pattern as long as they latch on well and breastfeed often. But, what if you think your child isn't getting what he needs to grow and thrive? If you're breastfeeding and your newborn is gaining weight slowly or inconsistently then he may not be getting enough breast milk. So, here's what to look for and what to do if you think your child isn't gaining weight well.

Breastfeeding and Slow Weight Gain: What's Normal?

Breastfed newborns can lose up to 10 percent of their birth weight during the first week. Then, by the time a child is two weeks old, he should regain the weight that was lost. After that, for the next three months or so, breastfed babies gain about an ounce a day.

Of course, every newborn is different, and some children just normally grow more slowly than others. So, as long as your baby is breastfeeding well and his health care exams are on target, a slower weight gain may not be an issue.

When Is Slow Weight Gain a Problem?

Weight gain is the best sign that a child is getting enough breast milk. When a baby is gaining weight slower than expected, it could mean that she's not getting enough. So, if your newborn is not back to her birth weight in two weeks, or she's not gaining weight consistently after that, it may be that there's a breastfeeding issue that's preventing your child from getting enough breast milk.

The Reasons Your Baby May Not Be Gaining Weight as Expected

  • Your newborn is not latching on well. A good latch allows your child to remove the breast milk from your breast without getting tired out and frustrated. If your baby is not latching on correctly, or latching on to just your nipple, she won't be able to remove the breast milk very well.

  • Your baby isn't breastfeeding often enough. Breastfeed your newborn at least every two to three hours through the day and night for the first six to eight weeks. If he wants to breastfeed more often, put him back to the breast.

  • Your child is not breastfeeding long enough at each feeding. Newborns should breastfeed for about 8 to 10 minutes on each side. As your child gets older, she won't need to breastfeed as long to get the breast milk she needs, but during the first few weeks, try to keep her awake and actively sucking for as long as you can.

  • Your little one is in pain. If your baby is not comfortable because of a birth injury or an infection such as thrush in her mouth, she may not breastfeed well, and therefore she may be gaining weight slowly.

  • You have a low breast milk supply. A low milk supply can prevent your child from getting enough breast milk, but it could also be the result of your baby not breastfeeding well. It's a bit of a vicious cycle. The good news is that a typical low milk supply can often be recovered pretty easily.

  • You have a true low milk supply. Although it's not as common, there are some medical issues that can cause a true low breast milk supply. You may still be able to increase a true low milk supply, but it's more difficult. It needs to be treated and followed by a doctor.

    Are Some Babies More Likely to Have Trouble Gaining Weight?

    While most newborns and infants will breastfeed well and gain weight, some babies are more likely to have difficulty breastfeeding. When a child is at risk for breastfeeding difficulties, the chances of growing and gaining weight at a slower pace are higher. Here are some of the situations when a child is more likely to have a slower weight gain.

    • Preemies and Near-Term Newborns: Smaller babies or those born before 37 weeks may not have the strength or energy to breastfeed for a long enough time to get all the breast milk they need. They are also more likely to be sleepy and experience medical issues such as jaundice or dehydration which can make breastfeeding even more difficult.
    • Sick Babies: Infants with an illness or an infection may not breastfeed well. They may not gain weight or even lose weight especially if they have diarrhea or they're vomiting.
    • Infants With Latch Issues: If a baby has a small mouth or a mom has large nipples, the baby may not be able to latch on. It's also difficult for a baby to latch on if his mother has hard, engorged breasts. Other newborns who may have a problem with the latch include those who are born with neurological issues such as Down Syndrome, or physical issues such as a tongue-tie or a cleft lip and palate.
    • Newborns of Mother's With a Low Breast Milk Supply: When a mother experiences a delay in the onset of breast milk production, her baby is at risk for not getting enough milk. Other issues such as a previous breast surgery, PCOS, or hypoplastic breasts can also interfere with the establishment of a healthy supply of breast milk.
    • Babies With Jaundice: Newborns with jaundice may have a yellow tone to their skin. Jaundice can make babies very sleepy and not interested in breastfeeding.
    • Children With Reflux: Infants with reflux spit up or vomit after feedings. Not only do they lose some of the feeding, but the acid from the reflux can irritate their throat and esophagus making it painful to breastfeed.

    Should You Get a Baby Scale to Weigh Your Baby at Home?

    For some moms, an at-home baby scale can help relieve some of the anxiety that comes with breastfeeding a baby who's gaining weight slowly. However, it will only make you feel better if you have an accurate scale and you know how to use it.

    A scale can be a helpful tool to measure how much breast milk your baby is taking at each feeding, or just to keep track of your baby's weight between doctor visits. But, weighing your baby at home is not a substitute for taking your baby to the doctor. It is, however, a great way to work with your child's doctor to be sure your baby is gaining a healthy amount of weight.

    What You Can Do If Your Child Is Gaining Weight Slowly

    • Take your child to see his healthcare provider as soon as possible. The doctor will examine, measure, and weigh your baby.

    • Make sure your baby is latching on to your breasts correctly. You can ask a friend with breastfeeding experience, your doctor, a lactation consultant, or the mothers in a local breastfeeding group for help if you need it.

    • Breastfeed your baby every two to three hours and whenever she shows signs of hunger. Don't put your baby on an every three to four-hour feeding schedule like a formula fed baby. Since breast milk is more easily digested, breastfed babies need to eat more often.

    • Stay away from the pacifier for the first four to six weeks. If your baby sucks on a pacifier instead of nursing at the breast, she won't be getting as much breast milk. A pacifier can also tire your baby out so she may not breastfeed as well when she does get to the breast. Once your baby is breastfeeding and gaining weight well, you can offer the pacifier if you want.

    • Try to keep your baby actively breastfeeding for about 20 minutes at each feeding. If you have a sleepy newborn, try to keep him awake by tickling his feet, changing your breastfeeding position, changing his diaper and burping him, or using the switch nursing technique.

    • If the issue is your breast milk supply, takes steps to increase your milk production. Besides breastfeeding more often, you can pump in-between feedings, add some milk-boosting foods to your meals, or try a breastfeeding herb or tea.

    • If your baby's doctor thinks it's necessary, you may have to supplement your baby with additional feedings of either your own pumped breast milk or infant formula.

    • If you have a premature baby, you can breastfeed first, then offer the supplement of infant formula or your own expressed breast milk after each feeding. You can also try to pump and separate your foremilk from your hindmilk. Hindmilk is higher in fat and calories to help your preemie gain more weight.

    Should You Stop Breastfeeding If Your Baby Isn't Gaining Weight as Expected?

    If you child isn't gaining weight well, you don't have to stop breastfeeding but it's really up to you. As long as it's safe for your baby, you can continue to breastfeed exclusively while working closely with your health care providers. Or, depending on your situation, you may decide to partially breastfeed, or breastfeed just for comfort. Of course, if it's just too frustrating and difficult, it's OK to stop breastfeeding completely, too.

    If you do wean from the breast, you can choose to exclusively pump, switch over to infant formula, or give your child a combination of both. The goal is to have a healthy child who is growing and gaining weight well. It doesn't have to be breastfeeding or breast milk only. Infant formula is a safe alternative and you don't have to feel guilty if you need to or choose to use it. You can feel good that you tried your best, and you're doing what you need to do for yourself and your child.

    Sources:

    Cadwell, Karin, Turner-Maffei, Cynthia, O'Connor, Barbara, Cadwell Blair, Anna, Arnold, Lois D.W., and Blair Elyse M. Maternal and Infant Assessment for Breastfeeding and Human Lactation A Guide for the Practitioner Second Edition. Jones and Bartlett Publishers. 2006.

    Dewey KG, Nommsen-Rivers LA, Heinig MJ, Cohen RJ. Risk factors for suboptimal infant breastfeeding behavior, delayed onset of lactation, and excess neonatal weight loss. Pediatrics. 2003 Sep 1;112(3):607-19.

    Lawrence, Ruth A., MD, Lawrence, Robert M., MD. Breastfeeding A Guide For The Medical Profession Eighth Edition. Elsevier Health Sciences. 2015.

    Neifert M, DeMarzo S, Seacat J, Young D, Leff M, Orleans M. The Influence of Breast Surgery, Breast Appearance, and Pregnancy‐Induced Breast Changes on lactation Sufficiency as Measured by Infant Weight Gain. Birth. 1990 Mar 1;17(1):31-8.

    Riordan, J., and Wambach, K. Breastfeeding and Human Lactation Fourth Edition. Jones and Bartlett Learning. 2014.

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