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Introduction
Sometimes, babies who
are doing very well with breastfeeding alone
for the first few months, start not to gain
as well after 2 to 4 months just with
breastfeeding. 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 way of feeding infants and
small babies. Using the formula feeding baby
as the 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, 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. 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. 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. Bendryl),
pseudephedrine (e.g. Sudafed).
9. You are feeding one side only each
feeding. Remember, if the baby is not
drinking, he’s not getting any milk.
“Finish” one side and if he wants more,
offer the other.
10. a combination of some of the
above.
11. sometimes the milk supply
decreases, particularly around 3 months for
no obvious reason.
One more reason requires a little 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). 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 6 or 8 weeks of age, younger
sometimes, many babies start to pull away
from the breast when the flow slows down,
often within a few minutes of starting
nursing. This is more likely to occur in
babies who received bottles early on. 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
the 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 late 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
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.
About The Author: Dr. Jack Newman is a Toronto
pediatrician who has practiced medicine since 1970. In 1984 he established the
first hospital based breastfeeding clinic in Canada, at the Hospital for Sick
Children in Toronto. He now holds breastfeeding clinics in several Toronto area
hospitals. Jack has been a consultant with UNICEF's Baby Friendly Hospital
Initiative and has spoken at conferences around the world. He is the father of
three children, all breastfed. Dr. Newman is the author of
"The Ultimate Breastfeeding Book of Answers"
NOTE: The article above titled "Slow weight gain after the first few
months" was written by Dr. Jack Newman and is the opinion of its author. "The New Parents Guide" does not guarantee the information to
be factual. Always use the guidance of your personal
doctor or your child's doctor over information you read on this site or elsewhere; your doctors know what is
best for you and your baby.
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