Dr. Hive: 14% weight loss in bf newborn - question

[knit247]

I am almost embarrassed to ask this, as I was a LLL leader 6-8 years ago, but I am not sure on this one and I no longer have my BF Answer Book, nor any related materials.

 

My SIL has just had a baby (6 days old) and he has lost 14% of his weight. He was 8.8 at birth and 7.6 today. I do not know his discharge weight. SIL had gestational diabetes and my nephew was born two weeks early by c/s (big boy)!

 

SIL wants to bf, but BIL and MIL are adamant that she supplement with formula because she "obviously isn't making enough milk" :001_huh: SIL bf on demand, which works out to every 2-3 hours in the daytime, and closer to 3 hours at night, if she is lucky. I forgot to ask about wet diapers, but she mentioned that he was not producing enough of them. SIL reports that the baby nurses very well during the day, but in the middle of the night he "fights" her and cries and arches away from her. This does not happen ever during the day, so I do not think oversupply is an issue.

 

She went to the ped. today and he suggested supplementing with formula and contacting a LC ASAP. She had not heard of LLL & I gave her the no. of four leaders near her. She does not want to supplement with formula, but I am a bit concerned with the baby losing over 10%. For now she is pumping between feedings and giving the baby that after his nighttime feedings.

 

Can someone give me any info that I can pass on to her? Thanks so much! (FWIW it's almost midnight where I am - I will be up for a bit but will most likely answer any replies in the AM, my time)

[amey311]

"Weight gain after birth should always be measured from the lowest weight which is usually on the 3rd or 4th day" (which might be discharge weight since she would've stayed in hospital longer after the surgical birth). (that's from Breastfeeding Answers Made Simple).

 

Those weights you listed - are they actual decimals or are they pound ounces (did he weight 8.8 pounds or 8 pounds, 8 ounces?)

 

8#8oz = 3855.54 grams to 7# 6oz = 3345.24 g = 13.23% loss

8.8 pounds = 3991.6129 grams to 7.6 lbs = 3447.302 g = 13.63% loss (assuming I did that correctly - subtracted the difference and then found the percentage of the difference and the higher weight - 510.3/3855.54 in the first example)

 

Assuming you stick with one or the other, that's a loss of 13%. However, the birth weight to current weight loss isn't as accurate as that lowest weight, and that's what you need to know.

 

That said, talking to an IBCLC would be very helpful. If they're in the US (or covered by US law - I have no idea how this works for military families), seeing a LC is now part of the Affordable Healthcare act, and it's definitely worth contacting her health insurance provider to find out how to use that service: http://www.hrsa.gov/womensguidelines/

[Jennifer in MI]

Another thing to consider - a baby born via c-section is born with a higher weight than he/she would have been if he/she had been born vaginally. During a vaginal birth many of the extra fluids are pushed out when descending through the birth canal. It is extra important to get that low weight on a c-section baby when figuring out weight issues.

 

Definitely get in to an LC - if for nothing else - to reassure her. She needs to be told now more than ever that her body IS working right and she can work this out.

[peachskittles]

Is he red? Like really red? My son lost a bunch of weight and we found out his red blood cells were way too high (polycythemia), which caused him to be sleepy, which caused him to not eat well, which caused him to be diagnosed FTT (this is the basic idea).The easiest fix for it is him eating every 2-3 hours. It might not apply to her baby, but if he's too red, ask for a CBC. Otherwise, I'm not sure.

[knit247]

"Weight gain after birth should always be measured from the lowest weight which is usually on the 3rd or 4th day" (which might be discharge weight since she would've stayed in hospital longer after the surgical birth)...the birth weight to current weight loss isn't as accurate as that lowest weight, and that's what you need to know.

 

That said, talking to an IBCLC would be very helpful. If they're in the US (or covered by US law - I have no idea how this works for military families), seeing a LC is now part of the Affordable Healthcare act, and it's definitely worth contacting her health insurance provider to find out how to use that service: http://www.hrsa.gov/womensguidelines/

 

My BIL & SIL are civilian in the US and she is covered for a LC. Weights I listed were in lbs/oz. I will ask her tomorrow about discharge weight. TY :)

 

Another thing to consider - a baby born via c-section is born with a higher weight than he/she would have been if he/she had been born vaginally. During a vaginal birth many of the extra fluids are pushed out when descending through the birth canal. It is extra important to get that low weight on a c-section baby when figuring out weight issues.

 

Definitely get in to an LC - if for nothing else - to reassure her. She needs to be told now more than ever that her body IS working right and she can work this out.

 

TY - I need to remind her about the fluids retained from a surgical birth. Strangely enough, DH remembered that fact before I did ;) He actually tried to take one of my LLL calls many years ago while I was upstairs nursing and I had to remind him that *I* was the "expert". I am starting to think that he remembers more than I do, LOL!

[Ellie]

I'm going to go with no supplementing, not even with her own bmilk that she pumped. If she gives him extra *anything,* that means he may go longer between feedings, which means he won't nurse as much, which means she won't produce more milk, KWIM?

 

Can she just go to bed with the baby and nursenursenurse?

 

Is she eating enough? Getting enough fluids?

 

I'd take advice from LLL over a lactation consultant. Just sayin'...

[staceyobu]

When did her milk come in?

 

My milk came in late with my first three (around 5 days). My babies lost down a lot due to that.

 

Is he on the upswing weight wise? Or is this the first weight they have done? Have all weights been done on the same scale naked?

 

It could be a scale difference if it was hospital to ped office.

 

How is his latch? Is she in any pain?

[Plateau Mama]

I had issues with my 3rd. He was nursing nonstop but he wasn't really nursing. He was 9 pounds at birth and at his lowest a bit under 8. He got to where he was totally lethargic. My pediatrician had given us till morning before we took him to Childrens. He was 3 days (I think). The lactation nurse had me do the following around the clock, to build suppy & make sure he was getting enough. I did this every 3 hours.

 

Nurse for (I think 15 minutes)

Pump

Feed bottle of pumped milk

 

My husband would do the bottle while I was pumping so we didn't have confusion.

 

It took 6 hours of this to get him semi alert again and 48 hours before my supply was up.

 

That being said it took him forever to get back to birth weight. He at one point during the first year actually fell of the weight chart. My pediatrican said she was not concerned because he was on a steady decline down and that was just his curve. He was meeting all his milestones etc.

[Jpoy85]

I can give advice!!!!!!!!!!!!!!!!!!!!!

 

Alrighty as a former LLL Leader myself, here is what I would say!

 

kellymom.com has a GREAT list of herbs to help increase her supply naturally. Feenugreek and Milk Thistle are the top ones recommended. Oatmeal is a great option as well. (You can get these at any grocery store- Kroger, walmart, etc)

 

Domperidone and Reglan are RXs and you would need a LC to prescribe them. Reglan is not good for those with depression. Both are NOT made for BF but the side effects are increased milk. This is what they give Adoptive Mothers to BF with!!

 

I WOULD recommend a nurse in. Lay in bed and nurse nurse nurse! IF she cant then pump pump pump (she could pump and dump if she didnt want to give the baby a bottle and this would avoid nipple confusion).

[greenbabybottoms]

I am a current LLL leader so can offer some advice. It is true that with a surgical birth a slighly higher weight loss can be expected, also if she labored for a long time before he was actually born and was hooked up to iv fluids it is normal to see some additional weight loss. BUT almost 14% weight loss is pretty significant no matter how the birth went. That coupled with the fact she said he is not having enough wet diapers would both be red flags for me. I agree with pp who mentioned a nurse in. I would absolutely crawl into bed with him for the next 48 hours and nurse nurse nurse! Have someone bring her food and beverages and offer the breast as much as he will take it. I would also suggest coupling that with some breast compression to encourage the fattier hindmilk out.

 

I would really consider supplementing as well, preferably with her own milk if possible but I would be concerned about dehydration with the lack of wet diapers and the weight loss. If she does choose to supplement though I would try to avoid bottles. She could try a syringe or if she can get her hands on a supplemental nursing system that would be great too. She needs to have him at the breast as much as possible and offering a bottle is not going to stimulate milk production at all.

 

Also try some of the easier methods of increasing milk like oatmeal, a dark beer (if she's comfortable with that), fenugreek and blessed thistle combo. Has she seen an IBCLC who could evaluate latch and confirm that milk transfer is going well? Also she may want to do some reading on the "late term preemie". It isn't uncommon to see significant weight loss and nursing problems in those babies born 37-39 weeks gestation.

[amey311]

I wouldn't necessarily assume he needs suppliments or that her supply is too low initially. There isn't enough information yet to assume either (because we're missing that lowest weight). It's quite possible that his weight gain is adequate once we know the missing piece.

 

Also, (I can find the study if you need it) there was some information out of Canada that indicates that surgical birth babies gain weight slower initially.

 

It can be increasingly hard to find doctors who are willing to prescribe domperidone, FYI. The FDA is trying to crack down on doctors prescribing it for lactation (it's a GI drug). I know that's not the case everywhere, so YMMV and all that.

[Susan C.]

Check under baby's tongue, see if its too attached (tongue-tied). The arched back and refusing sounds like what we dealt with, tons of gas from having to suck tons of air because of the tongue issue.

[melissad2]

I'm going to go with no supplementing, not even with her own bmilk that she pumped. If she gives him extra *anything,* that means he may go longer between feedings, which means he won't nurse as much, which means she won't produce more milk, KWIM?

 

Can she just go to bed with the baby and nursenursenurse?

 

Is she eating enough? Getting enough fluids?

 

I'd take advice from LLL over a lactation consultant. Just sayin'...

 

:iagree:

[Forget-Me-Not]

My SIL has just had a baby (6 days old) and he has lost 14% of his weight. He was 8.8 at birth and 7.6 today. I do not know his discharge weight.

 

If he truly has lost 14%, then yeah, she needs to supplement. If he's latching well, she should look into an SNS or Lact-Aid type system.

Edited October 9, 2012 by LemonPie
math error!

[besroma]

Check under baby's tongue, see if its too attached (tongue-tied). The arched back and refusing sounds like what we dealt with, tons of gas from having to suck tons of air because of the tongue issue.

 

Yes, please check this! Have her look for pics on the internet and compare to her baby's tongue.

 

I would definitely pay the money for a LC. Many peds do not agree that tongue ties cause nursing problems. LCs are trained to recognize them.

[Forget-Me-Not]

I'd take advice from LLL over a lactation consultant. Just sayin'...

 

I wouldn't, assuming the lactation consultant is an IBCLC.

 

I'm an ex-LLL leader and I think LLL's educational methods are less than stellar. There's no system in place for continuing education and re-certification and there really should be. I worked as a Professional Liaison Leader, and did some work towards becoming an IBCLC. I attended some conferences with big names in the field and heard a lot of the up-and-coming data. It would literally make me cringe to then to go LLL functions and hear the misinformation some of the Leaders would spew. Certainly not all of them--some are very, very good--but in a case like this where baby has lost that much weight. . . I'd go the IBCLC route.

[catz]

I'm curious with how they calculated 14% too? Sounds like an error.

 

I had 2 c-section kids and had heavy IV fluids before their birth because of low blood pressure (mine). I did not labor at all (I had to do them early). Both kids lost over a lb of birth weight (they were born at 6'12" and 6'14"), but both came home well under 6 lbs. BOTH times they wanted to supplement and both times I said no way, give it another day or 2. They nursed constantly and had many wet diapers. Once my milk came in they turned a corner quickly and started gaining like crazy. I personally think both their birth weights were artificially inflated by the IV fluids. By 1 month, both these kids were roly poly.

 

I'd personally be counting those wet diapers religiously and get a scale for in home use. I wouldn't let it go much longer, particularly if he isn't gaining within a couple days. But about 1 week is where my kids really turned a corner.

 

An article about use of IV fluids and weight loss in newborns.

 

http://www.sciencedaily.com/releases/2011/08/110814223805.htm

[amey311]

How are you guys figuring the loss? I showed my process above (subtract the two weights in grams, divide the loss by the higher number to determine the percent of the higher weight), but I'm willing to have that be incorrect. If that's how they're figuring it, the 14% is roughly correct (one of my percentages could be rounded to 14%). Either way, it's above the "generally accepted" 10% loss.

 

But again, those two weights aren't the best numbers to use. We need to know the discharge weight.

[Forget-Me-Not]

How are you guys figuring the loss? I showed my process above (subtract the two weights in grams, divide the loss by the higher number to determine the percent of the higher weight), but I'm willing to have that be incorrect. If that's how they're figuring it, the 14% is roughly correct (one of my percentages could be rounded to 14%). Either way, it's above the "generally accepted" 10% loss.

 

But again, those two weights aren't the best numbers to use. We need to know the discharge weight.

 

I think I made an error. . . I forgot to subtract from 100. Off to correct my post :D

[brownie]

If you start to supplement but don't find the root cause, likely BFing won't work out. My first thought with screaming only at night would be reflux. All my dc likely had it but it wasn't until I was a seasoned mom with number three that we got it diagnosed (he was the worst as well...screamed his head off suddenly starting a 3 weeks). Additionally I would never let the child go past 3 hours without nursing if there is a weight gain problem. I would encourage every 2 hours during the day.

 

Another possible issue that I noticed someone mentioned is tongue tie. A tongue tie can be very hard to diagnose correctly when mild. We had an extremely knowledgeable neonatologist diagnose all three of mine (after the LC's at the hospital claimed none of the 3 had one). As this lovely dr. explained, a mild tongue tie can cause major issues and a moderate tongue tie can sometimes cause none. It's partly a match between mom and child. My milk would not let down for a pump or an improper suck, despite their tongue ties being mild. All 3 of mine had their frenulums clipped, but for ds#1 is was too late...we never got BFing to work past week 3 properly because he was 8 weeks when diagnosed and I'd already suffered multiple bouts of mastitis and misery. LLL is your best bet for finding a knowledgeable person to address this.

 

Another preferred option is to pump and supplement with your own milk. It can be done with a tube and syringe at the nipple too to increase flow to the baby and discourage nipple confusion. Some babies find bottles too easy and refuse to go back to the breast after supplementation. If you use a bottle, get a medela one for newborns with really slow flow so the child has to work for it.

 

BTW milk production tends to peak around 4AM due to hormone levels so 4-6AM is a really good time to feed and/or pump!

 

Brownie

[mom2myboys]

If the baby is not having enough wet diapers, supplementing sounds necessary. Rule number 1 is to feed the baby. Here is some excellent information on supplementing. This page helps make the decision on whether it is necessary or not. The links across the top give more information on the how.

 

I would recommend that she get in to see an IBCLC as soon as possible. It sounds like either the baby is not nursing effectively and/or the milk supply is too low. Hopefully, the IBCLC will do a pre- and post-feed weight check so that the amount of milk baby is taking in can be evaluated. This will let them know how effective the baby is at taking in milk. It is possible for a mom to make plenty of milk, but have a baby that has a difficult time getting enough.

 

Here is a guide to assess a baby for tongue-tie. Many tongue-ties are missed, especially the ones that are in the back. They are not usually visible to the naked eye. Also, a latch can look fine on the outside and not be fine on the inside.

 

Best of luck to her. Getting help as soon as possible increases the chances of success.

[Mrs Mungo]

I would definitely check for tongue-tie and reflux. I agree with seeing a lactation consultant certified by the IBCLC. I also agree that supplementing is usually necessary when baby loses more than 10%, at least short-term.

[Jpoy85]

FTR: I would see a LC. Only because they do medical things where LLL cant. We can watch latch, give advice, etc where a LC can look at tongue tie, treat thrush, etc. MOST Insurance plans (even the medical card) covers a LC and they cover Pump rental and anything else needed. WIC also rents out pumps if thats an option. (im not saying she needs a pump, im just saying to inform).

Docs are not keen on prescribing Dom or Reg but an LC is more likely to do so. You may have to call around but you can find one. I mentioned the herbs because they are easy to get and dont need dr approval (a RX i mean)

 

I wanted to throw that in there because i didnt in my post and IF there is something medical a LLL leader cant do much to help that.

[Mrs Mungo]

I wanted to throw that in there because i didnt in my post and IF there is something medical a LLL leader cant do much to help that.

 

:iagree:

[phathui5]

If he truly has lost 14%, then yeah, she needs to supplement. If he's latching well, she should look into an SNS or Lact-Aid type system.

 

It's not that simple. Some babies lose a higher percentage, particularly when moms had IV fluids.

 

She could express milk and feed it to the baby with a spoon or syringe to keep him hydrated.

[lewelma]

With my first, I had a c-section after 55 hours of labour. My ds lost his sucking reflex. Yes, lost a reflex. But we did not really know until a few days into it because it looked to all the experts that he was feeding properly. Apparently this problem is not unheard of with c-sections. My milk did not come in until day 10, so of course my little boy lost quite a bit of weight. We have terrible allergies in my family to dairy, so I did not want to supplement with formula. I did, however, supplement with milk from a friend of mine who was breastfeeding. A bit unusual, I know, but it was what we thought was best. In the end, I had to pump my milk in as my baby did not suck properly. I pumped every 3 hours round the clock for 7 days. And we fed my ds with a cup or syringe. There MUST be wet nappies. Must must must. No exceptions. I was told 6 to 8 per day. The moment there is blood in the urine, you are in crisis mode because dehydration has truly set in.

 

I would recommend that in addition to looking for wet nappies that she also pump and see what she is producing. If the production is low, she should pump between feeds to increase supply.

 

Oh, I also just remembered that one of the pain meds for the c-section went through the milk, and in a certain percentage of babies makes them sleepy. My ds was too sleepy to nurse properly until I went off this med. So talk to a pro-breastfeeding pediatrician. It was the ped not the OB that identified this medication problem.

 

Good luck,

 

Ruth in NZ

Edited October 9, 2012 by lewelma

[knit247]

TY all so much!

 

To answer several of the questions: I am not sure if he is gaining, as this was the first weight-check I am aware of. She did tell me that his discharge weight was 7 lbs, 12oz when he left the hospital (from an 8 lbs, 8 oz birth weight). It makes the 7 lbs, 6 oz weight check yesterday sound a lot better.

 

SIL went through a long (almost 24 hour) painful induction that did not work. They sent her home and the following afternoon she had the c/s, so I assume she had plenty of fluids by the time the baby was born :tongue_smilie: Her LC suggested that she continue to bf as much as possible (nurse-in) and to supplement with pumped milk. A nurse is coming to her house later this week; she is seeing a IBCLC today, I believe; and has contacted her local LLL.

 

One last note: SIL does not like water at all or oatmeal. She does not drink alcohol, either. She is determined, however, and said that she will add some flavoring to her water and try that. She also drinks coffee and diet soft drinks and said that she is going to cut that out JIC the caffeine is bothering him.

 

Thanks again for the wonderful advice!

 

ETA: I missed several posts before answering above. I will also mention tongue-tie to her. My other nephew (this baby's cousin) had it - maybe it runs in the family???

Edited October 9, 2012 by knit247

[Dobela]

I would definitely check for tongue-tie and reflux. I agree with seeing a lactation consultant certified by the IBCLC. I also agree that supplementing is usually necessary when baby loses more than 10%, at least short-term.

Yes, tongue tie can run in families. My dd was 3 before a dentist told us that hers was 'mildly tied'. Not enough for a notice, but enough to cause mobility problems for her. He discovered it after noticing that she was unable to lick her teeth when he asked. She had been in feeding therapy, speech therapy, and all sorts of other oral motor therapies and interventions before this and no one else saw it. She was also Failure to thrive as an infant. We kept being told it was reflux when in fact it was actually silent aspiration, which we now believed was connected to the tongue tie. She didn't have good tongue control so if milk came to fast then it would first go into her lungs before backing back up and entering the esophagus. She would cry, arch her back, refuse food/milk but reflux meds didn't work. She was a year old before we could get a swallow study referral but I wish we had one sooner. By that time she was actively refusing food on a regular basis.

[Melissa in Australia]

I was always told by the maternity nurse that all babies loose around one pound in their first week. She told me this after I had each baby, as she was surprised that my babies made it back to their birth weight at one week old.

[knit247]

Yes, tongue tie can run in families. My dd was 3 before a dentist told us that hers was 'mildly tied'. Not enough for a notice, but enough to cause mobility problems for her. He discovered it after noticing that she was unable to lick her teeth when he asked. She had been in feeding therapy, speech therapy, and all sorts of other oral motor therapies and interventions before this and no one else saw it. She was also Failure to thrive as an infant. We kept being told it was reflux when in fact it was actually silent aspiration, which we now believed was connected to the tongue tie. She didn't have good tongue control so if milk came to fast then it would first go into her lungs before backing back up and entering the esophagus. She would cry, arch her back, refuse food/milk but reflux meds didn't work. She was a year old before we could get a swallow study referral but I wish we had one sooner. By that time she was actively refusing food on a regular basis.

 

This sounds a lot like what happened with my other nephew. Because his tongue-tie was not caught until he was around 3 yo, his speech was affected. He also has all sorts of food "issues" and literally will only eat about three things. He was also failure to thrive and I am not sure if he is even on the charts now (6 yo).

[Acorn]

She really needs more water. Oatmeal can also really help, and sometimes just more calories. I can't really understand her "not liking" water, but she will need more fluids than she can imagine.