# Newborn baby not gaining enough weight



## ~Lindz~ (Mar 17, 2010)

My baby was born on 19th June weighing 2920g.  At her first midwife appointment on 23rd June she weighed 2710g, and on 25th June she weighed 2740g.  At my appointment today she was 2760g and had only gained 20g over the last 4 days.  I have been breastfeeding her on demand - she latches on well and can feed for upto an hour, although often she falls asleep on the breast so isn't constantly feeding for all that time.  She has several dirty and wet nappies a day so she is clearly getting some nutrition from me.


The midwife was concerned that she is not gaining enough weight and has told me to breastfeed her for 30 minutes and then top up with expressed milk.  I am now really confused about what to do and how to do it.  Am I supposed to pull her off after 30 minutes, even when she is feeding?  It doesn't seem right to do that.  When am I supposed to express the milk, before or after the feed? And how many mls of expressed milk do I need to give her?  I've tried doing this this afternoon but she doesn't want to have the expressed milk, she just wants my nipple. I don't understand why giving her expressed milk is better than letting her stay on my nipple. She has been crying loads since I started trying to do this and I'm now confused about whether she is hungry or not.  I've been giving her the expressed milk with a plastic syringe but I'm worried this will stop her breastfeeding.  Her sucking doesn't seem as strong as it did before.


I'm also worried that expressing the milk will mean there's none left in my breasts for her.


My midwife isn't available again until Monday so I'm not sure what the best thing is to do this weekend so your advice would be appreciated.  The midwife has got me realy confused about what to do and really worried about my baby.  


Thanks for your help,


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## emilycaitlin (Mar 7, 2006)

Hi,

Firstly, everything else sounds fine with her apart from the slow gain, so don't worry too much. 

If she's still feeding after 30 minutes, can you hear her swallowing or is she just sucking? I think the midwife was trying to stop her getting tired if she is on for too long before having the top up, as she won't have the energy to take the top up properly if she is too tired.
It's difficult for me to make a plan for her without seeing the notes and getting more information, however, I can see that it's very confusing for you to just be told half a story.
I can advise you but when your midwife comes on Monday if she wants to change this plan, go with her plan, as she can see your baby.
This is different to the normal advice that we give for breast feeding, as it's to try and boost her weight gain (although it's reassuring that she isn't losing weight).
Don't let her go any more than 4 hours without feeding, you can express just before a feed, or in between feeds, although in between may mean that you aren't doing much more in your life than feeding or expressing. For me, I would do it just before. Have you got a pump, or has someone gone through hand expressing with you? Keep relaxed and try not to focus on how much you are getting off, it's quality over quantity. Expressing will just give your supply an extra boost. Once she has had 30 minutes, or less if she's not bothered, then top her up. You will be ok to give her a bottle and teat now, she is established enough to not get confused, and it's safer than using the syringe. Try to make sure she takes all the ebm, aim for maybe 20-30 mls, any more, if she's not interested, save it for next time, if you can't get that amount, don't worry, just give her what you have got. 
It will mean waking her at night if she's going longer in between feeds, which I know sounds criminal when you could be getting some sleep, but it's just for a short while. If she wants feeding before the four hours, then let her, but let her take what she wants. 
She sounds to be getting an adequate amount to keep her well hydrated at the moment, so it's just this little bit extra that she needs, once your supply is increasing and she's gaining more weight, you will be able to stop having to top up. Fenugreek capsules from health food shops are good for increasing supply, just a couple a day, as is fennel tea.
See how you go with this over the weekend, and if you are really struggling, there will be midwives on call over the weekend and doing weekend visits that will be able to come and see you, just ring the hospital and explain the situation, and we are here for you too. We might not be able to get back to you straight away, but either of us looks at the board at different times each day,
I hope this helps, I feel like I've waffled a bit, I was typing as I was thinking!

Let me know how you get on,

Emilycaitlin xx


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## Kaz1979 (Apr 11, 2011)

Hi Lindz 

I had the same issue. 

Feed her for as long as she wants when you have finished feeding then do your expressing as you have got to the hind  milk so will be expressing the "fattier" milk that will help her gain weight. After that first expression keep tht milk and then get dh/dp give it after your next feed while you are expressing again. You are then always one expressed feed ahead. 

Have you got a pump? Or doing it by hand? 

Feed her 3hrly in the day if she will take it and you can go 4hrly at night. 

What EmilyCaitlun has said is all correct I've just tweaked it a bit and told you what I was advised by infant feeding advisor. 

Let us know how u get on

Make sure you are eating and drinking enough. 

Kaz cxxx


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## ~Lindz~ (Mar 17, 2010)

Hi Kaz and Emilycaitlin,

Thanks so much to both of you for taking the time to reply to me.  Sorry I haven't had the chance to post earlier, but I wanted to say that your advice has been really helpful and has got me through the weekend.  Fortunately someone gave a breast pump which has made life much easier.

I have been watching my LO feed closely and I think that she actually stops proper feeding after 10-20 minutes and then just sucks on my nipple for comfort which sends her off to sleep.  Maybe that is part of the problem - I think she is feeding more than she is?  

I will let you know how I get on at my midwife appointment tomorrow.  Fingers crossed that LO's weight gain has increased.

Thanks again, I'm so grateful that you are here to help.   

Lindz xxx


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## emilycaitlin (Mar 7, 2006)

It might be worth taking her off after ten minutes then, giving her the em, and see if she will go back on the breast afterwards. I would maybe express before feeding her, as expressing gets 70% less milk off than she can, so she will be able to get more of the richer milk than expressing will, and it will stop her getting tired while she's waiting for the ebm, 

Emilycaitlin xx


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