Breastfeeding/Lactation Consultant

Hello,

My little one, 4 month old, has been gaining weight very slowly. He was a 7 (7Lb,4oz) pounder at birth. When we went for a 4 month check up, he weighed in at 11Lb, 3oz. His pediatrician is visibly upset and concerned about this. He has been diagnosed with GERD, and was prescribed Zantac and Reglan (after his 2 month check up). Being hesitant on medications for the little one, i postponed gving Zantac, until we really thought it would help. We started on Zantac (twice a day), but skipped on reglan (side effects were too scary for me to venture giving on this one).  He still has not gained a lot of weight. He is quite happy and does not fuss that much (only for food). He also has grade 2 reflux on both his kidneys.

During his 4th month check up, his pediatrician has prescribed Prevacid (half a tablet to be dissolved and syringe fed) for one month. I am not sure I understand the diagnosis, nevertheless, since we have always chosen not to follow the recommendations until now, we have decided to give Prevacid a shot.

My concern is the fact that, although he is a slow gainer on weight, is that really a concern? I seem to have lost my peice of mind off late with trying to get him to fit into some weight chart (right now, he is off the chart). He gets 3 bottles when I am away at work (and one at midnight/early morning feed). The rest he feeds off me and I pump an average of 3.5 oz per session (i try to pump every three hours for about 25-30 minutes). I dont think he is being underfed at this point. Going forward, he has been asked to begin rice cereal intake, which I plan on starting later this week. What am I missing?

Thanks!

from birth to 16 weeks I calculate the rate of gain to average 4 ounces per week. The Average rate of gain for a baby is age is 5-7 ounces per week. Since it is an average, that means some will gain more than the average and some will gain less.

Also as the PP asked, can you give us a complete weight history? Please noe which weights were on the EXACT same scale. Different scales can be off by a pound or more so that is VERY important. Also were the weights done with a naked baby? Clothing and even diapers have differing weights.

Is baby meeting milestones? Growing in length? Head Circumference? How big are you and dad? (genetics play a part in babies growth too)

I would encourage you to read this from Dr. Jay Gordon "Look at the Baby, not the Scale" http://drjaygordon.com/development/bf/scales.asp

The reflux can and often does effect rate of gain.

The charts really don't mean much especially since many Dr. use older charts that are based on FF babies. Do you know which chart your Dr. is using? We have lots of healthy babies that are not "on the charts", but are healthy and growing at their own rate. KWIM?

AS to the solids, ALL major medical organizations (including the American Academy of Pediatrics, World Health Organization, US Department of Health & Human Services, American Academy of Family Physicians, Health Canada, and BF experts world wide) recommend waiting until baby is AT LEAST 6 months old to introduce solids. http://www.kellymom.com/nutrition/solids/delay-solids.html

In addition to the reasons in the link above, solids have fewer fats AND calories than breastmilk (one exception is Avocado). So when weight gain is an issue, solids are definitly NOT recommended as they have fewer calories and baby will gain slower. Fat and calorie content of common baby foods: http://www.kellymom.com/nutrition/vitamins/babyfoodcalories.html

There are some tips here on increasing gain of the BF baby from Dr. Jay Gordon: http://www.kellymom.com/babyconcerns/growth/weight-gain_increase.html

I believe the previcid is for the reflux. Have you seen this on reflux? There are some Bf tips for babies with reflux. http://www.kellymom.com/babyconcerns/reflux.html#refluxsymptoms

Has Dr done any testing for the reflux? Was the possibility of allergy ruled out?

how big are the bottles baby is getting? The general rule of thumb is 2-3 ounces every 2-3 hours. Most BF babies do best with smaller bottles more often and this is even more true of those with reflux. How often is baby BF when home with you?

Do take a look at the link and follow up with questions/concerns and we can go from there. Hang in there mama!

Loral -

Thanks for bumping. Also feel free to contact Theresa, Dana or through our profile if something slips down that we have missed.